- Email: [email protected]
Colonoscopy in the elderly: when to stop?
S168
Sn Sp PPV NPV Accuracy
Abstracts
AJG – Vol. 96, No. 9, Suppl., 2001
WLE
WLE ⴙ LIFE
80% 69% 59% 87% 71%
95% 80% 71% 97% 85%
526 Treatment of anorectal condyloma acuminata with argon plasma coagulator-first reported case Asheesh Sood, MD1 and Christine Frissora, MD1*. 1Division of Gastroenterology and Hepatology, Cornell University Medical College and New York Presbyterian Hospital, New York, NY USA. Purpose: Laser(Nd:YAG) coagulation is currently considered as an effective alternative in the treatment for urogenital condylomata, but there are no published case reports of Argon Plasma Coagulator (APC) use for anorectal condylomata. Methods: A 38 year old male with Human Immunodeficiency Virus (HIV) infection presented with several months history of rectal bleeding and pain. Physical Examination and flexible sigmoidoscopy revealed perianal and rectal warts. Biopsy of rectal lesions was consistent with condyloma acuminatum. Argon plasma coagulation of the rectal condylomata was done under intravenous conscious sedation. APC machine was set at 40 Watts and flow rate of 0.8 liters/minute. Smoke evacuation system was used during the procedure to minimize airborne spread of the papilloma virus. Patient was followed up and his symptoms were assessed. Repeat flexible sigmoidoscopy was also done after four months. Results: The procedure was well tolerated. He reported significantly decreased rectal pain during defecation and bleeding, beginning one week after the treatment. Repeat flexible sigmoidoscopy done after four months showed markedly decreased rectal condylomata. Repeat Argon Plasma Coagulation was done at that time for the residual lesions. Conclusions: This is the first reported case of Argon Plasma Coagulator use for treating rectal condylomata. Our patient had symptomatic and endoscopic improvement after APC treatment. Anorectal condylomata due to papilloma virus is a known risk factor for anal carcinoma. Therefore, it appears that eradication of warts should be the treatment goal. Precautions to prevent airborne spread of the human papilloma virus during the procedure should always be taken during the procedure. Larger series of patients need to be studied to further assess the efficacy of APC for rectal condylomata.
527 Colonoscopy in the elderly: when to stop? Tyler Stevens1 and Carol A Burke, M.D., FACG1*. 1The Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, OH, United States. Purpose: Recommendations of the age to begin colorectal cancer (CRCA) screening are based upon the risk of neoplasia. The age to stop colorectal cancer (CRCA) screening should in part be based on the same principle. The purpose of this study was to analyze the association between age and gender on the prevalence of neoplasia detected by colonoscopy. To identify if there is an age at which the prevalence of neoplasia is low enough to recommend ceasing colonoscopy. Methods: Records of all colonoscopies performed between 1997–2000 at the Cleveland Clinic Foundation for CRCA screening in asymptomatic subjects, or in symptomatic subjects with abdominal pain, and change in bowel habits were reviewed. Chi-square or Fisher’s exact test were used to analyze the effect of age (by 10 year decrements) and gender on the prevalence of neoplasia, including ⱖ3 adenomas, adenomas of advanced pathology (AAP);tubulovillous, villous, severe dysplasia, or size ⱖ1cm, and invasive cancers (CRCA).
Results: 981 colonoscopies (51% male) were included. 359 pts were 50 – 60 yrs, 271 pts 61–70 yrs, 298 pts 71– 80 yrs and 53 pts 81–100 yrs. 52% of exams were performed for screening and 48% for symptoms. There was a marginal association between age and neoplasia (p ⫽ 0.053) that was most significant among the 2 lower age groups (p ⫽ 0.010). CRCA was detected in 4 subjects;1 (0.28%) in 50 – 60 yrs group, 1 (0.33%) in 71– 80 yrs, and 2 (3.7%) in the 81–100 yrs group. The latter 3 subjects were all symptomatic. Increasing age was associated with CRCA (p ⫽ 0.016) but not AAP (p ⫽ 0.51) or ⱖ3 polyps (p ⫽ 0.53). Men had an increased prevalence of neoplasia (p ⫽ 0.045) and multiple polyps (p ⫽ 0.011) but no difference in AAP or CRCA versus women. Conclusions: The prevalence of neoplasia peaked in the 7th decade and declined thereafter but not significantly. An age related increase in CRCA was seen after the 7th decade but all cancers in subjects ⬎ age 60 were symptomatic. Neither age nor gender should be a factor in ceasing colonoscopy. The effect of indication for exam on the yield of neoplasia should be analyzed to determine if there is an age to stop screening colonoscopy in the asymptomatic elderly.
528 Serrated adenomas of the colon and their K-ras codon 12 mutation Satoru Tamura1*, Yoshifumi Higashidani1, Tomoko Morita1, Takehisa Tadokoro1, Yuichi Yokoyama1 and Saburo Onishi1. 1First department of Internal medicine, Kochi Medical School, Nankoku, Kochi, Japan. Purpose: The serrated adenoma(SA) is still a relatively new pathological concept. The origin and developmental process of SA are also obscure, and the importances of genetic alteralations have not been elucidated clearly for SA. Some SAs contain admixed hyperplastic glands, and a few SAs contain admixed carcinoma glands. The possibility that the developmental process and genetic alteralations of SAs could differ from those of ordinary tubular adenomas was explored in this work. We therefore set a value on the K-ras mutations of SA relative to the gross configurations, locations and sizes of lesions. Methods: We obtained SAs by endoscopic resection (n ⫽ 57). 䊐@䊐@According to the gross configuration, SAs were divided into two groups as: 1) flat (n ⫽ 10), when the lesions were a laterally spreading type with a smooth surface, and 2) rough (n ⫽ 47), when the lesions presented a protruded type of tumor or nodular aggregating type laterally spreading tumor. Here, we defined a laterally spreading tumor as the lesion lacking an exophytic polypoid configuration and consisting of a slightly elevated component which creeped along surface of the colonic mucosa. DNA preparation and K-ras codon 12 mutation analysis: Mutation of the K-ras gene was analyzed by Enriched PCR-ELMA (SMITEC K-ras codon 12 genotype; Sumitomo Metal, Tokyo, Japan), which can detect not only the presence of a mutation but also the mutation type of K-ras codon 12 with high sensitivity. Results: SAs located in rectum were more likely to have a K-ras mutation than SAs located in the sigmoid and more proximal colon (75% versus 31%, odds ratio ⫽ 6.6429, p ⫽ 0.0087). Flat-type SAs of were less likely to have a K-ras mutation than rough-type SAs (10% versus 46.8%, odds ratio ⫽ 7.92, p ⫽ 0.038). There was no significant relationship between the mutation rate and tumor size or histological grading. Conclusions: Our study shows that the development of rough type SAs may depend upon the mutation of the K-ras codon 12 gene, but flat type SAs may not. Additionally, SAs that occur in the rectum are closely related to the mutation of the K-ras codon 12 gene.
529 Circadian variation of topoisomerase II-alpha in human rectal crypt epithelium Kathryn A Tessnow1, John C Fang1, Joseph A Holden2, John G Moore2 and Frederic C Clayton2*. 1Gastroenterology, University of Utah, Salt Lake City, Utah, United States; and 2Pathology, Salt Lake City Veteran’s Affairs Health Care Center, Salt Lake City, Utah, United States.
Sn Sp PPV NPV Accuracy
Abstracts
AJG – Vol. 96, No. 9, Suppl., 2001
WLE
WLE ⴙ LIFE
80% 69% 59% 87% 71%
95% 80% 71% 97% 85%
526 Treatment of anorectal condyloma acuminata with argon plasma coagulator-first reported case Asheesh Sood, MD1 and Christine Frissora, MD1*. 1Division of Gastroenterology and Hepatology, Cornell University Medical College and New York Presbyterian Hospital, New York, NY USA. Purpose: Laser(Nd:YAG) coagulation is currently considered as an effective alternative in the treatment for urogenital condylomata, but there are no published case reports of Argon Plasma Coagulator (APC) use for anorectal condylomata. Methods: A 38 year old male with Human Immunodeficiency Virus (HIV) infection presented with several months history of rectal bleeding and pain. Physical Examination and flexible sigmoidoscopy revealed perianal and rectal warts. Biopsy of rectal lesions was consistent with condyloma acuminatum. Argon plasma coagulation of the rectal condylomata was done under intravenous conscious sedation. APC machine was set at 40 Watts and flow rate of 0.8 liters/minute. Smoke evacuation system was used during the procedure to minimize airborne spread of the papilloma virus. Patient was followed up and his symptoms were assessed. Repeat flexible sigmoidoscopy was also done after four months. Results: The procedure was well tolerated. He reported significantly decreased rectal pain during defecation and bleeding, beginning one week after the treatment. Repeat flexible sigmoidoscopy done after four months showed markedly decreased rectal condylomata. Repeat Argon Plasma Coagulation was done at that time for the residual lesions. Conclusions: This is the first reported case of Argon Plasma Coagulator use for treating rectal condylomata. Our patient had symptomatic and endoscopic improvement after APC treatment. Anorectal condylomata due to papilloma virus is a known risk factor for anal carcinoma. Therefore, it appears that eradication of warts should be the treatment goal. Precautions to prevent airborne spread of the human papilloma virus during the procedure should always be taken during the procedure. Larger series of patients need to be studied to further assess the efficacy of APC for rectal condylomata.
527 Colonoscopy in the elderly: when to stop? Tyler Stevens1 and Carol A Burke, M.D., FACG1*. 1The Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, OH, United States. Purpose: Recommendations of the age to begin colorectal cancer (CRCA) screening are based upon the risk of neoplasia. The age to stop colorectal cancer (CRCA) screening should in part be based on the same principle. The purpose of this study was to analyze the association between age and gender on the prevalence of neoplasia detected by colonoscopy. To identify if there is an age at which the prevalence of neoplasia is low enough to recommend ceasing colonoscopy. Methods: Records of all colonoscopies performed between 1997–2000 at the Cleveland Clinic Foundation for CRCA screening in asymptomatic subjects, or in symptomatic subjects with abdominal pain, and change in bowel habits were reviewed. Chi-square or Fisher’s exact test were used to analyze the effect of age (by 10 year decrements) and gender on the prevalence of neoplasia, including ⱖ3 adenomas, adenomas of advanced pathology (AAP);tubulovillous, villous, severe dysplasia, or size ⱖ1cm, and invasive cancers (CRCA).
Results: 981 colonoscopies (51% male) were included. 359 pts were 50 – 60 yrs, 271 pts 61–70 yrs, 298 pts 71– 80 yrs and 53 pts 81–100 yrs. 52% of exams were performed for screening and 48% for symptoms. There was a marginal association between age and neoplasia (p ⫽ 0.053) that was most significant among the 2 lower age groups (p ⫽ 0.010). CRCA was detected in 4 subjects;1 (0.28%) in 50 – 60 yrs group, 1 (0.33%) in 71– 80 yrs, and 2 (3.7%) in the 81–100 yrs group. The latter 3 subjects were all symptomatic. Increasing age was associated with CRCA (p ⫽ 0.016) but not AAP (p ⫽ 0.51) or ⱖ3 polyps (p ⫽ 0.53). Men had an increased prevalence of neoplasia (p ⫽ 0.045) and multiple polyps (p ⫽ 0.011) but no difference in AAP or CRCA versus women. Conclusions: The prevalence of neoplasia peaked in the 7th decade and declined thereafter but not significantly. An age related increase in CRCA was seen after the 7th decade but all cancers in subjects ⬎ age 60 were symptomatic. Neither age nor gender should be a factor in ceasing colonoscopy. The effect of indication for exam on the yield of neoplasia should be analyzed to determine if there is an age to stop screening colonoscopy in the asymptomatic elderly.
528 Serrated adenomas of the colon and their K-ras codon 12 mutation Satoru Tamura1*, Yoshifumi Higashidani1, Tomoko Morita1, Takehisa Tadokoro1, Yuichi Yokoyama1 and Saburo Onishi1. 1First department of Internal medicine, Kochi Medical School, Nankoku, Kochi, Japan. Purpose: The serrated adenoma(SA) is still a relatively new pathological concept. The origin and developmental process of SA are also obscure, and the importances of genetic alteralations have not been elucidated clearly for SA. Some SAs contain admixed hyperplastic glands, and a few SAs contain admixed carcinoma glands. The possibility that the developmental process and genetic alteralations of SAs could differ from those of ordinary tubular adenomas was explored in this work. We therefore set a value on the K-ras mutations of SA relative to the gross configurations, locations and sizes of lesions. Methods: We obtained SAs by endoscopic resection (n ⫽ 57). 䊐@䊐@According to the gross configuration, SAs were divided into two groups as: 1) flat (n ⫽ 10), when the lesions were a laterally spreading type with a smooth surface, and 2) rough (n ⫽ 47), when the lesions presented a protruded type of tumor or nodular aggregating type laterally spreading tumor. Here, we defined a laterally spreading tumor as the lesion lacking an exophytic polypoid configuration and consisting of a slightly elevated component which creeped along surface of the colonic mucosa. DNA preparation and K-ras codon 12 mutation analysis: Mutation of the K-ras gene was analyzed by Enriched PCR-ELMA (SMITEC K-ras codon 12 genotype; Sumitomo Metal, Tokyo, Japan), which can detect not only the presence of a mutation but also the mutation type of K-ras codon 12 with high sensitivity. Results: SAs located in rectum were more likely to have a K-ras mutation than SAs located in the sigmoid and more proximal colon (75% versus 31%, odds ratio ⫽ 6.6429, p ⫽ 0.0087). Flat-type SAs of were less likely to have a K-ras mutation than rough-type SAs (10% versus 46.8%, odds ratio ⫽ 7.92, p ⫽ 0.038). There was no significant relationship between the mutation rate and tumor size or histological grading. Conclusions: Our study shows that the development of rough type SAs may depend upon the mutation of the K-ras codon 12 gene, but flat type SAs may not. Additionally, SAs that occur in the rectum are closely related to the mutation of the K-ras codon 12 gene.
529 Circadian variation of topoisomerase II-alpha in human rectal crypt epithelium Kathryn A Tessnow1, John C Fang1, Joseph A Holden2, John G Moore2 and Frederic C Clayton2*. 1Gastroenterology, University of Utah, Salt Lake City, Utah, United States; and 2Pathology, Salt Lake City Veteran’s Affairs Health Care Center, Salt Lake City, Utah, United States.