- Email: [email protected]
Factors Predicting Uncomfortable Colonoscopy: Pre-Procedure Selection Criteria for Sedation
Abstracts
T1383 Factors Predicting Uncomfortable Colonoscopy: Pre-Procedure Selection Criteria for Sedation Sheila L. Eswaran, Douglas a. Howell, Michael K. Sanders, Burr J. Loew, Kirk P. Bernadino, Asif Ansari, Christopher Lawrence, Janice M. Campana
T1385 Correlation Between Detection of Adenomas and Non-Adenomas: An Argument for Real Time Differentiation of Non-Adenomatous Colonic Polyps Shawn C. Chen, Douglas K. Rex
Background: Sedation, and more recently anesthesia in the form of propofol, is given at colonoscopy for the relief of anxiety and pain. Painless colonoscopy can be achieved without sedation in many patients (pts) with a positive impact on complications, unit efficiency and costs (GIE 2005; 61:89 AB). Predicting the need for sedation to plan for selective propofol use would greatly improve the overall colonoscopy experience especially if anesthesia services are mandated. Methods: Collected data of 200 pts (M Z 101, F Z 99; ages 20 - 90) who underwent colonoscopy between 09/04 - 03/05, using new magnetic localization (Olympus America) was retrospectively analyzed. In this study, all pts were offered to begin without sedation (SED) and 72 pts accepted. 67/72 (93%) received no SED throughout the procedure (Group A). 128 pts received pre-insertion medication with midazolam and fentanyl to achieve ASA Class I SED and 100/128 (78%) experienced little or no pain and required no additional SED (Group B). Five of the 72 (7%) pts beginning without SED were medicated due to pain, while 28 of the 128 pts (22%) pre-medicated pts required additional SED to achieve a deeper level (ASA Classes II or III). Overall, 33/200 (17%) required additional SED (Group C). No pt in this study received propofol. Results: Pts with anxiety (OR 4.52), depression (OR 4.39), a history of abdominal surgery (OR 4.27), female gender (OR 3.38), BMI ! 25 (OR 2.92) and those reporting a change in bowel habits (OR 2.30) were independently more likely (p ! 0.05) to be in Group C requiring a deeper level of SED than pts without these characteristics. Moreover, when analyzed retrospectively by a multivariable model, the presence of 2 or more of these factors identified 29/33 patients in Group C (p ! 0.001; sensitivity 88%). By using these selection criteria, only 96/200 (48%) of the total would have been identified for consideration of propofol use. Conclusions: In a consecutive series of 200 patients undergoing magnetic localization colonoscopy beginning with either no or ASA Class I sedation, only 17% of patients required initiation of medication or additional sedation. Retrospective analysis of multiple factors identified 88% of these patients. Selecting appropriate candidates for sedation/anesthesia would improve outcomes by limiting medication effects and reducing costs when administration by anesthesia personnel is mandated. Prospective validation of these selection criteria may improve specificity and is planned.
Background and aim: Recent studies have demonstrated variable detection of adenomatous polyps by endoscopists. It is a general practice that endoscopists typically remove all encountered polyps. However, the percentages of nonadenomas or non-cancerous polyps in those removed polyps are not known. In the United States, real time methods to differentiate adenomas from non-adenomas (e.g. chromoendoscopy and magnification) are seldom used. In this study, we evaluated whether superior detection of adenomas by individual endoscopists is associated with higher detection of non-adenomas. Methods and Statistical Analysis: Consecutive colonoscopy reports by nine attending gastroenterologists at Indiana University Hospital between January 1999 and January 2004 were obtained. Patients with indications of inflammatory bowel disease or who were referred for polypectomy were excluded. Adenomas included tubular adenomas, tubulovillous, villous adenomas, and serrated adenomas. Logistic regression was performed for comparison of the percentages of colonoscopies with at least one adenoma and with at least one non-adenoma/non-carcinoma. Pearson correlations were used to evaluate the relationship between the number of adenomas per colonoscopy and the number of non-adenomas/non-carcinomas per colonoscopy. Results: There were 10,034 included colonoscopies. The range of detecting R1 adenoma between the endoscopists for the entire cohort was 14.5 - 35.6% and for patients R50 years of age was 15.5 - 41.1%. The range of finding R1 non-adenoma/non-carcinoma between the endoscopists for the entire cohort was 11.8 - 35.3% and for patients R50 years of age was 12.9 - 37.5%. The correlation between the adjusted values for finding R1 adenoma and R1 non-adenoma/non-carcinoma for the entire cohort was 0.72. The range for the mean number of adenomas detected per colonoscopy between the endoscopists for the entire cohort was 0.20 - 0.72 and for patients R50 years of age was 0.21 - 0.86, whereas the range for the mean number of finding nonadenomas/non-carcinomas per colonoscopy between endoscopists for the entire cohort was 0.15 - 0.65 and for patients R50 years of age was 0.16 - 0.70. The correlation between the mean number of adenomas and the mean number of nonadenomas/non-carcinomas detected per colonoscopy for the entire cohort was 0.79. In persons age R50 the correlation was 0.84. Conclusion: Correlation between detection of adenomas and non-adenomas by individual endoscopists were moderately strong to strong. Highly sensitive endoscopists will benefit most by use of reliable real time methods to differentiate adenomas from nonadenomatous polyps.
T1384 Size Does Not Determine Aggressiveness of Colorectal Cancer: An Inside to Lesions of Less Than 10 mm Takahisa Matsuda, Yutaka Saito, Toshio Uraoka, Fabian Emura, Takeshi Nakajima, Hisatomo Ikehara, Yumi Mashimo, Tsuyoshi Kikuchi, Yoko Tateishi, Naoko Okabe, Yasushi Sano, Takahiro Fujii, Daizo Saito Background: Early invasive colorectal cancer (invasion limited to the sm layer) is increasing worldwide. Small lesions are suspected of having a lower malignant potential than large ones. However, pathological characteristics of small early cancers are still poorly studied. The aim of this study was to determine the clinicopathological characteristics of small (less than 10 mm) and large early lesions and their implications for endoscopic treatment. Material and Methods: A total of 583 sm cancers treated by EMR or surgery between January 1980 and December 2003 at National Cancer Center Hospital were analyzed. Lesions were classified into 3 groups based on their size: small (&10 mm), intermediate (11-20 mm) and large (S21 mm). Histological analysis was performed in all resected specimens. Results: There were 120 (21%), 272 (46%) and 191 (33%) small, intermediate and large lesions respectively. Histological analysis of small lesions revealed submucosal deep cancer (sm: S1000 mm) in 90 (75%) cases, lymphovascular invasion in 26(22%) cases and poorly differentiated component in 12 (10%) cases. Similarly, intermediate and large lesions exhibited sm deep cancer in 235 (86%) and 145 (76%) cases, lymphovascular invasion in 70 (26%) and 55 (29%) cases, and poorly differentiated component in 49 (18%) and 30 (16%) cases respectively. Moreover, the rate of lymph node metastasis was 11.2% (10/89), 13.5% (30/222) and 10.1% (16/159) in small, intermediate and large tumors respectively (N.S). EMR treatment was performed in 62 (52%) small lesions, 88(32%) intermediate and 45(24%) large lesions. Among these cases, there were no differences in the positive vertical and unknown margin rate in small (18%), intermediate (18%) and large lesions (22%). Conclusion: Small early invasive colorectal cancers demonstrate same aggressiveness and malignant potential than large lesions. Special attention must be paid when treating even small early invasive lesions. Results N lymph node metastasis sm-deep (S1000 mm) lymphovascular invasion (C) poorly component (C) positive vertical and unknown margin rate(EMR)
S10 mm
11-20 mm
S21 mm
120(21%) 11.2% 90(75%) 26(22%) 12(10%) 18%
272(46%) 13.5% 235(86%) 70(26%) 49(18%) 18%
191(33%) 10.1% 145(76%) 55(29%) 30(16%) 22%
AB210 GASTROINTESTINAL ENDOSCOPY Volume 63, No. 5 : 2006
T1386 Could Gastric Cancer Be a New Indication for Surveillance Colonoscopy?: The Kasid Prospective Multicenter Case Controlled Study Tae Woo Yoo, Dong I. Park, Hyun S. Kim, Suk K. Yang, Jeong S. Byeon, Bong M. Koh, Jin O. Kim, Ki N. Shim, Yoon T. Jeen, Bo I. Lee, Kyu Y. Choi, Hang L. Lee, Dong S. Han, Ilhyun Baek, Cheol H. Park, Seun J. Park Objectives: Could the patients with gastric cancer be a new indication for surveillance colonoscopy? The aim of this study was to determine the prevalence of colorectal neoplasm and necessity of surveillance colonoscopy in patients with gastric cancer. Methods: Total colonoscopies were performed in 11 tertiary medical centers in Korea from November 2004 to October 2005. The patient group was composed of 695 patients with gastric cancer who agreed to take colonoscopy within 6 months of gastric operation. The 1,549 consecutive, age and sex matched, average risk people without gastric polyp or cancer proven by prior gastroscopy and who taken colonoscopy prospectively within 6 months were belonged to the control group. Results: The relative risk of the patient group for all colon polyps, colorectal adenoma and cancer was 1.787 (CI 1.591-2.009, p ! 0.001), 1.937 (CI 1.674-2.242, p ! 0.001), and 2.105 (CI 1.091-4.060, p ! 0.023). However, there was no significant difference of adenoma prevalence according to pathologic type (early gastric cancer vs advanced gastric cancer), Lauren’s classification (intestinal vs diffuse type), and TNM staging within the patient group. Conclusions: The prevalence of colorectal adenoma and cancer remarkably increased in patients with gastric cancer. Therefore, the patients with gastric cancer might be a high risk group for colorectal adenoma or cancer and should be recommended to take surveillance colonoscopy.
www.giejournal.org
T1383 Factors Predicting Uncomfortable Colonoscopy: Pre-Procedure Selection Criteria for Sedation Sheila L. Eswaran, Douglas a. Howell, Michael K. Sanders, Burr J. Loew, Kirk P. Bernadino, Asif Ansari, Christopher Lawrence, Janice M. Campana
T1385 Correlation Between Detection of Adenomas and Non-Adenomas: An Argument for Real Time Differentiation of Non-Adenomatous Colonic Polyps Shawn C. Chen, Douglas K. Rex
Background: Sedation, and more recently anesthesia in the form of propofol, is given at colonoscopy for the relief of anxiety and pain. Painless colonoscopy can be achieved without sedation in many patients (pts) with a positive impact on complications, unit efficiency and costs (GIE 2005; 61:89 AB). Predicting the need for sedation to plan for selective propofol use would greatly improve the overall colonoscopy experience especially if anesthesia services are mandated. Methods: Collected data of 200 pts (M Z 101, F Z 99; ages 20 - 90) who underwent colonoscopy between 09/04 - 03/05, using new magnetic localization (Olympus America) was retrospectively analyzed. In this study, all pts were offered to begin without sedation (SED) and 72 pts accepted. 67/72 (93%) received no SED throughout the procedure (Group A). 128 pts received pre-insertion medication with midazolam and fentanyl to achieve ASA Class I SED and 100/128 (78%) experienced little or no pain and required no additional SED (Group B). Five of the 72 (7%) pts beginning without SED were medicated due to pain, while 28 of the 128 pts (22%) pre-medicated pts required additional SED to achieve a deeper level (ASA Classes II or III). Overall, 33/200 (17%) required additional SED (Group C). No pt in this study received propofol. Results: Pts with anxiety (OR 4.52), depression (OR 4.39), a history of abdominal surgery (OR 4.27), female gender (OR 3.38), BMI ! 25 (OR 2.92) and those reporting a change in bowel habits (OR 2.30) were independently more likely (p ! 0.05) to be in Group C requiring a deeper level of SED than pts without these characteristics. Moreover, when analyzed retrospectively by a multivariable model, the presence of 2 or more of these factors identified 29/33 patients in Group C (p ! 0.001; sensitivity 88%). By using these selection criteria, only 96/200 (48%) of the total would have been identified for consideration of propofol use. Conclusions: In a consecutive series of 200 patients undergoing magnetic localization colonoscopy beginning with either no or ASA Class I sedation, only 17% of patients required initiation of medication or additional sedation. Retrospective analysis of multiple factors identified 88% of these patients. Selecting appropriate candidates for sedation/anesthesia would improve outcomes by limiting medication effects and reducing costs when administration by anesthesia personnel is mandated. Prospective validation of these selection criteria may improve specificity and is planned.
Background and aim: Recent studies have demonstrated variable detection of adenomatous polyps by endoscopists. It is a general practice that endoscopists typically remove all encountered polyps. However, the percentages of nonadenomas or non-cancerous polyps in those removed polyps are not known. In the United States, real time methods to differentiate adenomas from non-adenomas (e.g. chromoendoscopy and magnification) are seldom used. In this study, we evaluated whether superior detection of adenomas by individual endoscopists is associated with higher detection of non-adenomas. Methods and Statistical Analysis: Consecutive colonoscopy reports by nine attending gastroenterologists at Indiana University Hospital between January 1999 and January 2004 were obtained. Patients with indications of inflammatory bowel disease or who were referred for polypectomy were excluded. Adenomas included tubular adenomas, tubulovillous, villous adenomas, and serrated adenomas. Logistic regression was performed for comparison of the percentages of colonoscopies with at least one adenoma and with at least one non-adenoma/non-carcinoma. Pearson correlations were used to evaluate the relationship between the number of adenomas per colonoscopy and the number of non-adenomas/non-carcinomas per colonoscopy. Results: There were 10,034 included colonoscopies. The range of detecting R1 adenoma between the endoscopists for the entire cohort was 14.5 - 35.6% and for patients R50 years of age was 15.5 - 41.1%. The range of finding R1 non-adenoma/non-carcinoma between the endoscopists for the entire cohort was 11.8 - 35.3% and for patients R50 years of age was 12.9 - 37.5%. The correlation between the adjusted values for finding R1 adenoma and R1 non-adenoma/non-carcinoma for the entire cohort was 0.72. The range for the mean number of adenomas detected per colonoscopy between the endoscopists for the entire cohort was 0.20 - 0.72 and for patients R50 years of age was 0.21 - 0.86, whereas the range for the mean number of finding nonadenomas/non-carcinomas per colonoscopy between endoscopists for the entire cohort was 0.15 - 0.65 and for patients R50 years of age was 0.16 - 0.70. The correlation between the mean number of adenomas and the mean number of nonadenomas/non-carcinomas detected per colonoscopy for the entire cohort was 0.79. In persons age R50 the correlation was 0.84. Conclusion: Correlation between detection of adenomas and non-adenomas by individual endoscopists were moderately strong to strong. Highly sensitive endoscopists will benefit most by use of reliable real time methods to differentiate adenomas from nonadenomatous polyps.
T1384 Size Does Not Determine Aggressiveness of Colorectal Cancer: An Inside to Lesions of Less Than 10 mm Takahisa Matsuda, Yutaka Saito, Toshio Uraoka, Fabian Emura, Takeshi Nakajima, Hisatomo Ikehara, Yumi Mashimo, Tsuyoshi Kikuchi, Yoko Tateishi, Naoko Okabe, Yasushi Sano, Takahiro Fujii, Daizo Saito Background: Early invasive colorectal cancer (invasion limited to the sm layer) is increasing worldwide. Small lesions are suspected of having a lower malignant potential than large ones. However, pathological characteristics of small early cancers are still poorly studied. The aim of this study was to determine the clinicopathological characteristics of small (less than 10 mm) and large early lesions and their implications for endoscopic treatment. Material and Methods: A total of 583 sm cancers treated by EMR or surgery between January 1980 and December 2003 at National Cancer Center Hospital were analyzed. Lesions were classified into 3 groups based on their size: small (&10 mm), intermediate (11-20 mm) and large (S21 mm). Histological analysis was performed in all resected specimens. Results: There were 120 (21%), 272 (46%) and 191 (33%) small, intermediate and large lesions respectively. Histological analysis of small lesions revealed submucosal deep cancer (sm: S1000 mm) in 90 (75%) cases, lymphovascular invasion in 26(22%) cases and poorly differentiated component in 12 (10%) cases. Similarly, intermediate and large lesions exhibited sm deep cancer in 235 (86%) and 145 (76%) cases, lymphovascular invasion in 70 (26%) and 55 (29%) cases, and poorly differentiated component in 49 (18%) and 30 (16%) cases respectively. Moreover, the rate of lymph node metastasis was 11.2% (10/89), 13.5% (30/222) and 10.1% (16/159) in small, intermediate and large tumors respectively (N.S). EMR treatment was performed in 62 (52%) small lesions, 88(32%) intermediate and 45(24%) large lesions. Among these cases, there were no differences in the positive vertical and unknown margin rate in small (18%), intermediate (18%) and large lesions (22%). Conclusion: Small early invasive colorectal cancers demonstrate same aggressiveness and malignant potential than large lesions. Special attention must be paid when treating even small early invasive lesions. Results N lymph node metastasis sm-deep (S1000 mm) lymphovascular invasion (C) poorly component (C) positive vertical and unknown margin rate(EMR)
S10 mm
11-20 mm
S21 mm
120(21%) 11.2% 90(75%) 26(22%) 12(10%) 18%
272(46%) 13.5% 235(86%) 70(26%) 49(18%) 18%
191(33%) 10.1% 145(76%) 55(29%) 30(16%) 22%
AB210 GASTROINTESTINAL ENDOSCOPY Volume 63, No. 5 : 2006
T1386 Could Gastric Cancer Be a New Indication for Surveillance Colonoscopy?: The Kasid Prospective Multicenter Case Controlled Study Tae Woo Yoo, Dong I. Park, Hyun S. Kim, Suk K. Yang, Jeong S. Byeon, Bong M. Koh, Jin O. Kim, Ki N. Shim, Yoon T. Jeen, Bo I. Lee, Kyu Y. Choi, Hang L. Lee, Dong S. Han, Ilhyun Baek, Cheol H. Park, Seun J. Park Objectives: Could the patients with gastric cancer be a new indication for surveillance colonoscopy? The aim of this study was to determine the prevalence of colorectal neoplasm and necessity of surveillance colonoscopy in patients with gastric cancer. Methods: Total colonoscopies were performed in 11 tertiary medical centers in Korea from November 2004 to October 2005. The patient group was composed of 695 patients with gastric cancer who agreed to take colonoscopy within 6 months of gastric operation. The 1,549 consecutive, age and sex matched, average risk people without gastric polyp or cancer proven by prior gastroscopy and who taken colonoscopy prospectively within 6 months were belonged to the control group. Results: The relative risk of the patient group for all colon polyps, colorectal adenoma and cancer was 1.787 (CI 1.591-2.009, p ! 0.001), 1.937 (CI 1.674-2.242, p ! 0.001), and 2.105 (CI 1.091-4.060, p ! 0.023). However, there was no significant difference of adenoma prevalence according to pathologic type (early gastric cancer vs advanced gastric cancer), Lauren’s classification (intestinal vs diffuse type), and TNM staging within the patient group. Conclusions: The prevalence of colorectal adenoma and cancer remarkably increased in patients with gastric cancer. Therefore, the patients with gastric cancer might be a high risk group for colorectal adenoma or cancer and should be recommended to take surveillance colonoscopy.
www.giejournal.org