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Mo1727 Endoscopic Features of Mucous-Capped Polyps During Colonoscopy: A Retrospective Study Predicting Sessile Serrated Adenomas
AGA Abstracts
Mo1726 Is First-Year Surveillance Needed After a Good-Quality Basal Colonoscopy in a FIT-Based Colorectal Cancer Screening Program, As Recommended By European Guidelines? Alvaro Teran, Carmen Alonso, Patricia Ruiz-Bueno, Silvia Alvarez-Gonzalez, Maria Jesus Lopez-Arias, Carlos Rodriguez de Lope, Pedro Fernandez-Gil, Beatriz Castro, Maria Teresa Arias-Loste, Joaquin de la Peña INTRODUCTION: Surveillance following adenoma removal is basic to reduce colorectal cancer (CRC) incidence and mortality after first screening colonoscopy. However, followup intervals are based on weak evidence, and optimal surveillance is not known. Moreover main Clinical Practice Guidelines such as US Multi-Society Task Force and European Guidelines (EG) differ on their recommendations for high-risk subjects (HRS), the latter establishing a first-year follow-up colonoscopy (FyFuC) for those HRS ( ‡5 adenomas or at least one adenoma ‡ 20 mm). This intensive surveillance impacts both patients and health services. OBJECTIVE: To analyze endoscopic findings such as adenomas, advanced adenomas (AA: ‡ 10mm and/or villous component and/or high-grade dysplasia) or CRC, but also their clinical relevance, on FyFuC in a fecal immunochemical test (FIT)-based CRC Screening Program. We also related patients, endoscopists and basal colonoscopy parameters to the risk of such findings at FyFuC. MATERIAL AND METHODS: Retrospective analysis of basal and first surveillance colonoscopies in a 3-year period after EG recommendations adherence in a FIT-based CRC Screening Program, (April-2011 to June-2014). RESULTS: There were 192 HRS according to EG (13.8%), 156 men (81.3%). A mean of 1.3 (1-4) basal colonoscopies were performed. Data from 174 FyFuC (90.6%) performed after a mean time of 14 months (6-22) were available. 105 patients (63.8%) were found to have at least one adenoma, while only 15 (8.6%) had an AA. There were no invasive CRC found at FyFuC. Basal colonoscopy parameters statistically associated on univariate analysis to adenoma finding at FyFuC were: endoscopist's adenoma detection rate (ADR), presence of ‡ 5 lesions and simultaneous adenoma location distal and proximal to splenic flexure. Male sex and bowel cleansing nearly reached statistical significance. Basal colonoscopy endoscopist's ADR was the only parameter with statistical significance on multivariate analysis for adenoma detection as well as the only parameter associated to AA finding at FyFuC. CONCLUSIONS: 1) While most of HRS still have adenomas at FyFuC, in our series there were no invasive CRC at this moment and only a few of patients have high-risk lesions such an AA. 2) High-quality basal colonoscopy defined by high endoscopist`s ADR, and maybe a good bowel cleansing, may reduce the risk of adenomas at FyFuC even more. 3) Randomized control trials are guaranteed to assess optimal follow-up colonoscopy intervals. Risk of Findings at First-year Follow-up Colonoscopy in High-risk Subjects
Mo1727 Endoscopic Features of Mucous-Capped Polyps During Colonoscopy: A Retrospective Study Predicting Sessile Serrated Adenomas Brian T. Moy, Imad Ahmad, Thomas J. Devers Background: Traditionally, colorectal cancer screening has been defined by the adenomacarcinoma sequence in which genetic alterations in tumor suppressor genes and oncogenes are accumulated over time requiring identification, surveillance, and removal. An alternative theory of colon cancer development has been described in the serrated adenoma pathway which involves the accumulation of molecular mutations in serrated adenomas leading to colorectal cancer. There is evidence that a subset of sessile serrated adenoma/polyps (SSA/ Ps) can be characterized by a brown-mucous cap which can be seen in up to 60% of these lesions. Mucous-capped SSA/Ps can often be missed during colonoscopy because they are
AGA Abstracts
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reported data and is similar to other countries in the region. Almost half of the patients for whom staging was obtained presented with regional or distant spread highlighting the need for more aggressive screening programs. Further studies are warranted to identify possible risk factors unique to this population. A significant percentage of cases were under the age of 50 years, representing a population potentially missed by current colon cancer screening guidelines. Further data collection is required to optimize screening strategies in the Bahamas that focus on prevention and early detection of colon cancer.
Mo1730 Bowel Cancer Screening Non Responders: What Can Be Done to Increase Uptake in Men From Lower Socioeconomic Groups? Jennifer A. Scott, Peter Elton, George Lipscomb, Shenna Paynter, John Scott, Natalie Hill Background In the 2006 UK Bowel Cancer Screening Pilot, uptake levels were around 60% (1). As of 2014, in Bolton, the uptake rate amongst men in the lowest deprivation quintiles was less than 50% (2). This study aims to aims to discover the factors that influence Bowel Cancer Screening Non-Responders to not complete their kit; and to explore interventions to increase uptake in this population. Method Between Sept 2012 and Sept 2013, 131 male BCS non-responders were exposed to incremental GP endorsement interventions of increasing intensity (letter, telephone call and the offer of a face to face interview). 10 non-responders were resistant to both letters and telephone calls, but consented to an interview. The interviews were semi-structured, and explored BCS attitudinal barriers and "Cues to Action" found in a review of the current literature. Analysis was performed using an inductive, grounded theory approach (3). Results Interview analysis yielded 32 attitudinal and interventional themes. Common attitudinal themes included "the Poo Taboo", "Masculinity" and "the NHS Disconnect". Most participants felt embarrassed to talk about or handle their faeces (the Poo Taboo). Some felt that screening tests, particularly invasive tests, weren't "manly" (Masculinity). A few declined the test, because they distrusted the local hospital or the NHS in general (the NHS Disconnect). Health literacy was low in this group, the majority knew very little about Bowel Cancer and Bowel Cancer Screening. Improving knowledge and health education were thought to be important interventional "Cues to Action". Conclusion Bowel Cancer Screening Non-Respondence is a complex and multifactorial problem with no "silver bullet" solution. The subject of Bowels and Bowel Cancer Screening requires further normalization. Strategies such as endorsement from Friends and Family; and GP group educational events were thought to be important tools for improving BCS perceptions, behaviour and ultimately response. References 1) Bowel Cancer Screening Pilot http:// www.cancerscreening.nhs.uk/bowel/pilot-2nd-round-evaluation.pdf 2) Bolton Health Matters http://www.boltonhealthmatters.org/sites/default/files/PHIT-Report-10-Bowel-CancerScreening-in-Bolton.pdf 3) Crabtree B, Miller W, eds. Doing Qualitiative Reasearch. 2nd ed. Newbury Park, Calif: Sage; 1999
Mo1728 Reducing Income-Related Inequities in Colorectal Cancer Screening: Lessons Learned From a Retrospective Analysis of Organized Program and NonProgram Screening Delivery in Winnipeg, Manitoba Kathleen Decker, Alain Demers, Zoann Nugent, Natalie Biswanger, Harminder Singh Background & Objectives: In late 2007, a province-wide, organized colorectal cancer (CRC) screening program that mails fecal occult blood test (FOBT) kits to eligible individuals was implemented in Manitoba. Non-program CRC screening (screening initiated during patient visits to health care providers) continues to be available to all residents of the province. One of the primary aims of organized screening is to reach all individuals eligible for screening thereby reducing the impact of inequities that can occur with non-program screening. The objective of the study was to examine income-related inequities in CRC screening by comparing organized program and non-program provided FOBT use by area-level average household income. Methods: Non-program FOBT data were extracted from health care provider reimbursement claims as part of the province's universal health care program. Information about FOBTs provided by the screening program was available from the screening program's population-based registry. Income quintiles were assigned based on area of residence using 2006 Canada Census data. Trends in age-standardized FOBT rates were examined using Joinpoint regression. Logistic regression was performed to explore the association between program and non-program FOBT use and income quintile. Results: FOBT use (non-program and program) increased from 32.2% in 2008 to 41.6% in 2012. Individuals living in the highest income areas (Quintile 5 (Q5)) were more likely to have a non-program FOBT compared to those living in other areas. Individuals living in areas with the lowest average income level (Q1) were less likely to have had program FOBT than those living in areas with the highest average income level (Odds Ratio (OR): 0.80, 95% Confidence Interval (CI): 0.77-0.82). There was no difference in program FOBT use for individuals living in areas with the second lowest income level (Q2) compared to those living in areas with the highest income quintile. Individuals living in an areas with a moderate income level (Q3 and Q4) were more likely to have had a program FOBT compared to individuals living in an area with the highest income level (OR: 1.12, 95% CI: 1.09-1.15 for Q3 and OR: 1.10, 95% CI: 1.07-1.13 for Q4). Conclusion: Inequities in CRC screening participation by income observed for non-program FOBTs were largely eliminated when program FOBTs were examined. However, targeted interventions within organized screening programs in the lowest income areas are still needed.
Mo1731 High Incidence of Ulcerative Colitis Related Colorectal Cancer in a Low Incidence Area of Sporadic Colon Cancer Sawan Bopanna, Prasenjit Das, S Dattagupta, V Pratap Mouli, Saurabh Kedia, Rajan Dhingra, Rajesh Padhan, N Suraj Kumar, Dawesh P Yadav, Govind K. Makharia, Vineet Ahuja Background and Aim: The magnitude of colorectal cancer (CRC) due to ulcerative colitis (UC) as well as sporadic CRC is considered low in India. As a result, screening for CRC in UC although advocated may not be followed everywhere. We report our data over the last decade in UC associated CRC and the yield of dysplasia surveillance strategy. Methods: 1012 patients with left sided colitis or pancolitis registered at IBD Clinic were included. The study population had at least one full-length colonoscopy done atleast a year after the onset of symptoms. In addition, 136 patients with high risk of developing CRC (duration of disease >10 years) underwent surveillance white light colonoscopy. A subset of these patients who had pancolitis and disease >15 years underwent dysplasia surveillance with 33 random biopsies (4 taken every 10 cm). Results: In 1012 patients ( 693 males) the mean age of disease onset was 31.9 ± 11.7 years and disease duration was 6.4± 6.8 years. 55.1% had left sided colitis and 44.9% had pancolitis. 20 (1.97%) patients developed CRC. The cumulative risk of developing CRC was 1.5%, 7.2% and 23.6% in first, second and third decade respectively. Of 136 high-risk UC cases, 5(3.6%) had CRC on screening colonoscopy. Dysplasia surveillance was done in 30 patients. 924 biopsies were taken, none of them revealed dysplasia. Conclusions: Cumulative risk of CRC in Indian UC patients is high and 23.6% at 30 years. Screening colonoscopy is mandatory after 10 years of disease onset. Random biopsy sampling for dysplasia has a poor yield.
Mo1729 Epidemiology of Colorectal Cancer In The Bahamas: A Three-Year Study Anjali Chandra, Eugene M. Cooper, Sheldon Ferguson PURPOSE: Colorectal cancer (CRC) is reported to be the third most common malignancy in the Bahamas however limited data is available about the epidemiology of the disease in this region. The aim of this study is to update a previous study determining the annual incidence and prevalence of CRC in the Bahamas and the stage at presentation. METHODS: A retrospective chart review of histology reports for all colon and rectal cancers identified in the Bahamas by colonoscopy or laparotomy between January 1, 2012 and December 31, 2014 were retrieved by diagnosis codes using an electronic database. All private hospitals and ambulatory endoscopy centers also provided histological data for all biopsies performed during this period. Demographics and staging information was recorded for each patient when available. RESULTS: 191 new cases of CRC were identified in the Bahamas during the 3-year study period corresponding to a national 3-year incidence rate of approximately 16.5 per 100,000 in the Bahamas. 83 cases were identified during colonoscopy and 108 cases at laparoscopy or laparotomy. 55% (n =108) were male (ratio of 1.3:1). Ages ranged from 22 to 93 years (mean 63 years). 31% (n=60) of tumors were identified in the proximal colon, 41% (n=78) in the distal colon and 17% (n=33) in the rectum. 82% (n=156) of the tumors were well or moderately differentiated adenocarcinomas. Staging was available for 124 patients. 43% (n=83) were identified as advanced neoplasms with regional or distant metastatic spread (TNM stages 3 and 4). Patients under the age of 50 represented 19% of new colon cancers diagnosed during the study period. Although staging could not be confirmed in 66 patients, at least 50% of patients under 50 years of age presented with stage 3 disease or higher. CONCLUSION: The calculated incidence rate is similar to previously
Mo1732 CRC in Young Individuals and Potential Use of Screening FOBT Elizabeth E. Half, Ronen Zalts, Maria Passhak, Zeid Moadi, Tomer Hananya, Ophir Avizohar, Alex Beny, Amir Karban Background: In Israel 3000 CRCs are diagnosed annually. Approximately 10% of these individuals are younger than 50 yrs of age. Previous studies suggest that colorectal cancer (CRC) presenting at a young age tends to be advanced, distally located and associated with a poor outcome. Aim: To analyze characteristics of CRC in an Israeli cohort under the age of 50 and to examine the effectiveness of FOBT testing in this population. Methods: A single center retrospective cohort study of consecutive patients under the age of 50 who had been seen at least once at an Oncology service in one of the largest hospitals in Israel between 2010-2015. Clinical and pathological data was collected from a prospectively maintained cancer registry database and patient chart review. Data was also extracted from the Israeli cancer registry. Data on FOBT testing was obtained from the electronic database of the preventive medicine institute at Rambam Health Care Campus between the years 2004-2013. Uptake of the guaiac-fecal occult blood test (gFOBT, Hemocult II) within this young (<50yrs) population was measured. Subjects with positive occult blood test were
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AGA Abstracts
AGA Abstracts
difficult to identify especially with suboptimal bowel preparation. The goal of the study was to identify endoscopic features of mucous-capped polyps that help predict SSA/Ps. Methods: We analyzed 147 mucous-capped polyps identified from 2069 colonic polyps from 20112014. The 8 features looked at included: presence of borders, elevation, rim of debris, location in colon, size, varicose vessels, nodular surface, and alteration of mucosal folds. Predefined criteria for each endoscopic feature were used to analyze mucous-capped polyps from previously taken pictures through retrospective chart review. One experienced endoscopist (Devers TJ) confirmed the morphology from documentation for a representative group of adenomas. Polyps were identified as an SSA/P when histology showed abnormal proliferation and/or abnormal architecture without the presence of cytological dysplasia seen in adenomatous polyps. We used conditional logistic regression with backward selection to compute odds ratios (ORs), confidence intervals (CI), and p-values looking for endoscopic features that predict SSA/Ps. Results: Ninety-seven percent (n=142) of mucous-capped polyps were from the serrated pathway (hyperplastic (n=98) and SSA/P (n=44)), while 3% (n=5) were from the adenoma-carcinoma sequence. Rim of debris (OR 4.086, 95% CI 0.45936.348, p=0.207), varicose vessels (OR 9.921, 95% CI 3.234-32.616, p <0.005), and nodular surface (OR 3.076, 95% CI 1.250-7.570, p=0.014) were selected out after backward selection. Presence of a nodular surface and varicose vessels were found to have statistical significance in predicting SSA/Ps. Polyp size greater than 10 mm, elevation, distinct borders, location in colon, alteration of mucosal folds, and rim of debris were not found to be statistically significant endoscopic predictors for SSA/Ps. Conclusion: The current study demonstrates that mucous-capped polyps are usually associated with the serrated pathway and that SSA/ Ps possess predictive endoscopic features. Recognition of these characteristics might assist endoscopists in differentiating and detecting these often subtle lesions which may help improve the effectiveness of colonoscopy.
Mo1726 Is First-Year Surveillance Needed After a Good-Quality Basal Colonoscopy in a FIT-Based Colorectal Cancer Screening Program, As Recommended By European Guidelines? Alvaro Teran, Carmen Alonso, Patricia Ruiz-Bueno, Silvia Alvarez-Gonzalez, Maria Jesus Lopez-Arias, Carlos Rodriguez de Lope, Pedro Fernandez-Gil, Beatriz Castro, Maria Teresa Arias-Loste, Joaquin de la Peña INTRODUCTION: Surveillance following adenoma removal is basic to reduce colorectal cancer (CRC) incidence and mortality after first screening colonoscopy. However, followup intervals are based on weak evidence, and optimal surveillance is not known. Moreover main Clinical Practice Guidelines such as US Multi-Society Task Force and European Guidelines (EG) differ on their recommendations for high-risk subjects (HRS), the latter establishing a first-year follow-up colonoscopy (FyFuC) for those HRS ( ‡5 adenomas or at least one adenoma ‡ 20 mm). This intensive surveillance impacts both patients and health services. OBJECTIVE: To analyze endoscopic findings such as adenomas, advanced adenomas (AA: ‡ 10mm and/or villous component and/or high-grade dysplasia) or CRC, but also their clinical relevance, on FyFuC in a fecal immunochemical test (FIT)-based CRC Screening Program. We also related patients, endoscopists and basal colonoscopy parameters to the risk of such findings at FyFuC. MATERIAL AND METHODS: Retrospective analysis of basal and first surveillance colonoscopies in a 3-year period after EG recommendations adherence in a FIT-based CRC Screening Program, (April-2011 to June-2014). RESULTS: There were 192 HRS according to EG (13.8%), 156 men (81.3%). A mean of 1.3 (1-4) basal colonoscopies were performed. Data from 174 FyFuC (90.6%) performed after a mean time of 14 months (6-22) were available. 105 patients (63.8%) were found to have at least one adenoma, while only 15 (8.6%) had an AA. There were no invasive CRC found at FyFuC. Basal colonoscopy parameters statistically associated on univariate analysis to adenoma finding at FyFuC were: endoscopist's adenoma detection rate (ADR), presence of ‡ 5 lesions and simultaneous adenoma location distal and proximal to splenic flexure. Male sex and bowel cleansing nearly reached statistical significance. Basal colonoscopy endoscopist's ADR was the only parameter with statistical significance on multivariate analysis for adenoma detection as well as the only parameter associated to AA finding at FyFuC. CONCLUSIONS: 1) While most of HRS still have adenomas at FyFuC, in our series there were no invasive CRC at this moment and only a few of patients have high-risk lesions such an AA. 2) High-quality basal colonoscopy defined by high endoscopist`s ADR, and maybe a good bowel cleansing, may reduce the risk of adenomas at FyFuC even more. 3) Randomized control trials are guaranteed to assess optimal follow-up colonoscopy intervals. Risk of Findings at First-year Follow-up Colonoscopy in High-risk Subjects
Mo1727 Endoscopic Features of Mucous-Capped Polyps During Colonoscopy: A Retrospective Study Predicting Sessile Serrated Adenomas Brian T. Moy, Imad Ahmad, Thomas J. Devers Background: Traditionally, colorectal cancer screening has been defined by the adenomacarcinoma sequence in which genetic alterations in tumor suppressor genes and oncogenes are accumulated over time requiring identification, surveillance, and removal. An alternative theory of colon cancer development has been described in the serrated adenoma pathway which involves the accumulation of molecular mutations in serrated adenomas leading to colorectal cancer. There is evidence that a subset of sessile serrated adenoma/polyps (SSA/ Ps) can be characterized by a brown-mucous cap which can be seen in up to 60% of these lesions. Mucous-capped SSA/Ps can often be missed during colonoscopy because they are
AGA Abstracts
S-764
reported data and is similar to other countries in the region. Almost half of the patients for whom staging was obtained presented with regional or distant spread highlighting the need for more aggressive screening programs. Further studies are warranted to identify possible risk factors unique to this population. A significant percentage of cases were under the age of 50 years, representing a population potentially missed by current colon cancer screening guidelines. Further data collection is required to optimize screening strategies in the Bahamas that focus on prevention and early detection of colon cancer.
Mo1730 Bowel Cancer Screening Non Responders: What Can Be Done to Increase Uptake in Men From Lower Socioeconomic Groups? Jennifer A. Scott, Peter Elton, George Lipscomb, Shenna Paynter, John Scott, Natalie Hill Background In the 2006 UK Bowel Cancer Screening Pilot, uptake levels were around 60% (1). As of 2014, in Bolton, the uptake rate amongst men in the lowest deprivation quintiles was less than 50% (2). This study aims to aims to discover the factors that influence Bowel Cancer Screening Non-Responders to not complete their kit; and to explore interventions to increase uptake in this population. Method Between Sept 2012 and Sept 2013, 131 male BCS non-responders were exposed to incremental GP endorsement interventions of increasing intensity (letter, telephone call and the offer of a face to face interview). 10 non-responders were resistant to both letters and telephone calls, but consented to an interview. The interviews were semi-structured, and explored BCS attitudinal barriers and "Cues to Action" found in a review of the current literature. Analysis was performed using an inductive, grounded theory approach (3). Results Interview analysis yielded 32 attitudinal and interventional themes. Common attitudinal themes included "the Poo Taboo", "Masculinity" and "the NHS Disconnect". Most participants felt embarrassed to talk about or handle their faeces (the Poo Taboo). Some felt that screening tests, particularly invasive tests, weren't "manly" (Masculinity). A few declined the test, because they distrusted the local hospital or the NHS in general (the NHS Disconnect). Health literacy was low in this group, the majority knew very little about Bowel Cancer and Bowel Cancer Screening. Improving knowledge and health education were thought to be important interventional "Cues to Action". Conclusion Bowel Cancer Screening Non-Respondence is a complex and multifactorial problem with no "silver bullet" solution. The subject of Bowels and Bowel Cancer Screening requires further normalization. Strategies such as endorsement from Friends and Family; and GP group educational events were thought to be important tools for improving BCS perceptions, behaviour and ultimately response. References 1) Bowel Cancer Screening Pilot http:// www.cancerscreening.nhs.uk/bowel/pilot-2nd-round-evaluation.pdf 2) Bolton Health Matters http://www.boltonhealthmatters.org/sites/default/files/PHIT-Report-10-Bowel-CancerScreening-in-Bolton.pdf 3) Crabtree B, Miller W, eds. Doing Qualitiative Reasearch. 2nd ed. Newbury Park, Calif: Sage; 1999
Mo1728 Reducing Income-Related Inequities in Colorectal Cancer Screening: Lessons Learned From a Retrospective Analysis of Organized Program and NonProgram Screening Delivery in Winnipeg, Manitoba Kathleen Decker, Alain Demers, Zoann Nugent, Natalie Biswanger, Harminder Singh Background & Objectives: In late 2007, a province-wide, organized colorectal cancer (CRC) screening program that mails fecal occult blood test (FOBT) kits to eligible individuals was implemented in Manitoba. Non-program CRC screening (screening initiated during patient visits to health care providers) continues to be available to all residents of the province. One of the primary aims of organized screening is to reach all individuals eligible for screening thereby reducing the impact of inequities that can occur with non-program screening. The objective of the study was to examine income-related inequities in CRC screening by comparing organized program and non-program provided FOBT use by area-level average household income. Methods: Non-program FOBT data were extracted from health care provider reimbursement claims as part of the province's universal health care program. Information about FOBTs provided by the screening program was available from the screening program's population-based registry. Income quintiles were assigned based on area of residence using 2006 Canada Census data. Trends in age-standardized FOBT rates were examined using Joinpoint regression. Logistic regression was performed to explore the association between program and non-program FOBT use and income quintile. Results: FOBT use (non-program and program) increased from 32.2% in 2008 to 41.6% in 2012. Individuals living in the highest income areas (Quintile 5 (Q5)) were more likely to have a non-program FOBT compared to those living in other areas. Individuals living in areas with the lowest average income level (Q1) were less likely to have had program FOBT than those living in areas with the highest average income level (Odds Ratio (OR): 0.80, 95% Confidence Interval (CI): 0.77-0.82). There was no difference in program FOBT use for individuals living in areas with the second lowest income level (Q2) compared to those living in areas with the highest income quintile. Individuals living in an areas with a moderate income level (Q3 and Q4) were more likely to have had a program FOBT compared to individuals living in an area with the highest income level (OR: 1.12, 95% CI: 1.09-1.15 for Q3 and OR: 1.10, 95% CI: 1.07-1.13 for Q4). Conclusion: Inequities in CRC screening participation by income observed for non-program FOBTs were largely eliminated when program FOBTs were examined. However, targeted interventions within organized screening programs in the lowest income areas are still needed.
Mo1731 High Incidence of Ulcerative Colitis Related Colorectal Cancer in a Low Incidence Area of Sporadic Colon Cancer Sawan Bopanna, Prasenjit Das, S Dattagupta, V Pratap Mouli, Saurabh Kedia, Rajan Dhingra, Rajesh Padhan, N Suraj Kumar, Dawesh P Yadav, Govind K. Makharia, Vineet Ahuja Background and Aim: The magnitude of colorectal cancer (CRC) due to ulcerative colitis (UC) as well as sporadic CRC is considered low in India. As a result, screening for CRC in UC although advocated may not be followed everywhere. We report our data over the last decade in UC associated CRC and the yield of dysplasia surveillance strategy. Methods: 1012 patients with left sided colitis or pancolitis registered at IBD Clinic were included. The study population had at least one full-length colonoscopy done atleast a year after the onset of symptoms. In addition, 136 patients with high risk of developing CRC (duration of disease >10 years) underwent surveillance white light colonoscopy. A subset of these patients who had pancolitis and disease >15 years underwent dysplasia surveillance with 33 random biopsies (4 taken every 10 cm). Results: In 1012 patients ( 693 males) the mean age of disease onset was 31.9 ± 11.7 years and disease duration was 6.4± 6.8 years. 55.1% had left sided colitis and 44.9% had pancolitis. 20 (1.97%) patients developed CRC. The cumulative risk of developing CRC was 1.5%, 7.2% and 23.6% in first, second and third decade respectively. Of 136 high-risk UC cases, 5(3.6%) had CRC on screening colonoscopy. Dysplasia surveillance was done in 30 patients. 924 biopsies were taken, none of them revealed dysplasia. Conclusions: Cumulative risk of CRC in Indian UC patients is high and 23.6% at 30 years. Screening colonoscopy is mandatory after 10 years of disease onset. Random biopsy sampling for dysplasia has a poor yield.
Mo1729 Epidemiology of Colorectal Cancer In The Bahamas: A Three-Year Study Anjali Chandra, Eugene M. Cooper, Sheldon Ferguson PURPOSE: Colorectal cancer (CRC) is reported to be the third most common malignancy in the Bahamas however limited data is available about the epidemiology of the disease in this region. The aim of this study is to update a previous study determining the annual incidence and prevalence of CRC in the Bahamas and the stage at presentation. METHODS: A retrospective chart review of histology reports for all colon and rectal cancers identified in the Bahamas by colonoscopy or laparotomy between January 1, 2012 and December 31, 2014 were retrieved by diagnosis codes using an electronic database. All private hospitals and ambulatory endoscopy centers also provided histological data for all biopsies performed during this period. Demographics and staging information was recorded for each patient when available. RESULTS: 191 new cases of CRC were identified in the Bahamas during the 3-year study period corresponding to a national 3-year incidence rate of approximately 16.5 per 100,000 in the Bahamas. 83 cases were identified during colonoscopy and 108 cases at laparoscopy or laparotomy. 55% (n =108) were male (ratio of 1.3:1). Ages ranged from 22 to 93 years (mean 63 years). 31% (n=60) of tumors were identified in the proximal colon, 41% (n=78) in the distal colon and 17% (n=33) in the rectum. 82% (n=156) of the tumors were well or moderately differentiated adenocarcinomas. Staging was available for 124 patients. 43% (n=83) were identified as advanced neoplasms with regional or distant metastatic spread (TNM stages 3 and 4). Patients under the age of 50 represented 19% of new colon cancers diagnosed during the study period. Although staging could not be confirmed in 66 patients, at least 50% of patients under 50 years of age presented with stage 3 disease or higher. CONCLUSION: The calculated incidence rate is similar to previously
Mo1732 CRC in Young Individuals and Potential Use of Screening FOBT Elizabeth E. Half, Ronen Zalts, Maria Passhak, Zeid Moadi, Tomer Hananya, Ophir Avizohar, Alex Beny, Amir Karban Background: In Israel 3000 CRCs are diagnosed annually. Approximately 10% of these individuals are younger than 50 yrs of age. Previous studies suggest that colorectal cancer (CRC) presenting at a young age tends to be advanced, distally located and associated with a poor outcome. Aim: To analyze characteristics of CRC in an Israeli cohort under the age of 50 and to examine the effectiveness of FOBT testing in this population. Methods: A single center retrospective cohort study of consecutive patients under the age of 50 who had been seen at least once at an Oncology service in one of the largest hospitals in Israel between 2010-2015. Clinical and pathological data was collected from a prospectively maintained cancer registry database and patient chart review. Data was also extracted from the Israeli cancer registry. Data on FOBT testing was obtained from the electronic database of the preventive medicine institute at Rambam Health Care Campus between the years 2004-2013. Uptake of the guaiac-fecal occult blood test (gFOBT, Hemocult II) within this young (<50yrs) population was measured. Subjects with positive occult blood test were
S-765
AGA Abstracts
AGA Abstracts
difficult to identify especially with suboptimal bowel preparation. The goal of the study was to identify endoscopic features of mucous-capped polyps that help predict SSA/Ps. Methods: We analyzed 147 mucous-capped polyps identified from 2069 colonic polyps from 20112014. The 8 features looked at included: presence of borders, elevation, rim of debris, location in colon, size, varicose vessels, nodular surface, and alteration of mucosal folds. Predefined criteria for each endoscopic feature were used to analyze mucous-capped polyps from previously taken pictures through retrospective chart review. One experienced endoscopist (Devers TJ) confirmed the morphology from documentation for a representative group of adenomas. Polyps were identified as an SSA/P when histology showed abnormal proliferation and/or abnormal architecture without the presence of cytological dysplasia seen in adenomatous polyps. We used conditional logistic regression with backward selection to compute odds ratios (ORs), confidence intervals (CI), and p-values looking for endoscopic features that predict SSA/Ps. Results: Ninety-seven percent (n=142) of mucous-capped polyps were from the serrated pathway (hyperplastic (n=98) and SSA/P (n=44)), while 3% (n=5) were from the adenoma-carcinoma sequence. Rim of debris (OR 4.086, 95% CI 0.45936.348, p=0.207), varicose vessels (OR 9.921, 95% CI 3.234-32.616, p <0.005), and nodular surface (OR 3.076, 95% CI 1.250-7.570, p=0.014) were selected out after backward selection. Presence of a nodular surface and varicose vessels were found to have statistical significance in predicting SSA/Ps. Polyp size greater than 10 mm, elevation, distinct borders, location in colon, alteration of mucosal folds, and rim of debris were not found to be statistically significant endoscopic predictors for SSA/Ps. Conclusion: The current study demonstrates that mucous-capped polyps are usually associated with the serrated pathway and that SSA/ Ps possess predictive endoscopic features. Recognition of these characteristics might assist endoscopists in differentiating and detecting these often subtle lesions which may help improve the effectiveness of colonoscopy.