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6969 Outcome of rescreening patients referred for open access flexible fiberoptic sigmoidoscopy.
6969 OUTCOME OF RESCREENING PATIENTS REFERRED FOR OPEN ACCESS FLEXIBLE FIBEROPTIC SIGMOIDOSCOPY. Eric J. Lawitz, Shailesh C. Kadakia, Norma Cantu, Nancy Meier, Brooke Army Med Ctr, SanAntonio, TX. Backround: Open access flexible fiberoptic sigmoidoscopy (FFS) has been in place for one year at Brooke Army Medical Center. This service is available for routine colorectal cancer screening and thus performed on average risk asymptomatic patients. To ensure that these patients are appropriate candidates a health care provider must answer a series of questions to ensure that these patients are at average risk. After these screening questions have been answered, the patient is enrolled into the open access FFS clinic. The patients are not interviewed further and a FFS is completed. Methods: Three hundred and thirty seven patients, who were enrolled in the open access FFS program by the primary care providers, were contacted by telephone and rescreened by a member of the gastroenterology clinic for appropriateness of the FFS. Those who did not meet criteria for screening FFS were referred back to the primary care provider to obtain a full gastroenterology appointment. Results: There were two hundred and eighty three or 83.9% who fulfilled the criteria for screening FFS. The remaining 16.1% were either not average risk for colorectal cancer or needed a total colonic exam rather than a screening flexible sigmoidoscopy. Twentyfour (7.1%) patients had a family history of colon cancer, 15 (4.5%) patients had a personnel history of colonic polyps, 12 (3.6%) patients had recent history of hematochezia, and 3 (.9%) patients had a personnel history of colon cancer. Conclusion: Routine screening FFS is an appropriate screening strategy in approximately 3⁄4 of patients in an open access FFS program. Further questioning will result in a total colonic exam as being a more appropriate test in about 1/4 of patients. 6970 PRELIMINARY RESULTS OF EXTENDED SIGMOIDOSCOPY (EXT-SIG) FOR COLON CANCER SCREENING IN UNSELECTED, AVERAGE RISK, ASYMPTOMATIC PERSONS. John G. Lee, Lum Donald, Shiro Urayama, Surinder Mann, Susan Saavedra, Heather Vigil, Chi Vilaysak, Joseph W. Leung, UC Davis Med Ctr, Sacramento, CA; N Ca Vahcs, Sacramento, CA. Background: patient comfort, quality of the prep, and length of the endoscope determine the extent of the colon examined during screening sigmoidoscopy (Screen-sig). Using a colonoscope could increase the extent of colon sceened during Screen-sig if the subject is prepped properly and comfortable. We present the initial results of this concept, called Ext-sig. Methods: we enrolled 41 unselected, average risk, asymptomatic, 50-60 year olds (11 women; 13 from VA) referred for Screen-sig by their primary care MD’s. Ext-sig after PEG prep was terminated either because of pain or if full colonoscopy and polypectomy was performed. Results: Ext-sig was performed proximal to the splenic flexure in 38 (92.7%); 29 (70.7%) tolerated unsedated full colonoscopy and polypectomy. Pain stopped the procedure at the descending (3), transverse (5), or ascending colon (4). Ext-sig took 18.3±5.1 min and time to cecum was 6.0±2.5 min; it took 10.2±4.6 min in the 12 subjects who could not tolerate full colonoscopy. Ext-sig was terminated before reaching the cecum in 63.6% of women vs 16.7% of men (p<0.02). 5 of these 12 had previous pelvic surgery, diverticula, or IBS. Of 23 undergoing polypectomy (<5mm in 14, 5-9mm in 9, none ≥10mm), 8 had tubular adenomas (all VA subjects). 14 of 15 university subjects had hyperplastic or inflammatory polyps and 1 had a malignant carcinoid, which was completely removed endoscopically. 12 had polyps only distal to the splenic flexure and 7 had polyps only proximal to it; 4 had L and R-sided polyps. One had soliatry R-sided adenoma, one had L and R-sided adenomas, and 6 had only L-sided adenomas. Of the 12 who did not undergo full colonoscopy, 1 had a distal adenoma and underwent sedated colonoscopy and polypectomy later. Pain was none (1), slight (8), some (13), moderate (12), severe (7) and lasted few seconds (21) or few minutes (19); no one complained of pain lasting for most or all of the Ext-sig. Response to undergoing Ext-sig again was not sure (4), definitely (16), probably (15), probably not (2), definitely not (4). 32 were willing to undergo Ext-sig as likely as a conventional Screen-sig in the future. Conclusion: (1) Using a colonoscope for routine Screen-sig extends the screening to proximal to the splenic flexure in 93% and allows complete colonoscopy and polypectomy in 71%. (2) Although preliminary, isolated R-sided adenoma appears to be very common among unselected, average risk, asymptomatic 50-60 year olds referred for routine Screen-sig by their primary care MD’s.
AIMS To study the association of the duration of the test with the polyps yield and the miss rate for polyps of sigmoidoscopy (FS) among patients undergoing FS screening for coloretal cancer (CRC). METHODS We compared the polyps yield of FS and colonoscopy (TC) among subjects referred for TC in Turin in the context of the SCORE trial of FS screening for CRC, conducted as parallel study to the UK trial (coordinator: W Atkin). Endoscopists were instructed to excise all small (≤5 mm) polyps detected at FS and to record the duration of the test, as well as shape, size and location of all polyps detected. Patients detected with polyps >5 mm, CRC, high-risk polyps ≤5 mm (villous component, severe dysplasia), >2 adenomas were referred for TC. TCs were performed within 1 month from FS in the same Endoscopy Unit. Only subjects with complete FS (instrument passed beyond the sigmoid-descending colon junction, under adequate bowel preparation) were included in this analysis. Patients with distal CRC were excluded. RESULTS Out of 3540 FSs performed in Turin, 2888 (81.6%) were completed. Complete information for the analysis is available for 2225 tests (duration of the procedure was not recorded in 557 and polyp size in 6 cases). FS was completed within 5 minutes in 64.6% of the cases, between 6 and 10 minutes in 29.6% and it required >10 minutes in 5.7% of the patients. Polyps yield was 11%, 27.3%, and 45.9% (p-trend-:<0.001) for tests completed within 5, 10 and >10 minutes respectively. The observed increase in the detection rate was associated with an increase in the proportion of polyps ≤5 mm: 56.7%, 68.1% and 88.5% for tests completed within 5, 10 and >10 minutes respectively (p-trend:<0.001). Out of 329 subjects without distal CRC referred for TC 323 were examined. FS had not been completed in 117 of these cases and the duration of the FS had not been reported in 37. Miss rate was evaluated among 169 cases with complete data. Additional polyps (N=29) were detected in the rectum or sigmoid in 23 patients (13.6%). Miss rate was 7.8%, 20.6% and 18.2% for FSs completed within 5, 10 and >10 minutes respectively. CONCLUSIONS Only a small proportion of the screening FS lasted more than 10 minutes. A positive association was observed between polyps yield and duration of the test, mainly attributable to a trend toward a higher detection rate for small polyps. The time devoted to the excision of small polyps might explain the longer duration of the tests in these cases. Accuracy of the screening FS was apparently not reduced if the test was completed within 5 minutes. 6972 PREVALENCE OF RECTAL CANCERS AT VETERANS AFFAIRS NEW JERSEY HEALTH CARE SYSTEM (VANJHCS). Godwin O. Molokwu, Isabelita Cordoba-Rellosa, Sima Vossough, Gerald Salen, Alden W. Dudley, Carolyn Riley, UMDNJ NewJersey Med Sch, Newark, NJ; Veterans Affairs NJ Health Care System, East Orange, NJ. Background: The incidence of rectal ca rose in the 2nd half of this century, among minority groups and veterans. Rectal ca remains a major problem in the US.It is estimated that more than 45,000 new cases are diagnosed annually in the US and about 15,000 of those will die. Survival for rectal ca treated with curative surgery has not changed over the last several decades and remains in the 45% to 65% range.We assessed the prevalence of rectal ca at VANJHCS over the past ten years. Methods: We reviewed the records of 600 patients at VANJHCS diagnosed with rectal mass from 1/88 to 1/98. The clinical indications for endoscopy were: rectal bleeding, heme + stool, wt loss, change in bowel habits, family history of colorectal ca, colorectal ca screening age > 50 and/or severe microcytic anemia. The endoscopies and biopsies were done at East Orange and Lyons Veterans Hospitals. Each patient was given only one histological diagnosis. Results: Out of 600 patients diagnosed with rectal mass over the past ten years at VANJHCS, the incidence of rectal ca was 42% (250/600),tubulovillous adenoma 16%(97/600),tubular adenoma 20%(120/600), adenomatous polyps 14%(81/600), Villous adenoma 5%(32/600) and others 3%(20/600) which included Kaposi’s Sarcoma, Leiomyoma, Carcinoids and Leukemia. Conclusions: Etiologic studies are needed to understand the large increases in the incidence of rectal ca and tubulovillous adenoma among the VANJHCS .
6971 ASSOCIATION OF DURATION OF THE TEST WITH YIELD AND MISS RATE OF POLYPS AT SCREENING SIGMOIDOSCOPY. Pennazio Marco, Senore Carlo, Ferraris Roberto, Arrigoni Arrigo, Bertone Alberto, Coppola Franco, Fracchia Mario, Gemme Carlo, Spandre Mauro, Pera Angelo, Rossini P. Francesco, Segnan Nereo, Hosp MAURIZIANO UMBERTO I, Torino, Italy; CPO - Piemonte, Torino, Italy; Hosp S GIOVANNI AS, Torino, Italy.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB233
AIMS To study the association of the duration of the test with the polyps yield and the miss rate for polyps of sigmoidoscopy (FS) among patients undergoing FS screening for coloretal cancer (CRC). METHODS We compared the polyps yield of FS and colonoscopy (TC) among subjects referred for TC in Turin in the context of the SCORE trial of FS screening for CRC, conducted as parallel study to the UK trial (coordinator: W Atkin). Endoscopists were instructed to excise all small (≤5 mm) polyps detected at FS and to record the duration of the test, as well as shape, size and location of all polyps detected. Patients detected with polyps >5 mm, CRC, high-risk polyps ≤5 mm (villous component, severe dysplasia), >2 adenomas were referred for TC. TCs were performed within 1 month from FS in the same Endoscopy Unit. Only subjects with complete FS (instrument passed beyond the sigmoid-descending colon junction, under adequate bowel preparation) were included in this analysis. Patients with distal CRC were excluded. RESULTS Out of 3540 FSs performed in Turin, 2888 (81.6%) were completed. Complete information for the analysis is available for 2225 tests (duration of the procedure was not recorded in 557 and polyp size in 6 cases). FS was completed within 5 minutes in 64.6% of the cases, between 6 and 10 minutes in 29.6% and it required >10 minutes in 5.7% of the patients. Polyps yield was 11%, 27.3%, and 45.9% (p-trend-:<0.001) for tests completed within 5, 10 and >10 minutes respectively. The observed increase in the detection rate was associated with an increase in the proportion of polyps ≤5 mm: 56.7%, 68.1% and 88.5% for tests completed within 5, 10 and >10 minutes respectively (p-trend:<0.001). Out of 329 subjects without distal CRC referred for TC 323 were examined. FS had not been completed in 117 of these cases and the duration of the FS had not been reported in 37. Miss rate was evaluated among 169 cases with complete data. Additional polyps (N=29) were detected in the rectum or sigmoid in 23 patients (13.6%). Miss rate was 7.8%, 20.6% and 18.2% for FSs completed within 5, 10 and >10 minutes respectively. CONCLUSIONS Only a small proportion of the screening FS lasted more than 10 minutes. A positive association was observed between polyps yield and duration of the test, mainly attributable to a trend toward a higher detection rate for small polyps. The time devoted to the excision of small polyps might explain the longer duration of the tests in these cases. Accuracy of the screening FS was apparently not reduced if the test was completed within 5 minutes. 6972 PREVALENCE OF RECTAL CANCERS AT VETERANS AFFAIRS NEW JERSEY HEALTH CARE SYSTEM (VANJHCS). Godwin O. Molokwu, Isabelita Cordoba-Rellosa, Sima Vossough, Gerald Salen, Alden W. Dudley, Carolyn Riley, UMDNJ NewJersey Med Sch, Newark, NJ; Veterans Affairs NJ Health Care System, East Orange, NJ. Background: The incidence of rectal ca rose in the 2nd half of this century, among minority groups and veterans. Rectal ca remains a major problem in the US.It is estimated that more than 45,000 new cases are diagnosed annually in the US and about 15,000 of those will die. Survival for rectal ca treated with curative surgery has not changed over the last several decades and remains in the 45% to 65% range.We assessed the prevalence of rectal ca at VANJHCS over the past ten years. Methods: We reviewed the records of 600 patients at VANJHCS diagnosed with rectal mass from 1/88 to 1/98. The clinical indications for endoscopy were: rectal bleeding, heme + stool, wt loss, change in bowel habits, family history of colorectal ca, colorectal ca screening age > 50 and/or severe microcytic anemia. The endoscopies and biopsies were done at East Orange and Lyons Veterans Hospitals. Each patient was given only one histological diagnosis. Results: Out of 600 patients diagnosed with rectal mass over the past ten years at VANJHCS, the incidence of rectal ca was 42% (250/600),tubulovillous adenoma 16%(97/600),tubular adenoma 20%(120/600), adenomatous polyps 14%(81/600), Villous adenoma 5%(32/600) and others 3%(20/600) which included Kaposi’s Sarcoma, Leiomyoma, Carcinoids and Leukemia. Conclusions: Etiologic studies are needed to understand the large increases in the incidence of rectal ca and tubulovillous adenoma among the VANJHCS .
6971 ASSOCIATION OF DURATION OF THE TEST WITH YIELD AND MISS RATE OF POLYPS AT SCREENING SIGMOIDOSCOPY. Pennazio Marco, Senore Carlo, Ferraris Roberto, Arrigoni Arrigo, Bertone Alberto, Coppola Franco, Fracchia Mario, Gemme Carlo, Spandre Mauro, Pera Angelo, Rossini P. Francesco, Segnan Nereo, Hosp MAURIZIANO UMBERTO I, Torino, Italy; CPO - Piemonte, Torino, Italy; Hosp S GIOVANNI AS, Torino, Italy.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB233