- Email: [email protected]
Assessment of patient awareness of colorectal cancer screening
AJG – September, Suppl., 2002
AR subjects were male (48% vs. 28%, p ⬍ 0.05). Among AR patients, 13% reported that they had been screened in the past year with a completed Fecal Occult Blood Test (FOBT), 16% of women and 3% of men, p ⬍ 0.05. 36% reported that they had undergone either sigmoidoscopy or colonoscopy in the past five years (59% of men, 27% of women, p ⬍ 0.001), and 14% indicated that they had received a barium enema within the past five years (p ⬎ 0.05 for gender comparison). There were no significant differences in screening rates by race/ethnicity. Screening rates among AR subjects are similar to those obtained on the latest BRFSS survey in which 21% had received a FOBT in the past year and 34% had received either segmoidoscopy or colonoscopy within 5 years. Among HR patients, 56% reported having been screened by segmoidoscopy or colonoscopy in the past 5 years. This was significantly higher than among AR subjects (p ⬍ 0.05). The rates of FOBT (19%) and barrium enema (17%) screening in the HR group were similar to those among AR patients. There were no significant differences by race/ethnicity or gender. Conclusions: It is notable that this inner city population had colorectal cancer screening rates comparable to those from a national sample. Strategies to increase CRC screening in this setting need to be developed. Explanation of gender differences in this self reported survey will need further exploration.
331 PYOGENIC GRANULOMA OF THE COLON IN CHILDREN Samra S. Blanchard, M.D., Gisela Chelimsky, M.D., Steve Czinn, M.D., Fred Rothstein, M.D., Raymond Redline, M.D. and Judy Splawski, M.D.*. Pediatric Gastroenterology, Pediatric Pathology, University Hospitals of Cleveland, Cleveland, OH. Purpose: Pyogenic granuloma is a common disease in the skin, but it is extremely rare in the gastrointestinal tract. We report two patients who presented with rectal bleeding found to have pyogenic granuloma in their histopathological evaluation. Patient 1 was a 5 year– old– girl with no past medical history who presented with a 2 month history of painless rectal bleeding. She had no fever, abdominal pain or weight loss. Her physical exam was within normal limits. She underwent colonoscopy which revealed a 4 mm polypoid lesion in the rectum. It appeared to be a juvenile polyp and was removed by snare with cautery. There were no complications. The histology revealed a lobular capillary hemangioma/ pyogenic granuloma which consists entirely of small and dilated capillaries and a loose connective tissue stroma. Patient 2 was an 18 month old female who presented with intermittent fever and rectal bleeding. She previously underwent an orthotopic liver transplantation for biliary atresia at 7 months of age.She had an abdominal CT scan which revealed bowel wall thickening in left mid abdomen with fatty proliferation of the mesentery locally. Colonoscopic examination showed a black necrotic circumferential lesion at the splenic flexure. The histology revealed several fragments of fibrous scar tissue with areas of proliferating capillaries surrounded by inflammatory cells.Two weeks later, she had second colonoscopic evaluation because of anemia and melena. The examination of the same area showed a scarred area with circumferential narrowing and no black necrotic tissue. The biopsy revealed a small focus of granulation. These are the first pediatric case reports of colonic pyogenic granuloma. There is only one report in the adult literature describing intestinal pyogenic granulomas in 3 adult patients. All presented with melena and anemia. Two patients had polypoid lesions and one patient had protruding black necrotic tissue. Pyogenic granuloma can occur in the gastrointestinal tract of children. It presents with rectal bleeding. Visually it has polypoid or black necrotic appearance. The diagnosis is made by histopathology.
Abstracts
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332 STOOL DNA ANALYSIS FOR THE DETECTION AND FOLLOW–UP OF COLORECTAL CANCER (CRC) AND ADVANCED ADENOMAS (AA): SENSITIVITY IN A PROSPECTIVE SERIES Sapna Syngal, M.D.*, Daniel Chung, M.D., Christopher Willett, M.D., David Schoetz, M.D., Paul Schroy, M.D., Elena Stoffel, M.D., Deepa Jagadeesh, M.B.B.S., Kathleen Morel, R.N. and Michael Ross, M.D. Dana Farber Cancer Institute, Boston, MA; Brigham and Women’s Hosp., Boston, MA; Massachusetts General Hosp., Boston, MA; Lahey Clinic Medical Ctr, Burlington, MA; Boston Medical Ctr, Boston, MA and Exact Sciences Corp, Maynard, MA. Purpose: To assess the sensitivity of a stool– based assay for the detection of stool DNA abnormalities in patients with CRC and AA, and assess the effect of treatment on these abnormalities. We report the preliminary sensitivity results from the largest prospective series reported to date. Methods: Patients provided a single stool at least two weeks after endoscopy, but prior to therapy. Additional stool samples were obtained approximately one and six months after surgery. Stool was homogenized and DNA isolated and analyzed as previously described (Gastro. 2000;119: 1219). The stool based assay (PreGen–Plus™) includes 21 mutations (MuMu) in p53, K–ras and APC, a microsatellite instability marker (BAT– 26), and the DNA Integrity Assay (DIA™). Results: 75 patients have been enrolled to date. Results are available for 38 (21 M, 17 F, avg age 63 yrs, range 37– 82yrs). Baseline results in lesions of the right colon (6/13, 46%) and left colon (16/25, 64%) are similar. 21 samples were analyzed following surgery; of these 18 patients had no detectable DNA abnormalities and three were positive (2 with mutations, 1 positive by DIA). Sensitivity of PreGen–Plus
Invasive cancer TNM stages 3&4 TNM stages 1&2 High grade dysplasia (HGD) Low grade dysplasia (LGD)
Number
MuMuⴙBAT26
DIA
Overall
28 16 12 5 5
15/28 10/16 5/12 2/5 1/5
12/28 8/16 4/12 0/5 0/5
19/28 (68%) 13/16 (81%) 6/12 (50%) 2/5 (40%) 1/5 (20%)
Conclusions: Overall, PreGen–Plus had a sensitivity of 68% (95% CI 56 – 80%) for the detection of invasive CRC, and 40% for HGD. The sensitivity for LGD was 20%. Although there was better detection of advanced lesions, this was not statistically significant. These results support the utility of this technology as a non–invasive option for CRC screening. In addition, these results provide the first evidence to support the potential use of this test for monitoring CRC patients post–treatment.
333 ASSESSMENT OF PATIENT AWARENESS OF COLORECTAL CANCER SCREENING Carl Guillaume, M.D.*, David F. Stein, M.D., FACG, Malay Myaing, M.D., Leslie Cespedes, M.D., Jose Reinoso, M.D., Mitaung Zhang, M.D., Mezgebe Berhe, M.D., Lionette JeanJeune, M.D. and Robert Sable, M.D., FACG. Gastroenterology, St. Barnabas Hospital, Bronx, NY. Purpose: To determine awareness of colorectal cancer in our clinic population and to determine the factors that may increase community compliance with colorectal cancer screening. Methods: All clinic outpatients referred for colorectal cancer screening from July 2001 to November 2001 were asked to complete a questionaire on their knowledge of colorectal cancer, health maintainance, highest level of education and potentially modifiable risk factors.Post– colonoscopy, the patients were asked to rate their level of discomfort and state the worst aspect of the exam. On follow up, the patients were asked about the role of
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colonoscopy in the prevention of colorectal cancer and the best means of raising awareness of colorectal cancer prevention in the community. Results: From July 2001 to November 2001,102 patients participated in the survey. 66 (65%) women, 36 (35%) men, 56 (55%) Hispanics, 34 (34%) African Americans, 10 (9%) Caucasians and 2(2%) Asians. Ages ranged from 52 to 77. 27 (26%) were college graduates, 52 (51%) were high school graduates and 23 (23%) were elementary school graduates. 77 (75.6%) patients were referred from their primary physician, 11 (10.8%) were self–referred, 8 (7.8%) from family influence, and 6 (5.8%) were referred by friends who had a screening colonoscopy. 66 women (100%) had pap smears and regular mammography. 31 men (86%) had yearly prostate cancer screening by PSA and digital exam. 59 patients (57.8%) had yearly FOBT. 39 (38%) patients were smokers and 10 (9%) consumed alcohol regularly. 6 patients were strict vegetarians. 97 (95%)patients rated the procedure as tolerable with minimal discomfort of 1 to 2 on a scale of 1 to 10. All patients stated the preparation was the worst aspect of the exam. 93 (91%) patients stated that establishing a rapport with the gastroenterologist influenced their final decision to have a colonoscopy. 95 (93%) patients believed screening colonoscopy was very important in the prevention of colorectal cancer and would advise friends or family member to have colonoscopy. Conclusions: Efforts should be made to increase the awareness of colorectal cancer screening in the population. Gastroenterologists can play a very important role in influencing compliance via interacting with the patients in the community in which they practice, and by educating primary care physicians.
334 COLORECTAL CANCER SCREENING IN ASYMTPOMATIC, AVERAGE RISK FEMALES: IS AGE 50 THE PROPER STARTING POINT? Brooks D. Cash, M.D., Philip S. Schoenfeld, M.D., Andrew P. Flood, Ph.D. and David A. Lieberman, M.D.*. Gastroenterology, Uniformed Services University of the Health Sciences, Bethesda, MD; Gastroenterology, University of Michigan, Ann Arbor, MI; Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD and Gastroenterology, Oregon Health Sciences University, Portland, OR. Purpose: Removal of adenomatous polyps has been shown to prevent the development of colorectal cancer in up to 90% of patients. Current guidelines recommend that colorectal cancer screening begin at age 50 in average risk individuals. However, recent studies indicate that the prevalence of advanced and non–advanced adenomas may be less in women compared to men and it has been suggested that women may develop colorectal cancer and adenomas later than men. The appropriate age for initiation of colorectal cancer screening in women has yet to be determined. Methods: Colonoscopy was offered to all asymptomatic women referred for colorectal cancer screening. Exclusion criteria included iron deficiency anemia, positive stool guiaics, barium enema or colonoscopy within the last 10 years, flexible sigmoidoscopy within the last 5 years, or hematochezia within the last year. Colonoscopy findings for women age 50 –59 were compared to those in women age 60 – 69. Results: 695/1328 consecutive women undergoing colonoscopy for colorectal cancer screening were 50 –59 at the time of colonoscopy and 393/ 1328 were 60 – 69. In women 50 –59, 17.6% (122/695) had adenomas and 3.9% (27/695) had advanced adenomas. In women 60 – 69, the prevalence of an adenoma and an advanced adenoma was 20.6% (81/393) and 4.8% (19/393), respectively. 59.3% (16/27) of women 50 –59 with advanced adenomas had these lesions proximal to the splenic flexure without any adenomas distal to the splenic flexure compared to 52.6% (10/19) of women 60 – 69. 94.7% (18/19) of women 50 –59 with advanced adenomas proximal to the descending–sigmoid colon junction did not have any adenomas distal to the descending–sigmoid colon junction compared to 92.3% (12/13) of women 60 – 69.
AJG – Vol. 97, No. 9, Suppl., 2002
Conclusions: The prevalence of adenomas and advanced adenomas in women is less than general population estimates. There appear to be no significant differences in the prevalence or distribution of adenomas in women 50 –59 compared to women 60 – 69. There is no evidence that initiation of screening at age 60 in asymptomatic, average risk women would be more effective than current recommendations. Colonoscopy is superior to sigmoidoscopy for the identification of proximal adenomas in women and most women with advanced proximal adenomas do not have distal adenomas.
335 HYDROGEN BREATH TEST (HBT) WITH & WITHOUT FIBER SUPPLEMENTATION TO EVALUATE THE ADEQUACY OF PREPARATION FOR COLONOSCOPY Douglas F. Meyer, M.D., Daniel S. Mishkin, M.D., Jared Gold, M.D., Aaron Z. Tokayer, M.D., Lawrence J. Brandt, M.D.*, Allen Ahdoot, M.D. and Joel Kertznus, M.D. Gastroenterology, Montefiore Medical Center, Bronx, NY. Purpose: This study uses gas chromatography to see if 1) the difference between baseline (bHBT) & pre– colonoscopy HBT (⌬HBT) reliably measures the adequacy of preparation; 2) use of Fibercon, a fermentable carbohydrate, increases ⌬HBT; and 3) clinical parameters that predict the adequacy of preparation. Methods: Over 5 mos, 159 pts completed a questionnaire before colonoscopy. Clinical parameters included if NPO that day & whether fiber was consumed daily. After bHBT, half the pts were randomly given Fibercon 1250 mg the morning before colonoscopy. The day of colonoscopy, other clinical parameters were evaluated including understanding of instructions for the colonic preparation & self–assessment of the completeness of the bowel preparation. Repeat HBT was performed. After colonoscopy, the adequacy of bowel preparation was rated on a scale of 1 to 5, 1 & 5 being the best and worst of preparations respectively. Results were analyzed using chi–square & student t–tests. Results: 159 pts (104 females, 55 males) were evaluated by HBT for a baseline score. Daily fiber consumption & diet did not produce a signif diff in bHBT scores. Females & males had a mean bHBT score of 12.67 ppm and 8.53 ppm (p⫽.01) respectively. 61 pts (38 females, 23 males) had colonoscopy. 72% had an optimal preparation (score of 1–2) while 28% had a suboptimal preparation (score of 3–5). There were no signif diffs in ¨ HBT in those with an optimal preparation vs suboptimal preparation. An A optimal preparation was seen in 61% of pts ⬍65 yrs & in 86% of pts ⬎65 yrs (p⫽.03). All patients using Fleet Phosphosoda or Visicol had a score of 1–2, compared with 76% of pts using Golytely (p⫽.02). 91% of the pts who had fiber supplementation before colonic preparation had a score of 1–2 in contrast to 52% of pts who did not have fiber supplementation (P⬍.001). Clinical parameters, percentage of the preparation taken, whether oral or written instructions were given by the physician, baseline stool consistency & frequency did not have a significant effect on the adequacy of the colonic preparation. Conclusions: While ⌬HBT was shown not to be an effective means to predict the adequacy of colonic preparation, age⬎ 65 yrs, use of non– Golytely preparations, and ingestion of fiber supplementation prior to colonic preparation were effective predictors.
336 ASSOCIATION OF COLONIC POLYPS AND DIVERTICULOSIS Nejat Kiyici, M.D., Tanaya Nayak, M.D., Edward Norkus, M.D. and Hilary Hertan, M.D.*. Division of Gastroenterology and Clinical Nutrition, Our Lady of Mercy Medical Center, Bronx, NY. Purpose: To determine whether polyps are detected with a higher frequency in patients with diverticulosis. Methods: In this retrospective study, results of 1000 colonoscopies performed in 2001 were evaluated.Patient demographics, indications and
AR subjects were male (48% vs. 28%, p ⬍ 0.05). Among AR patients, 13% reported that they had been screened in the past year with a completed Fecal Occult Blood Test (FOBT), 16% of women and 3% of men, p ⬍ 0.05. 36% reported that they had undergone either sigmoidoscopy or colonoscopy in the past five years (59% of men, 27% of women, p ⬍ 0.001), and 14% indicated that they had received a barium enema within the past five years (p ⬎ 0.05 for gender comparison). There were no significant differences in screening rates by race/ethnicity. Screening rates among AR subjects are similar to those obtained on the latest BRFSS survey in which 21% had received a FOBT in the past year and 34% had received either segmoidoscopy or colonoscopy within 5 years. Among HR patients, 56% reported having been screened by segmoidoscopy or colonoscopy in the past 5 years. This was significantly higher than among AR subjects (p ⬍ 0.05). The rates of FOBT (19%) and barrium enema (17%) screening in the HR group were similar to those among AR patients. There were no significant differences by race/ethnicity or gender. Conclusions: It is notable that this inner city population had colorectal cancer screening rates comparable to those from a national sample. Strategies to increase CRC screening in this setting need to be developed. Explanation of gender differences in this self reported survey will need further exploration.
331 PYOGENIC GRANULOMA OF THE COLON IN CHILDREN Samra S. Blanchard, M.D., Gisela Chelimsky, M.D., Steve Czinn, M.D., Fred Rothstein, M.D., Raymond Redline, M.D. and Judy Splawski, M.D.*. Pediatric Gastroenterology, Pediatric Pathology, University Hospitals of Cleveland, Cleveland, OH. Purpose: Pyogenic granuloma is a common disease in the skin, but it is extremely rare in the gastrointestinal tract. We report two patients who presented with rectal bleeding found to have pyogenic granuloma in their histopathological evaluation. Patient 1 was a 5 year– old– girl with no past medical history who presented with a 2 month history of painless rectal bleeding. She had no fever, abdominal pain or weight loss. Her physical exam was within normal limits. She underwent colonoscopy which revealed a 4 mm polypoid lesion in the rectum. It appeared to be a juvenile polyp and was removed by snare with cautery. There were no complications. The histology revealed a lobular capillary hemangioma/ pyogenic granuloma which consists entirely of small and dilated capillaries and a loose connective tissue stroma. Patient 2 was an 18 month old female who presented with intermittent fever and rectal bleeding. She previously underwent an orthotopic liver transplantation for biliary atresia at 7 months of age.She had an abdominal CT scan which revealed bowel wall thickening in left mid abdomen with fatty proliferation of the mesentery locally. Colonoscopic examination showed a black necrotic circumferential lesion at the splenic flexure. The histology revealed several fragments of fibrous scar tissue with areas of proliferating capillaries surrounded by inflammatory cells.Two weeks later, she had second colonoscopic evaluation because of anemia and melena. The examination of the same area showed a scarred area with circumferential narrowing and no black necrotic tissue. The biopsy revealed a small focus of granulation. These are the first pediatric case reports of colonic pyogenic granuloma. There is only one report in the adult literature describing intestinal pyogenic granulomas in 3 adult patients. All presented with melena and anemia. Two patients had polypoid lesions and one patient had protruding black necrotic tissue. Pyogenic granuloma can occur in the gastrointestinal tract of children. It presents with rectal bleeding. Visually it has polypoid or black necrotic appearance. The diagnosis is made by histopathology.
Abstracts
S109
332 STOOL DNA ANALYSIS FOR THE DETECTION AND FOLLOW–UP OF COLORECTAL CANCER (CRC) AND ADVANCED ADENOMAS (AA): SENSITIVITY IN A PROSPECTIVE SERIES Sapna Syngal, M.D.*, Daniel Chung, M.D., Christopher Willett, M.D., David Schoetz, M.D., Paul Schroy, M.D., Elena Stoffel, M.D., Deepa Jagadeesh, M.B.B.S., Kathleen Morel, R.N. and Michael Ross, M.D. Dana Farber Cancer Institute, Boston, MA; Brigham and Women’s Hosp., Boston, MA; Massachusetts General Hosp., Boston, MA; Lahey Clinic Medical Ctr, Burlington, MA; Boston Medical Ctr, Boston, MA and Exact Sciences Corp, Maynard, MA. Purpose: To assess the sensitivity of a stool– based assay for the detection of stool DNA abnormalities in patients with CRC and AA, and assess the effect of treatment on these abnormalities. We report the preliminary sensitivity results from the largest prospective series reported to date. Methods: Patients provided a single stool at least two weeks after endoscopy, but prior to therapy. Additional stool samples were obtained approximately one and six months after surgery. Stool was homogenized and DNA isolated and analyzed as previously described (Gastro. 2000;119: 1219). The stool based assay (PreGen–Plus™) includes 21 mutations (MuMu) in p53, K–ras and APC, a microsatellite instability marker (BAT– 26), and the DNA Integrity Assay (DIA™). Results: 75 patients have been enrolled to date. Results are available for 38 (21 M, 17 F, avg age 63 yrs, range 37– 82yrs). Baseline results in lesions of the right colon (6/13, 46%) and left colon (16/25, 64%) are similar. 21 samples were analyzed following surgery; of these 18 patients had no detectable DNA abnormalities and three were positive (2 with mutations, 1 positive by DIA). Sensitivity of PreGen–Plus
Invasive cancer TNM stages 3&4 TNM stages 1&2 High grade dysplasia (HGD) Low grade dysplasia (LGD)
Number
MuMuⴙBAT26
DIA
Overall
28 16 12 5 5
15/28 10/16 5/12 2/5 1/5
12/28 8/16 4/12 0/5 0/5
19/28 (68%) 13/16 (81%) 6/12 (50%) 2/5 (40%) 1/5 (20%)
Conclusions: Overall, PreGen–Plus had a sensitivity of 68% (95% CI 56 – 80%) for the detection of invasive CRC, and 40% for HGD. The sensitivity for LGD was 20%. Although there was better detection of advanced lesions, this was not statistically significant. These results support the utility of this technology as a non–invasive option for CRC screening. In addition, these results provide the first evidence to support the potential use of this test for monitoring CRC patients post–treatment.
333 ASSESSMENT OF PATIENT AWARENESS OF COLORECTAL CANCER SCREENING Carl Guillaume, M.D.*, David F. Stein, M.D., FACG, Malay Myaing, M.D., Leslie Cespedes, M.D., Jose Reinoso, M.D., Mitaung Zhang, M.D., Mezgebe Berhe, M.D., Lionette JeanJeune, M.D. and Robert Sable, M.D., FACG. Gastroenterology, St. Barnabas Hospital, Bronx, NY. Purpose: To determine awareness of colorectal cancer in our clinic population and to determine the factors that may increase community compliance with colorectal cancer screening. Methods: All clinic outpatients referred for colorectal cancer screening from July 2001 to November 2001 were asked to complete a questionaire on their knowledge of colorectal cancer, health maintainance, highest level of education and potentially modifiable risk factors.Post– colonoscopy, the patients were asked to rate their level of discomfort and state the worst aspect of the exam. On follow up, the patients were asked about the role of
S110
Abstracts
colonoscopy in the prevention of colorectal cancer and the best means of raising awareness of colorectal cancer prevention in the community. Results: From July 2001 to November 2001,102 patients participated in the survey. 66 (65%) women, 36 (35%) men, 56 (55%) Hispanics, 34 (34%) African Americans, 10 (9%) Caucasians and 2(2%) Asians. Ages ranged from 52 to 77. 27 (26%) were college graduates, 52 (51%) were high school graduates and 23 (23%) were elementary school graduates. 77 (75.6%) patients were referred from their primary physician, 11 (10.8%) were self–referred, 8 (7.8%) from family influence, and 6 (5.8%) were referred by friends who had a screening colonoscopy. 66 women (100%) had pap smears and regular mammography. 31 men (86%) had yearly prostate cancer screening by PSA and digital exam. 59 patients (57.8%) had yearly FOBT. 39 (38%) patients were smokers and 10 (9%) consumed alcohol regularly. 6 patients were strict vegetarians. 97 (95%)patients rated the procedure as tolerable with minimal discomfort of 1 to 2 on a scale of 1 to 10. All patients stated the preparation was the worst aspect of the exam. 93 (91%) patients stated that establishing a rapport with the gastroenterologist influenced their final decision to have a colonoscopy. 95 (93%) patients believed screening colonoscopy was very important in the prevention of colorectal cancer and would advise friends or family member to have colonoscopy. Conclusions: Efforts should be made to increase the awareness of colorectal cancer screening in the population. Gastroenterologists can play a very important role in influencing compliance via interacting with the patients in the community in which they practice, and by educating primary care physicians.
334 COLORECTAL CANCER SCREENING IN ASYMTPOMATIC, AVERAGE RISK FEMALES: IS AGE 50 THE PROPER STARTING POINT? Brooks D. Cash, M.D., Philip S. Schoenfeld, M.D., Andrew P. Flood, Ph.D. and David A. Lieberman, M.D.*. Gastroenterology, Uniformed Services University of the Health Sciences, Bethesda, MD; Gastroenterology, University of Michigan, Ann Arbor, MI; Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD and Gastroenterology, Oregon Health Sciences University, Portland, OR. Purpose: Removal of adenomatous polyps has been shown to prevent the development of colorectal cancer in up to 90% of patients. Current guidelines recommend that colorectal cancer screening begin at age 50 in average risk individuals. However, recent studies indicate that the prevalence of advanced and non–advanced adenomas may be less in women compared to men and it has been suggested that women may develop colorectal cancer and adenomas later than men. The appropriate age for initiation of colorectal cancer screening in women has yet to be determined. Methods: Colonoscopy was offered to all asymptomatic women referred for colorectal cancer screening. Exclusion criteria included iron deficiency anemia, positive stool guiaics, barium enema or colonoscopy within the last 10 years, flexible sigmoidoscopy within the last 5 years, or hematochezia within the last year. Colonoscopy findings for women age 50 –59 were compared to those in women age 60 – 69. Results: 695/1328 consecutive women undergoing colonoscopy for colorectal cancer screening were 50 –59 at the time of colonoscopy and 393/ 1328 were 60 – 69. In women 50 –59, 17.6% (122/695) had adenomas and 3.9% (27/695) had advanced adenomas. In women 60 – 69, the prevalence of an adenoma and an advanced adenoma was 20.6% (81/393) and 4.8% (19/393), respectively. 59.3% (16/27) of women 50 –59 with advanced adenomas had these lesions proximal to the splenic flexure without any adenomas distal to the splenic flexure compared to 52.6% (10/19) of women 60 – 69. 94.7% (18/19) of women 50 –59 with advanced adenomas proximal to the descending–sigmoid colon junction did not have any adenomas distal to the descending–sigmoid colon junction compared to 92.3% (12/13) of women 60 – 69.
AJG – Vol. 97, No. 9, Suppl., 2002
Conclusions: The prevalence of adenomas and advanced adenomas in women is less than general population estimates. There appear to be no significant differences in the prevalence or distribution of adenomas in women 50 –59 compared to women 60 – 69. There is no evidence that initiation of screening at age 60 in asymptomatic, average risk women would be more effective than current recommendations. Colonoscopy is superior to sigmoidoscopy for the identification of proximal adenomas in women and most women with advanced proximal adenomas do not have distal adenomas.
335 HYDROGEN BREATH TEST (HBT) WITH & WITHOUT FIBER SUPPLEMENTATION TO EVALUATE THE ADEQUACY OF PREPARATION FOR COLONOSCOPY Douglas F. Meyer, M.D., Daniel S. Mishkin, M.D., Jared Gold, M.D., Aaron Z. Tokayer, M.D., Lawrence J. Brandt, M.D.*, Allen Ahdoot, M.D. and Joel Kertznus, M.D. Gastroenterology, Montefiore Medical Center, Bronx, NY. Purpose: This study uses gas chromatography to see if 1) the difference between baseline (bHBT) & pre– colonoscopy HBT (⌬HBT) reliably measures the adequacy of preparation; 2) use of Fibercon, a fermentable carbohydrate, increases ⌬HBT; and 3) clinical parameters that predict the adequacy of preparation. Methods: Over 5 mos, 159 pts completed a questionnaire before colonoscopy. Clinical parameters included if NPO that day & whether fiber was consumed daily. After bHBT, half the pts were randomly given Fibercon 1250 mg the morning before colonoscopy. The day of colonoscopy, other clinical parameters were evaluated including understanding of instructions for the colonic preparation & self–assessment of the completeness of the bowel preparation. Repeat HBT was performed. After colonoscopy, the adequacy of bowel preparation was rated on a scale of 1 to 5, 1 & 5 being the best and worst of preparations respectively. Results were analyzed using chi–square & student t–tests. Results: 159 pts (104 females, 55 males) were evaluated by HBT for a baseline score. Daily fiber consumption & diet did not produce a signif diff in bHBT scores. Females & males had a mean bHBT score of 12.67 ppm and 8.53 ppm (p⫽.01) respectively. 61 pts (38 females, 23 males) had colonoscopy. 72% had an optimal preparation (score of 1–2) while 28% had a suboptimal preparation (score of 3–5). There were no signif diffs in ¨ HBT in those with an optimal preparation vs suboptimal preparation. An A optimal preparation was seen in 61% of pts ⬍65 yrs & in 86% of pts ⬎65 yrs (p⫽.03). All patients using Fleet Phosphosoda or Visicol had a score of 1–2, compared with 76% of pts using Golytely (p⫽.02). 91% of the pts who had fiber supplementation before colonic preparation had a score of 1–2 in contrast to 52% of pts who did not have fiber supplementation (P⬍.001). Clinical parameters, percentage of the preparation taken, whether oral or written instructions were given by the physician, baseline stool consistency & frequency did not have a significant effect on the adequacy of the colonic preparation. Conclusions: While ⌬HBT was shown not to be an effective means to predict the adequacy of colonic preparation, age⬎ 65 yrs, use of non– Golytely preparations, and ingestion of fiber supplementation prior to colonic preparation were effective predictors.
336 ASSOCIATION OF COLONIC POLYPS AND DIVERTICULOSIS Nejat Kiyici, M.D., Tanaya Nayak, M.D., Edward Norkus, M.D. and Hilary Hertan, M.D.*. Division of Gastroenterology and Clinical Nutrition, Our Lady of Mercy Medical Center, Bronx, NY. Purpose: To determine whether polyps are detected with a higher frequency in patients with diverticulosis. Methods: In this retrospective study, results of 1000 colonoscopies performed in 2001 were evaluated.Patient demographics, indications and