- Email: [email protected]
Mo1048 Characteristics of and Risk Factors for Colorectal Neoplasms in Young Adults in a Screening Population
Abstracts (95% CI Z 80.1 to 86.8), 85.1% for MEI (95% CI Z 81.1 to 88.2), 99% for VAC. The difference in mean visual analog scale rating for MEI compared with standard colonoscopy was – 0.52 cm (95% CI, - 0.13 to – 0.86). Conclusion: Advanced novel techniques in routine unsedated endoscopy have the capability for quick, safe, simple and tolerable procedures, plus the major cost containment.
Mo1047 Effect of Gastrointestinal Bleeding Within Six Months of Continuous-Flow Left-Ventricular Assist Device Implantation on Patient Outcomes Adam L. Edwards*5, Paul S. Fitzmorris1, Ansley Hairrell2, Salpy V. Pamboukian4, James George3, C. Mel Wilcox5, Shajan Peter5 1 Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL; 2School of Medicine, University of Alabama at Birmingham, Birmingham, AL; 3Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 4Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL; 5Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL Background: Gastrointestinal bleeding (GIB) is a common occurrence in patients with continuous flow left ventricular assist devices (CF-LVADs). While 59% of studies report on recurrence of GIB and a minority (29%) of studies report mortality, there is little information in the literature on the effect of GIB on other outcomes. We aimed to assess the impact of GIB on survival, hospital admissions, length of stay, and 30-day readmission rate in patients with CF-LVADs. Methods: We conducted a retrospective analysis of all patients who underwent CF-LVAD implantation at our center. GIB was defined as overt bleeding resulting in or occurring during a hospitalization six days to six months post-CF-LVAD implantation. The medical record for each patient was reviewed for the GIB outcome up until 11/25/14 (close of the study period). We calculated survival at six months post-device implantation and at the end of the study; number of hospital admissions and hospital days at one-year post-device implantation and at the end of the study period; length of stay (LOS) for the first readmission and for the first three readmissions for each patient; and time to next readmission and 30-day readmission rates after hospitalization for nonbleeding indications, for GIB, for non-GI tract bleeding. Kaplan-Meier survival analysis, Kruskal-Wallis test, and Pearson chi-square test were used when appropriate. Results: A total of 133 patients met inclusion criteria. Median age was 56 years; 77% were men. Twenty-four (18%) patients experienced a GIB. Survival curves at six months post-LVAD implantation (Log-rank PZ0.194) and at the end of the study period (Log-rank PZ0.551) did not differ for GIB categories, a consistent finding when the analysis was restricted to patients with CF-LVADs implanted as destination therapy (Log-rank PZ0.075 and PZ0.091 for six-month and end of study comparisons, respectively; Figure). When comparing patients with and without GIB, there was no difference in the number of hospital admissions or hospital days at one-year post-device implantation and at the end of the study period. LOS, time to next readmission, and frequency of 30-day readmission did not differ among indications for admission (see Table for all comparisons). Conclusion: In our large cohort of patients with CF-LVADs, GIB had no effect on survival, hospital admissions, length of stay, or 30-day readmission rate compared to other reasons for admission. It is unclear if the lack of difference in outcomes is due to an effect of the GIB management algorithm of anticoagulation modification and a combination of upper, lower, and mid-bowel endoscopy commonly employed at our center. Future studies should prospectively evaluate whether outcomes of GIB in patients with CF-LVADs differ between the typical management algorithm and a less invasive, supportive care only strategy.
Effect of Gastrointestinal Bleeding within Six Months of ContinuousFlow Left-Ventricular Assist Device Implantation on Patient Outcomes Outcome
GIB
Entire Cohort* Six-month survival (%) 75.0 End of study survival (%) 40.9 Destination Therapy Only Six-month survival (%) 66.7 End of study survival (%) 33.3 Hospital admissions, 1-year 3.5 (1.5-5.5) post-device implantation Hospital admissions, end of 5.5 (1.5study period 11.5)
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Non-GI bleed
Non-bleed
P-value
– –
86.2 50.0
0.194** 0.551
– – –
88.1 50.0 3.0 (1.5-4.5)
0.075 0.091 0.152***
–
5.0 (2.0-9.0)
0.688
Outcome Hospital days, 1-year postdevice implantation Hospital days, end of study period Length of stay, days (1st readmission) Length of stay, days (first 3 readmissions) Time to next readmission, days Thirty day readmission rate (%)
GIB
Non-GI bleed
25.5 (12.553.5)
–
47.5 (17.593.0) 5.0 (3.0-9.0)
–
5.5 (3.5-9.0)
10.0 (6.510.5) 9.0 (4.0-11.5)
21.5 (9.055.0) 58
62.5 (21.5129.5) 50
Non-bleed 20.0 (5.037.0)
P-value 0.112
41.0 (16.0- 0.535 87.0) 4.0 (2.0-11.0) 0.270 5.0 (2.0-11.0) 0.667 43.0 (16.0115.0) 42
0.336****
Data are presented as percentages (survival or 30-day readmission rate) or median with IQR (all other variables) *Excluding patients who underwent heart transplantation without experiencing a GIB **Log-rank test ***Kruskal-Wallis test ****Pearson Chi-square test
Mo1048 Characteristics of and Risk Factors for Colorectal Neoplasms in Young Adults in a Screening Population Hyoun Woo Kang* Internal Medicine, Dongguk University College of Medicine., Goyang, Korea (the Republic of) Aim: To investigate prevalence and risk factors for colorectal neoplasms in adults aged < 50 years, for whom screening is not recommended. Methods: This crosssectional study compared prevalence and characteristics of colorectal and advanced adenomas in patients aged < 50 years who underwent colonoscopy screening with subjects aged 50 years. To evaluate risk factors for colorectal and advanced adenoma in young adults, we used multivariable logistic regression models. Colorectal neoplasm characteristics were evaluated and compared with those in older patients. Results: Among 2819 patients included, prevalences of colorectal adenoma and advanced adenoma were 19.7 % and 1.5 %, respectively. As patient age increased, so did the prevalence of colorectal neoplasm. However, prevalence of advanced adenoma did not differ between age-groups 45–49 years and 50 years [odds ratio (OR) Z 0.43, 95% confidence interval (CI): 0.17–1.07, p Z 0.070]. In younger agegroup (< 50 years), colorectal adenoma was significantly associated with older age, waist circumference (OR 1.72, 95 % CI 1.15–2.55, p Z 0.008), and current smoking (ORZ1.60, 95 % CI 1.07–2.41, p Z 0.023). Alcohol consumption was an independent risk factor for colorectal advanced adenoma (OR 3.69, 95 % CI 1.08–12.54, p Z 0.037). Multiple neoplasms and large neoplasms ( 1 cm) were more prevalent in subjects 50 years. Conclusion: Current screening strategies for colorectal cancer may need to be amended to account for patient age, especially in young subjects with abdominal obesity, current smoking and alcohol consumption. Key words: Colorectal adenoma; Advanced adenoma; Colorectal cancer; Cancer screening; Young patients
Mo1049 Diagnostic Yield and Long-Term Outcomes of Capsule Endoscopy in Patients With Unexplained Iron-Deficiency Anemia: A Capsule Endoscopy Nationwide Database Registry (CAPENTRY) Study Chang Mo Moon*1, Ki-Nam Shim1, Dae Young Cheung2, Hyun Seok Lee3, Yun Jeong Lim4, Seong Ran Jeon5, Soo Jung Park6, Kyeong Ok Kim7, Hyun Joo Song8, Hyun Joo Jang9, Ji Hyun Kim10 1 Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of); 2The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of); 3Kyungpook National University School of Medicine, Daegu, Korea (the Republic of); 4 Dongguk university ilsan hospital, Ilsan, Korea (the Republic of); 5Soon Chun Hyang University Hospital, Seoul, Korea (the Republic of); 6Yonsei University College of Medicine, Seoul, Korea (the Republic of); 7 Yeungnam University College of Medicine, Daegu, Korea (the Republic of); 8Jeju National University School of Medicine, Jeju, Korea (the Republic of); 9Hallym University College of Medicine, Hwasung, Korea (the Republic of); 10Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (the Republic of) Background: Iron-deficiency anemia (IDA), the most frequent cause of anemia, causes various negative influence on patients’ health outcomes and can lead to critical disease-related morbidity. Capsule endoscopy (CE) has been used for evaluating the origins of IDA to date, but its diagnostic performance and impact remains
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB441
Mo1047 Effect of Gastrointestinal Bleeding Within Six Months of Continuous-Flow Left-Ventricular Assist Device Implantation on Patient Outcomes Adam L. Edwards*5, Paul S. Fitzmorris1, Ansley Hairrell2, Salpy V. Pamboukian4, James George3, C. Mel Wilcox5, Shajan Peter5 1 Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL; 2School of Medicine, University of Alabama at Birmingham, Birmingham, AL; 3Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 4Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL; 5Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL Background: Gastrointestinal bleeding (GIB) is a common occurrence in patients with continuous flow left ventricular assist devices (CF-LVADs). While 59% of studies report on recurrence of GIB and a minority (29%) of studies report mortality, there is little information in the literature on the effect of GIB on other outcomes. We aimed to assess the impact of GIB on survival, hospital admissions, length of stay, and 30-day readmission rate in patients with CF-LVADs. Methods: We conducted a retrospective analysis of all patients who underwent CF-LVAD implantation at our center. GIB was defined as overt bleeding resulting in or occurring during a hospitalization six days to six months post-CF-LVAD implantation. The medical record for each patient was reviewed for the GIB outcome up until 11/25/14 (close of the study period). We calculated survival at six months post-device implantation and at the end of the study; number of hospital admissions and hospital days at one-year post-device implantation and at the end of the study period; length of stay (LOS) for the first readmission and for the first three readmissions for each patient; and time to next readmission and 30-day readmission rates after hospitalization for nonbleeding indications, for GIB, for non-GI tract bleeding. Kaplan-Meier survival analysis, Kruskal-Wallis test, and Pearson chi-square test were used when appropriate. Results: A total of 133 patients met inclusion criteria. Median age was 56 years; 77% were men. Twenty-four (18%) patients experienced a GIB. Survival curves at six months post-LVAD implantation (Log-rank PZ0.194) and at the end of the study period (Log-rank PZ0.551) did not differ for GIB categories, a consistent finding when the analysis was restricted to patients with CF-LVADs implanted as destination therapy (Log-rank PZ0.075 and PZ0.091 for six-month and end of study comparisons, respectively; Figure). When comparing patients with and without GIB, there was no difference in the number of hospital admissions or hospital days at one-year post-device implantation and at the end of the study period. LOS, time to next readmission, and frequency of 30-day readmission did not differ among indications for admission (see Table for all comparisons). Conclusion: In our large cohort of patients with CF-LVADs, GIB had no effect on survival, hospital admissions, length of stay, or 30-day readmission rate compared to other reasons for admission. It is unclear if the lack of difference in outcomes is due to an effect of the GIB management algorithm of anticoagulation modification and a combination of upper, lower, and mid-bowel endoscopy commonly employed at our center. Future studies should prospectively evaluate whether outcomes of GIB in patients with CF-LVADs differ between the typical management algorithm and a less invasive, supportive care only strategy.
Effect of Gastrointestinal Bleeding within Six Months of ContinuousFlow Left-Ventricular Assist Device Implantation on Patient Outcomes Outcome
GIB
Entire Cohort* Six-month survival (%) 75.0 End of study survival (%) 40.9 Destination Therapy Only Six-month survival (%) 66.7 End of study survival (%) 33.3 Hospital admissions, 1-year 3.5 (1.5-5.5) post-device implantation Hospital admissions, end of 5.5 (1.5study period 11.5)
www.giejournal.org
Non-GI bleed
Non-bleed
P-value
– –
86.2 50.0
0.194** 0.551
– – –
88.1 50.0 3.0 (1.5-4.5)
0.075 0.091 0.152***
–
5.0 (2.0-9.0)
0.688
Outcome Hospital days, 1-year postdevice implantation Hospital days, end of study period Length of stay, days (1st readmission) Length of stay, days (first 3 readmissions) Time to next readmission, days Thirty day readmission rate (%)
GIB
Non-GI bleed
25.5 (12.553.5)
–
47.5 (17.593.0) 5.0 (3.0-9.0)
–
5.5 (3.5-9.0)
10.0 (6.510.5) 9.0 (4.0-11.5)
21.5 (9.055.0) 58
62.5 (21.5129.5) 50
Non-bleed 20.0 (5.037.0)
P-value 0.112
41.0 (16.0- 0.535 87.0) 4.0 (2.0-11.0) 0.270 5.0 (2.0-11.0) 0.667 43.0 (16.0115.0) 42
0.336****
Data are presented as percentages (survival or 30-day readmission rate) or median with IQR (all other variables) *Excluding patients who underwent heart transplantation without experiencing a GIB **Log-rank test ***Kruskal-Wallis test ****Pearson Chi-square test
Mo1048 Characteristics of and Risk Factors for Colorectal Neoplasms in Young Adults in a Screening Population Hyoun Woo Kang* Internal Medicine, Dongguk University College of Medicine., Goyang, Korea (the Republic of) Aim: To investigate prevalence and risk factors for colorectal neoplasms in adults aged < 50 years, for whom screening is not recommended. Methods: This crosssectional study compared prevalence and characteristics of colorectal and advanced adenomas in patients aged < 50 years who underwent colonoscopy screening with subjects aged 50 years. To evaluate risk factors for colorectal and advanced adenoma in young adults, we used multivariable logistic regression models. Colorectal neoplasm characteristics were evaluated and compared with those in older patients. Results: Among 2819 patients included, prevalences of colorectal adenoma and advanced adenoma were 19.7 % and 1.5 %, respectively. As patient age increased, so did the prevalence of colorectal neoplasm. However, prevalence of advanced adenoma did not differ between age-groups 45–49 years and 50 years [odds ratio (OR) Z 0.43, 95% confidence interval (CI): 0.17–1.07, p Z 0.070]. In younger agegroup (< 50 years), colorectal adenoma was significantly associated with older age, waist circumference (OR 1.72, 95 % CI 1.15–2.55, p Z 0.008), and current smoking (ORZ1.60, 95 % CI 1.07–2.41, p Z 0.023). Alcohol consumption was an independent risk factor for colorectal advanced adenoma (OR 3.69, 95 % CI 1.08–12.54, p Z 0.037). Multiple neoplasms and large neoplasms ( 1 cm) were more prevalent in subjects 50 years. Conclusion: Current screening strategies for colorectal cancer may need to be amended to account for patient age, especially in young subjects with abdominal obesity, current smoking and alcohol consumption. Key words: Colorectal adenoma; Advanced adenoma; Colorectal cancer; Cancer screening; Young patients
Mo1049 Diagnostic Yield and Long-Term Outcomes of Capsule Endoscopy in Patients With Unexplained Iron-Deficiency Anemia: A Capsule Endoscopy Nationwide Database Registry (CAPENTRY) Study Chang Mo Moon*1, Ki-Nam Shim1, Dae Young Cheung2, Hyun Seok Lee3, Yun Jeong Lim4, Seong Ran Jeon5, Soo Jung Park6, Kyeong Ok Kim7, Hyun Joo Song8, Hyun Joo Jang9, Ji Hyun Kim10 1 Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of); 2The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of); 3Kyungpook National University School of Medicine, Daegu, Korea (the Republic of); 4 Dongguk university ilsan hospital, Ilsan, Korea (the Republic of); 5Soon Chun Hyang University Hospital, Seoul, Korea (the Republic of); 6Yonsei University College of Medicine, Seoul, Korea (the Republic of); 7 Yeungnam University College of Medicine, Daegu, Korea (the Republic of); 8Jeju National University School of Medicine, Jeju, Korea (the Republic of); 9Hallym University College of Medicine, Hwasung, Korea (the Republic of); 10Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (the Republic of) Background: Iron-deficiency anemia (IDA), the most frequent cause of anemia, causes various negative influence on patients’ health outcomes and can lead to critical disease-related morbidity. Capsule endoscopy (CE) has been used for evaluating the origins of IDA to date, but its diagnostic performance and impact remains
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB441