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Prevalence of Colorectal Polyps in Potential Cardiac Transplant Recipients
Abstracts
W1092 Impact of Having a Second Degree Relative with Colorectal Cancer on the Risks of Developing Adenomas Kenny Chiu, Hyung Cho, Sharon Bayuga, Tim Church, Margaret Mandelson, Andrew Feld, John Allen, Glenn Mills, Paul Jordan, Michael O’Brien, Ann Zauber, Sidney Winawer Colon cancer screening studies have concentrated on studying the risks of 1st degree relatives (FDR) with colon cancer and under current screening guidelines, having affected 2nd degree relatives (SDR) place a person in the average risk category. However, there is a small increase in colon cancer risks from having an affected SDR. The aim of this study is to evaluate how an affected SDR or FDR affect the prevalence of adenomas and advanced adenomas in a multicenter colon cancer screening trial. As part of the National Colonoscopy Study (NCS), 622 subjects enrolled from 1999 to 2002 underwent a screening colonoscopy. The presence of adenomas, their number, size, and location were recorded. All histologies were confirmed by an independent pathologist. The subjects were categorized as having an affected FDR, SDR, or neither. The endoscopists determined that 99.4% had a good preparation and the cecum was reached in 98.9%. Subjects with an affected FDR and those with an affected SDR show a similar trend towards an increased risk for adenomas. Having either an affected FDR or SDR increases the risk for adenomas when compared to those with neither (p Z 0.03). There was no difference in the ratio of right vs left sided adenomas or in their multiplicity based on family history. In conclusion, subjects with an affected SDR show a trend towards an increased risk for adenomas similar to those with an affected FDR. There is a statistically significant increase in the risk for adenomas in subjects with either an affected FDR or SDR. The number of advanced adenomas is too few to show a trend. The NCS is ongoing and will accrue a larger cohort to further evaluate the role of SDR’s in the risk of advanced adenomas. The impact of family histories is still being explored and with further studies, the presence of an affected SDR may place individuals in a higher risk screening category.
W1094 Endoscopic Tattooing of Colonic Lesions with a Carbon Particle Highly-Purified Suspension Angels Vilella, Carlos Dolz, Hernan Andreu, Alvaro Brotons, Joan Riera Introduction: Marking of colonic lesions for later therapeutic approaches is aquiring an increasingly important role in endoscopic practice. Tattooing is one of the methods for lesion marking. Aim: To develop a protocol for endoscopic tattooing of colonic lesions, in order to help in surgery or later endoscopic surveillance. To evaluate its safety and usefulness. Materials and Methods: Endoscopic tattooing of the colonic lesion was performed in all patients in whom colon cancer or large polyps subject to surgical resection were found during colonoscopy. For tattooing purposes, a carbon particle highly-purified suspension was injected through an endoscopic injection needle (Injecta FlowÒ 7Fr, 220 cm, Wilson-Cook) to create two contalateral lumps, both 1 cm proximal to the lesion. Results: Between November 2003 and September 2004, 31 tattooing procedures were performed in 29 patients, 19 men, 11 women, mean age 67 years (44-91). The lesions tattooed were: 23 adenocarcinoma, 4 adenoma, and 4 bases of endoscopic polypectomy of polyps with suspected neoplastic infiltration at colonoscopic examination. Tattooed lesion locations were: rectum (1), sigmoid (16), descendent (3), transverse (7) and ascendent-caecum (4). Two patients had another syncronic lesion at colonoscopy, which was also tattooed. 25 patients have undergone surgical resection of tattooed lesions, 2 are having endoscopic follow-up, and 2 are currently awaiting treatment. In 23 of 25 patients undergoing surgery, tattoo was correctly identified at surgery without peritoneal spilling of the carbon solution; the 2 cases in which the tattoo was not identified were large, exteriorized neoplasms. In all the 10 cases selected for laparoscopic surgical approach, tattoo was easily identified; the lesion was laparoscopically resectable in 9 of them. In no case complications of tattoiing were detected. Conclusions: Endoscopic tattooing with highly-purified carbon particles is a useful, safe technique to identify colonic lesions for treatment and follow-up. Lesion marking is helpful for laparoscopic surgical approach, which is advantageous for patients.
W1095 How To Diagnose Early Rectal Adenocarcinoma? Endoscopic Features and Predictors of Submucosal Invasion at National Cancer Center Tokyo Fabian Emura, Yutaka Saito, Takahisa Matsuda, Takuji Gotoda, Ichiro Oda, Nozomu Kobayashi, Toshio Uraoka, Takeshi Nakajima, Hisatomu Ikehara, Daizo Saito W1093 Prevalence of Colorectal Polyps in Potential Cardiac Transplant Recipients Cherag Daruwala, Benjamin Krevsky Colonoscopy is a routine part of the evaluation process for patients with advanced heart failure undergoing transplant evaluation. Our purpose was to investigate the prevalence of colorectal neoplasia and to make screening recommendations for this population based on age. Methods: The results of colonoscopies performed at Temple University Hospital from 1999 - 2003 as a part of the routine heart pretransplant evaluation process were compared to the results of screening average risk control patients after matching for age, sex, and date of procedure. Results: Ninety four eligible patients were compared to the same number of matched controls. There was no significant difference found in the prevalence of adenomatous polyps between heart transplant (OHT) evaluation patients (28%) and conrols (29%)(p O 0.05). Two of the controls were found to have adenocarcinoma, while no cancers were detected among OHT evaluation patients (p O 0.05). There was no significant difference (p O 0.05) found in the total number of polyps (adenomatous plus hyperplastic), prevalence of diverticular disease, or prevalence of hemorrhoids between OHT evaluation patients and controls. Fouteen percent of the study group was under age 50 (range 26-49). Among this group of patients, one patient was found to have an adenomatous polyp (0.5 cm) compared to two control patients with adenomas (p O 0.05). There were no complications related to the colonoscopy in either the OHT or control groups. Conclusions: In this study, screening colonoscopy performed as part of a heart transplant evaluation protocol in patients under the age of 50 did not reveal ‘‘significant’’ neoplasia. Therefore, colonoscopic evaluation in this population is unnecessary. Patients being evaluated for heart transplantation should be treated as persons otherwise at average risk as long as there is no significant family history of colorectal cancer, or personal history of colonic polyps, malignancy, inflammatory bowel disease or gastrointestinal bleeding.
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Background: Rectal cancer is usually diagnosed at late stage, however, the incidence of early cancer (confined to the mucosa and submucosa) is increasing in Japan. Endoscopic resection improves patients’s QOL and is the accepted treatment for mucosal cancer, however, remains controversial in submucosal tumors. In this regard, endoscopic differences between mucosal and submucosal tumors will determine treatment strategies, however have been scarcely studied and the role of endoscopic treatment is still unclear Aim: The aim of this study was to evaluate the endoscopic features of mucosal and submucosal rectal adenocarcinoma and the endoscopic predictors of submucosal invasion. Material and Methods: Early rectal adenocarcinoma diagnosed between October, 1988 and November, 2002 were the subject of the study. Age, gender, location (Rs, Ra and Rb), size, macroscopic type, depressed component (IIc), growth type: polypoid growth (PG), non polypoid growth (NPG), clinical pit pattern (non invasive, invasive) were analyzed to predict submucosal invasion. Treatment (endoscopic, surgical) and lymph node metastases (LNM) data were also analyzed. Results: There were 268 early rectal cancers, 196 (73%) mucosal and 72 (27%) submucosal. Overall mean age and size were 62G10.7 years and 15G8.4 mm respectively. There were no significant differences in age, gender, location and macroscopic type and the layer of invasion, however, mean size, presence of IIc component, NPG and invasive pattern were significantly different between mucosal and submucosal tumors. Multivariate analysis revealed that invasive pattern (OR Z 68), NPG (OR Z 17) and size R15 mm (OR Z 14) were independent factors predicting submucosal invasion. Endoscopic treatment was performed in all mucosal resections (curative rate:100%). Submucosal tumors were treated endoscopically in 26 (36%) and surgically in 46 (64%) cases. Among the endoscopic resected lesion, 9 (34%) lesions invaded %1000 um (sm1) and 17 (66%) invaded O1000 um (sm2). Additional surgery was performed in sm2 cases. LNM was found in 7 out of 72 (10%) submucosal tumors. Conclusions: Endoscopic resection effectively removed most early rectal adenocarcinomas. Invasive pit pattern, NPG and size R15 mm are accurate predictive factors of submucosal invasion and useful to define the therapeutic strategy. Endoscopic diagnosis might of early rectal adenocarcinoma is feasible and might reduce unnecessary surgical procedures.
Volume 61, No. 5 : 2005 GASTROINTESTINAL ENDOSCOPY AB249
W1092 Impact of Having a Second Degree Relative with Colorectal Cancer on the Risks of Developing Adenomas Kenny Chiu, Hyung Cho, Sharon Bayuga, Tim Church, Margaret Mandelson, Andrew Feld, John Allen, Glenn Mills, Paul Jordan, Michael O’Brien, Ann Zauber, Sidney Winawer Colon cancer screening studies have concentrated on studying the risks of 1st degree relatives (FDR) with colon cancer and under current screening guidelines, having affected 2nd degree relatives (SDR) place a person in the average risk category. However, there is a small increase in colon cancer risks from having an affected SDR. The aim of this study is to evaluate how an affected SDR or FDR affect the prevalence of adenomas and advanced adenomas in a multicenter colon cancer screening trial. As part of the National Colonoscopy Study (NCS), 622 subjects enrolled from 1999 to 2002 underwent a screening colonoscopy. The presence of adenomas, their number, size, and location were recorded. All histologies were confirmed by an independent pathologist. The subjects were categorized as having an affected FDR, SDR, or neither. The endoscopists determined that 99.4% had a good preparation and the cecum was reached in 98.9%. Subjects with an affected FDR and those with an affected SDR show a similar trend towards an increased risk for adenomas. Having either an affected FDR or SDR increases the risk for adenomas when compared to those with neither (p Z 0.03). There was no difference in the ratio of right vs left sided adenomas or in their multiplicity based on family history. In conclusion, subjects with an affected SDR show a trend towards an increased risk for adenomas similar to those with an affected FDR. There is a statistically significant increase in the risk for adenomas in subjects with either an affected FDR or SDR. The number of advanced adenomas is too few to show a trend. The NCS is ongoing and will accrue a larger cohort to further evaluate the role of SDR’s in the risk of advanced adenomas. The impact of family histories is still being explored and with further studies, the presence of an affected SDR may place individuals in a higher risk screening category.
W1094 Endoscopic Tattooing of Colonic Lesions with a Carbon Particle Highly-Purified Suspension Angels Vilella, Carlos Dolz, Hernan Andreu, Alvaro Brotons, Joan Riera Introduction: Marking of colonic lesions for later therapeutic approaches is aquiring an increasingly important role in endoscopic practice. Tattooing is one of the methods for lesion marking. Aim: To develop a protocol for endoscopic tattooing of colonic lesions, in order to help in surgery or later endoscopic surveillance. To evaluate its safety and usefulness. Materials and Methods: Endoscopic tattooing of the colonic lesion was performed in all patients in whom colon cancer or large polyps subject to surgical resection were found during colonoscopy. For tattooing purposes, a carbon particle highly-purified suspension was injected through an endoscopic injection needle (Injecta FlowÒ 7Fr, 220 cm, Wilson-Cook) to create two contalateral lumps, both 1 cm proximal to the lesion. Results: Between November 2003 and September 2004, 31 tattooing procedures were performed in 29 patients, 19 men, 11 women, mean age 67 years (44-91). The lesions tattooed were: 23 adenocarcinoma, 4 adenoma, and 4 bases of endoscopic polypectomy of polyps with suspected neoplastic infiltration at colonoscopic examination. Tattooed lesion locations were: rectum (1), sigmoid (16), descendent (3), transverse (7) and ascendent-caecum (4). Two patients had another syncronic lesion at colonoscopy, which was also tattooed. 25 patients have undergone surgical resection of tattooed lesions, 2 are having endoscopic follow-up, and 2 are currently awaiting treatment. In 23 of 25 patients undergoing surgery, tattoo was correctly identified at surgery without peritoneal spilling of the carbon solution; the 2 cases in which the tattoo was not identified were large, exteriorized neoplasms. In all the 10 cases selected for laparoscopic surgical approach, tattoo was easily identified; the lesion was laparoscopically resectable in 9 of them. In no case complications of tattoiing were detected. Conclusions: Endoscopic tattooing with highly-purified carbon particles is a useful, safe technique to identify colonic lesions for treatment and follow-up. Lesion marking is helpful for laparoscopic surgical approach, which is advantageous for patients.
W1095 How To Diagnose Early Rectal Adenocarcinoma? Endoscopic Features and Predictors of Submucosal Invasion at National Cancer Center Tokyo Fabian Emura, Yutaka Saito, Takahisa Matsuda, Takuji Gotoda, Ichiro Oda, Nozomu Kobayashi, Toshio Uraoka, Takeshi Nakajima, Hisatomu Ikehara, Daizo Saito W1093 Prevalence of Colorectal Polyps in Potential Cardiac Transplant Recipients Cherag Daruwala, Benjamin Krevsky Colonoscopy is a routine part of the evaluation process for patients with advanced heart failure undergoing transplant evaluation. Our purpose was to investigate the prevalence of colorectal neoplasia and to make screening recommendations for this population based on age. Methods: The results of colonoscopies performed at Temple University Hospital from 1999 - 2003 as a part of the routine heart pretransplant evaluation process were compared to the results of screening average risk control patients after matching for age, sex, and date of procedure. Results: Ninety four eligible patients were compared to the same number of matched controls. There was no significant difference found in the prevalence of adenomatous polyps between heart transplant (OHT) evaluation patients (28%) and conrols (29%)(p O 0.05). Two of the controls were found to have adenocarcinoma, while no cancers were detected among OHT evaluation patients (p O 0.05). There was no significant difference (p O 0.05) found in the total number of polyps (adenomatous plus hyperplastic), prevalence of diverticular disease, or prevalence of hemorrhoids between OHT evaluation patients and controls. Fouteen percent of the study group was under age 50 (range 26-49). Among this group of patients, one patient was found to have an adenomatous polyp (0.5 cm) compared to two control patients with adenomas (p O 0.05). There were no complications related to the colonoscopy in either the OHT or control groups. Conclusions: In this study, screening colonoscopy performed as part of a heart transplant evaluation protocol in patients under the age of 50 did not reveal ‘‘significant’’ neoplasia. Therefore, colonoscopic evaluation in this population is unnecessary. Patients being evaluated for heart transplantation should be treated as persons otherwise at average risk as long as there is no significant family history of colorectal cancer, or personal history of colonic polyps, malignancy, inflammatory bowel disease or gastrointestinal bleeding.
www.mosby.com/gie
Background: Rectal cancer is usually diagnosed at late stage, however, the incidence of early cancer (confined to the mucosa and submucosa) is increasing in Japan. Endoscopic resection improves patients’s QOL and is the accepted treatment for mucosal cancer, however, remains controversial in submucosal tumors. In this regard, endoscopic differences between mucosal and submucosal tumors will determine treatment strategies, however have been scarcely studied and the role of endoscopic treatment is still unclear Aim: The aim of this study was to evaluate the endoscopic features of mucosal and submucosal rectal adenocarcinoma and the endoscopic predictors of submucosal invasion. Material and Methods: Early rectal adenocarcinoma diagnosed between October, 1988 and November, 2002 were the subject of the study. Age, gender, location (Rs, Ra and Rb), size, macroscopic type, depressed component (IIc), growth type: polypoid growth (PG), non polypoid growth (NPG), clinical pit pattern (non invasive, invasive) were analyzed to predict submucosal invasion. Treatment (endoscopic, surgical) and lymph node metastases (LNM) data were also analyzed. Results: There were 268 early rectal cancers, 196 (73%) mucosal and 72 (27%) submucosal. Overall mean age and size were 62G10.7 years and 15G8.4 mm respectively. There were no significant differences in age, gender, location and macroscopic type and the layer of invasion, however, mean size, presence of IIc component, NPG and invasive pattern were significantly different between mucosal and submucosal tumors. Multivariate analysis revealed that invasive pattern (OR Z 68), NPG (OR Z 17) and size R15 mm (OR Z 14) were independent factors predicting submucosal invasion. Endoscopic treatment was performed in all mucosal resections (curative rate:100%). Submucosal tumors were treated endoscopically in 26 (36%) and surgically in 46 (64%) cases. Among the endoscopic resected lesion, 9 (34%) lesions invaded %1000 um (sm1) and 17 (66%) invaded O1000 um (sm2). Additional surgery was performed in sm2 cases. LNM was found in 7 out of 72 (10%) submucosal tumors. Conclusions: Endoscopic resection effectively removed most early rectal adenocarcinomas. Invasive pit pattern, NPG and size R15 mm are accurate predictive factors of submucosal invasion and useful to define the therapeutic strategy. Endoscopic diagnosis might of early rectal adenocarcinoma is feasible and might reduce unnecessary surgical procedures.
Volume 61, No. 5 : 2005 GASTROINTESTINAL ENDOSCOPY AB249