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Comparison Between High-Resolution Colonoscopy with and Without Chromoendoscopy and Histological Findings in Diminutive Lesions of Rectosigmoid
*W1655 Comparison Between High-Resolution Colonoscopy with and Without Chromoendoscopy and Histological Findings in Diminutive Lesions of Rectosigmoid Darius Apel, Ralf Jakobs, Dieter Schilling, Uwe Weickert, Jochen Teichmann, Juergen F. Riemann Background: The ability to accurately differentiate adenomatous (AP) from nonadenomatous colonic polyps (non-AP) with the use of chromoendoscopy would obviate the need to remove all diminutive hyperplastic lesions (HP). The aim of the study was to define the accuracy of high-resolution chromoendoscopy for the determination of diminutive colonic polyp histology. Methods: In 112 patients refered for routine colonoscopy 193 polyps in the rectosigmoid and <5 mm in size were estimated for their histology. The endoscopists predicted the histopathology of each lesion based on its surface characteristics in two steps: using high-resolution colonoscopic technique without any staining and after dyeing with indigo carmine (ICD) according to the Kudo classification. Results: The resected polyps were comprised by 34 AP and 159 non-AP. When comparing histologically confirmed HPs to APs, prediction of HP based on endoscopic findings had a sensitivity of 92%, a specificity of 62%, a positive predictive value (PPV) of 91%, a negative predictive value (NPV) of 64%, and an overall accuracy of 79% (table 1). The corresponding sensitivity, specificity, PPV, NPV, and overall accuracy of prediction the histological diagnosis after ICD were 92%, 62%, 91%, 64%, and 80% respectively. Discussion: It is beyond doubt that the ICD enables the demarcation of flat and depressed lesions from normal colon mucosa. But our results suggest that the staining with ICD improves only marginally the determination between HP and AP using the high-resolution colonoscopes. The overall accuracy rate increased after dyeing from 79% to 80%. It confirms a great role of the high-resolution chromoendoscopy in distinguishing these two polyps types without any additional dyeing. The complete renunciation of histopathologic analysis cannot yet be achieved by chromoendoscopy.
*W1657 Disparities in the Risk of Cancer of the Colon and Rectum Remaining Unstaged After Diagnosis James C. Hobley, Eugene Lengerich Background: Survival from cancer of the colon and rectum is significantly affected by the stage at which it is diagnosed; however, a substantial number of patients remain unstaged after diagnosis. In central cancer registry data, African Americans and rural residents are more likely than Caucasians and urban residents, respectively, to be unstaged at the time of diagnosis. Aim: To estimate the excess risk of unstaged cancer of the colon and rectum among African Americans in a large rural region of the U.S. Methods: Data from central cancer registries (1994-98), health care providers, and the U.S. Census in a three-state region that included a large rural geographic area were analyzed using unadjusted and adjusted hierarchical, logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with SAS software version 8. Results: From 1994-98, 2792 cases of colon and 1519 cases of rectal cancer were unstaged, 6.2 and 9.0 percent of all cases, respectively. Unstaged colon cancer was 1.28 (95% CI 1.11-1.35) and unstaged rectum cancer was 1.01 (0.91-1.14) times more likely in the rural areas than in the nonrural areas. For both colon and rectal cancer, African Americans from rural areas were more likely than Caucasians to have unstaged colon cancer (African Americans, OR=1.49; Caucasians OR=1.28) and rectum cancer (African Americans, OR=1.32; Caucasians OR=1.04). Significant interaction was found for rurality and race, as well as rurality and poverty. Conclusions: After controlling for health care access and demographic variables, these data suggest that persons from rural areas are significantly more likely to have colon and rectum cancer remain unstaged, and in these rural regions, African Americans are even more likely to remain unstaged than are Caucasians. Factors that may contribute to these disparities include patient preference for treatment, provider recommendations about treatment, and unmeasured patient psychosocial issues. The significance of these factors and the overall effect of unstaged disease on health disparities in cancer of the colon and rectum may warrant further investigation.
*W1656 Retrospective Analysis of Patients Diagnosed with Colorectal Cancer Above the Age of 75 by Colonoscopy Suneetha Duttala, Omar Al-Subee, Murray Ehrinpreis Introduction: Colon cancer is the third most common cancer in the United States with a higher incidence in the older patient population. Since studies on colonoscopy in the elderly are few, we felt It would be valuable to understand the therapeutic consequences following the detection of malignancy by colonoscopy in patients above 75 years of age, and whether age is a limiting factor in providing curative treatment for colorectal cancer. Such information could influence the threshold for utilizing colonoscopy in this subset of patients. Aim: to examine the presentation and management of colorectal cancer in the elderly at a an academic tertiary care center. Methods: We reviewed 115 charts of patients who presented between 1999 and 2002 and were diagnosed with adenocarcinoma of the colon or rectum above the age of 75. Data was available on 91 patients for analysis. The indication for colonoscopy, co-morbidities, cancer location, and stage (by Dukes classification) and treatment plan were recorded. Results: The average age of patients was 81 years old with a range between 75 and 94. Anemia (HB <13 in males, and <11.3 in females) was the most common indication for colonoscopy found in 76% of the patients, though only half of these patients had typical microcytic anemia. Lower overt or occult GI bleed was present in 49% of patients while change of bowel habits was reported in only 34%. Colonoscopy was done for screening purposes in 4%. No major procedure-related complications were observed. The right colon (beyond the splenic flexure) was involved in 52% of the cases. Interestingly, majority of patients (96%) were offered treatment with surgery and/or chemotherapy/radiation therapy. Surgery was performed in 91% of the cases with the intention for cure in most of the cases. Only 4 patients refused surgery. Advanced local or metastatic disease (stage C or D) was detected in more than half of the patients. Conclusions: A review of the current practice in our institution shows that the majority of patients above age of 75 who are diagnosed with colon caner are being offered surgical and other forms of treatment. This may encourage the performance of more diagnostic colonoscopies in the older patient population for various GI symptoms. However, such an approach needs to be examined carefully for issues related to cost-effectiveness and achievement of measurable benefit in morbidity and mortality before being widely adopted.
P280
GASTROINTESTINAL ENDOSCOPY
*W1658 Risk of Post-Colon Polypectomy Bleeding, Including Aspirin Intake with Discontinuation Period of Two Weeks. Shigeki Oka, Morio Takahashi, Hiroki Ichimura, Masafumi Kiumi, Hironobu Takada, Hajime Kuwayama Aspirin is known to increase the risk of post-colon polypectomy bleeding. How long aspirin administration should be discontinued before and after polypectomy is not clearly demonstrated. We evaluated if the period of time is justified: two weeks discontinuation, a week before and a week after polypectomy. We also evaluated other risks of bleeding, using multivariate analysis. Methods: From August, 1994 to August, 2003, we consecutively performed 3124 polypectomies (1306 cases). We evaluated the risks of post-polypectomy bleeding retrospectively, using multivariate analysis. Results: Thirty bleedings (29 cases) occurred after the polypectomies (0.98%). As for methods of polypectomy, hot biopsy (odds = 0.16, p = 0.00139) resulted in lower risk of bleeding, as compared with polypectomy using snair and EMR (odds = 3.861, p = 0.0087). As for sizes of the polyps, the bigger revealed the more risk (odds = 1.088, p = 0.0002). As for pathology, malignancy revealed more risk (odds = 2.103, p < 0.0001). Factor analysis revealed that these three categories are regarded as a single factor, which is interpreted as ‘‘a size factor’’. Aspirin administration did not change the risk of bleeding as long as it is discontinued for two weeks (2/286 = 0.84% vs. 28/2886 = 0.97%, p = 0.844). Age, gender, location, and polyp type did not reveal significant difference of risk. Conclusion: Polypectomy of the larger size polyps revealed the higher risk of post-polypectomy beleeding. Aspirin intake did not change the risk of bleeding as long as it is discontinued for two weeks, one week before and after polypectomy.
VOLUME 59, NO. 5, 2004
*W1657 Disparities in the Risk of Cancer of the Colon and Rectum Remaining Unstaged After Diagnosis James C. Hobley, Eugene Lengerich Background: Survival from cancer of the colon and rectum is significantly affected by the stage at which it is diagnosed; however, a substantial number of patients remain unstaged after diagnosis. In central cancer registry data, African Americans and rural residents are more likely than Caucasians and urban residents, respectively, to be unstaged at the time of diagnosis. Aim: To estimate the excess risk of unstaged cancer of the colon and rectum among African Americans in a large rural region of the U.S. Methods: Data from central cancer registries (1994-98), health care providers, and the U.S. Census in a three-state region that included a large rural geographic area were analyzed using unadjusted and adjusted hierarchical, logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with SAS software version 8. Results: From 1994-98, 2792 cases of colon and 1519 cases of rectal cancer were unstaged, 6.2 and 9.0 percent of all cases, respectively. Unstaged colon cancer was 1.28 (95% CI 1.11-1.35) and unstaged rectum cancer was 1.01 (0.91-1.14) times more likely in the rural areas than in the nonrural areas. For both colon and rectal cancer, African Americans from rural areas were more likely than Caucasians to have unstaged colon cancer (African Americans, OR=1.49; Caucasians OR=1.28) and rectum cancer (African Americans, OR=1.32; Caucasians OR=1.04). Significant interaction was found for rurality and race, as well as rurality and poverty. Conclusions: After controlling for health care access and demographic variables, these data suggest that persons from rural areas are significantly more likely to have colon and rectum cancer remain unstaged, and in these rural regions, African Americans are even more likely to remain unstaged than are Caucasians. Factors that may contribute to these disparities include patient preference for treatment, provider recommendations about treatment, and unmeasured patient psychosocial issues. The significance of these factors and the overall effect of unstaged disease on health disparities in cancer of the colon and rectum may warrant further investigation.
*W1656 Retrospective Analysis of Patients Diagnosed with Colorectal Cancer Above the Age of 75 by Colonoscopy Suneetha Duttala, Omar Al-Subee, Murray Ehrinpreis Introduction: Colon cancer is the third most common cancer in the United States with a higher incidence in the older patient population. Since studies on colonoscopy in the elderly are few, we felt It would be valuable to understand the therapeutic consequences following the detection of malignancy by colonoscopy in patients above 75 years of age, and whether age is a limiting factor in providing curative treatment for colorectal cancer. Such information could influence the threshold for utilizing colonoscopy in this subset of patients. Aim: to examine the presentation and management of colorectal cancer in the elderly at a an academic tertiary care center. Methods: We reviewed 115 charts of patients who presented between 1999 and 2002 and were diagnosed with adenocarcinoma of the colon or rectum above the age of 75. Data was available on 91 patients for analysis. The indication for colonoscopy, co-morbidities, cancer location, and stage (by Dukes classification) and treatment plan were recorded. Results: The average age of patients was 81 years old with a range between 75 and 94. Anemia (HB <13 in males, and <11.3 in females) was the most common indication for colonoscopy found in 76% of the patients, though only half of these patients had typical microcytic anemia. Lower overt or occult GI bleed was present in 49% of patients while change of bowel habits was reported in only 34%. Colonoscopy was done for screening purposes in 4%. No major procedure-related complications were observed. The right colon (beyond the splenic flexure) was involved in 52% of the cases. Interestingly, majority of patients (96%) were offered treatment with surgery and/or chemotherapy/radiation therapy. Surgery was performed in 91% of the cases with the intention for cure in most of the cases. Only 4 patients refused surgery. Advanced local or metastatic disease (stage C or D) was detected in more than half of the patients. Conclusions: A review of the current practice in our institution shows that the majority of patients above age of 75 who are diagnosed with colon caner are being offered surgical and other forms of treatment. This may encourage the performance of more diagnostic colonoscopies in the older patient population for various GI symptoms. However, such an approach needs to be examined carefully for issues related to cost-effectiveness and achievement of measurable benefit in morbidity and mortality before being widely adopted.
P280
GASTROINTESTINAL ENDOSCOPY
*W1658 Risk of Post-Colon Polypectomy Bleeding, Including Aspirin Intake with Discontinuation Period of Two Weeks. Shigeki Oka, Morio Takahashi, Hiroki Ichimura, Masafumi Kiumi, Hironobu Takada, Hajime Kuwayama Aspirin is known to increase the risk of post-colon polypectomy bleeding. How long aspirin administration should be discontinued before and after polypectomy is not clearly demonstrated. We evaluated if the period of time is justified: two weeks discontinuation, a week before and a week after polypectomy. We also evaluated other risks of bleeding, using multivariate analysis. Methods: From August, 1994 to August, 2003, we consecutively performed 3124 polypectomies (1306 cases). We evaluated the risks of post-polypectomy bleeding retrospectively, using multivariate analysis. Results: Thirty bleedings (29 cases) occurred after the polypectomies (0.98%). As for methods of polypectomy, hot biopsy (odds = 0.16, p = 0.00139) resulted in lower risk of bleeding, as compared with polypectomy using snair and EMR (odds = 3.861, p = 0.0087). As for sizes of the polyps, the bigger revealed the more risk (odds = 1.088, p = 0.0002). As for pathology, malignancy revealed more risk (odds = 2.103, p < 0.0001). Factor analysis revealed that these three categories are regarded as a single factor, which is interpreted as ‘‘a size factor’’. Aspirin administration did not change the risk of bleeding as long as it is discontinued for two weeks (2/286 = 0.84% vs. 28/2886 = 0.97%, p = 0.844). Age, gender, location, and polyp type did not reveal significant difference of risk. Conclusion: Polypectomy of the larger size polyps revealed the higher risk of post-polypectomy beleeding. Aspirin intake did not change the risk of bleeding as long as it is discontinued for two weeks, one week before and after polypectomy.
VOLUME 59, NO. 5, 2004