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Mo1421 Not Antithrombotic Agents, but Chronic Constipation Increases Risk of Severe Diverticular Bleeding
Abstracts
Korea between December 2007 and November 2008 to compare guaiac-based and quantitative immunochemical fecal occult blood tests. Serrated polyps included hyperplastic polyps, sessile serrated adenomas, and traditional serrated adenomas. Results: A total of 926 subjects were analyzed. The mean age was 59.3 ⫾ 7.3 (SD) years and 492 subjects (52.1%) were male. Of these, 454 subjects (49.0%) and 356 (38.4%) had a total of 859 polyps and 709 adenomas, respectively. One hundred ten subjects (11.9%) had a total of 150 SPs and 49 (5.3%) had a total of 60 proximal SPs. The average number of SPs per patient was 1.36 ⫾ 0.77; 85 subjects (77.3%) had one SP, 14 (12.7%) had two, and 10 (10.0%) had three or more. The majority of SPs (95.3%) were less than 10mm in size; 107 (71.3%) were 1-5mm, 36 (24.0%) were 6-10mm, and 7 (4.7%) were ⱖ10mm in size. In comparison between subjects with and without proximal SP, there were no differences with respect to procedure related variables including endoscopic training, day of week, time of day, and elapsed time as well as demographic features such as age and sex. Conclusions: In average-risk people underwent screening colonoscopy, the prevalence of proximal SP was 5.3% in Korea. The prevalence of proximal SP in Korea was lower than previously reported in Western countries.
Mo1421 Not Antithrombotic Agents, but Chronic Constipation Increases Risk of Severe Diverticular Bleeding Kazuko Beppu*, Taro Osada, Kenshi Matsumoto, Tomoyoshi Shibuya, Naoto Sakamoto, Akihito Nagahara, Tatsuo Ogihara, Sumio Watanabe Gastroenterology, Juntendo University, Tokyo, Japan Background and Aim: Diverticular bleeding is a common cause of lower gastrointestinal hemorrhage and is a potentially serious problem. Although some reports showed that antithrombotic agents were a risk factor for diverticular bleeding, controversy still exists as to whether antithrombotic agents is a main risk of bleeding. Therefore, we performed a case-control study to ascertain the risk of severe diverticular bleeding, including analysis of patients’ background and medications. Method: Between January 2010 to October 2011, 31 cases were diagnosed with severe colonic diverticular hemorrhage at our hospital according to the following criteria: admission to the hospital because of massive bleeding and observation of active bleeding from a colonic diverticulum. We randomly selected from our database 93 non-bleeding diverticular cases matched for age and gender as control subjects. We investigated the influences of background factors (hypertension, diabetes mellitus, ischemic heart disease, cerebral vessel disease, chronic constipation) and medication (anticoagulants, antiplatelet agents with aspirin and thienopyridine) on diverticular hemorrhage by univariate and multivariate logistic regression analysis. Results: The diverticular bleeding cases were aged 68.5⫾23.2 (mean⫾SD) and 71% were males. Nine cases required endoscopic hemostasis, 10 cases required blood transfusions and 2 cases required surgery. Chronic constipation had only significant association with diverticular bleeding (OR 3.1; 11/31 vs 14/93; p⫽0.01). Hypertension (OR 1.1; 14/31 vs 40/93; p⫽0.83) and ischemic heart disease (OR 1.1; 8/31 vs 23/93; p⫽0.90) were not found to be a significant risk factor for bleeding. Neither anticoagulants (OR 2.2; 4/31 vs 6/93; p⫽0.25) nor antiplatelet agents such as aspirin (OR 0.9; 5/31 vs 19/93; p⫽0.90) and thienopyridine (OR 1.2; 3/31 vs 10/ 93; p⫽0.74) were found to increase the risk of bleeding. Multivariate analysis of factors influencing bleeding revealed that the significant independent risk factor was chronic constipation (OR 3.1; 95%CI 1.2-8.3; p⫽0.02). Conclusions: Chronic constipation was a significant independent risk factor for severe diverticular bleeding whereas anticoagulants and antiplatelet agents were not associated with such bleeding. Our results suggest that the fragile mucosa induced by chronic constipation could be a cause of severe diverticular bleeding. Therefore, the avoidance of constipation might prevent severe diverticular bleeding.
Mo1422 Colorectal Cancer Surveillance in Inflammatory Bowel Disease: a Retrospective Audit of Primary and Secondary Care Elizabeth A. Arthurs*, Kate L. Burley, Bethan K. Gholkar, Melanie J. Lockett Gastroenterology, North Bristol NHS Trust, Bristol, United Kingdom Background: Patients with colitis are at increased risk of colorectal cancer (CRC). Colonoscopic surveillance to detect dysplasia and early cancers has been advocated by the British Society of Gastroenterology since 2002 (1). The aim was to assess whether patients with colitis had received appropriate surveillance. Methods: A 3 stage audit was performed in 3 primary care practices and a secondary care trust. Patients with IBD were identified from primary care computerised records and secondary care coding databases. Patients with colitis who developed CRC were identified from cancer multidisciplinary team summaries and histopathology records. Paper records were retrospectively reviewed. Individualised recommendations were made according to the 2010 BSG guidelines for CRC surveillance (2). Detailed reports were issued. Results: 166 patients (0.6%) were identified with IBD from 29,054 patients in primary care. 100 patients (60%) had colitis extent requiring surveillance; 59 (59%) had
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symptom onset ⬎10 years; 10 (17%) underwent colonoscopy at 8-10 years; 19 (32%) had not; 6 (10%) were due in 2010. 11 (19%) had unknown disease extent but no clear surveillance; 13 (22%) had no record of colonoscopy within their record. Of 59 patients, 37 (63%) were eligible for repeat colonoscopy; 3 (8%) underwent this, 27 (73%) had not, and in 7 (19%) records were unclear. 45 colitis patient records in secondary care were reviewed. 35 (78%) had colitis extent requiring surveillance. 26 patients (58%) had symptom onset ⬎10 years; 11 patients (42%) underwent screening colonoscopy at 8-10 years; 15 (58%) did not. 1 patient underwent colonoscopy but date of diagnosis was unclear. 9 patients (35%) underwent inconsistent surveillance, in 6 patients (23%) there was no record of a colonoscopy. Of 26 patients, 24 patients were eligible for repeat colonoscopy; 3 (13%) underwent this at the advised interval; 1 patient was due in 2011; 11 (46%) underwent inconsistent surveillance. 9 (38%) patients did not undergo any surveillance. 16 cases of colitis and CRC were identified from our IBD patient cohort of 1820. 12 patients (75%) had symptom onset of ⬎10 years; 3 patients (25%) underwent screening colonoscopy at 8 - 10 years. 8 patients (75%) underwent surveillance; 2 (25%) had surveillance in accordance with 2002 BSG guidelines; in 6 (75%) it was inconsistent. 4 patients (33%) did not undergo any surveillance. 1 CRC (8.3%) was diagnosed by surveillance; the remaining 11 cases were interval cancers. Conclusions: Patients with colitis in primary and secondary care have not received appropriate CRC surveillance according to the BSG guidelines. These results emphasise the need for a coordinated surveillance programme and a reliable interface between primary and secondary care. References: (1)Eaden JA, Mayberry JF Gut v10-v12 51 Suppl V (2) Cairns SR et al. Gut 2010;59:666e690.
Mo1423 Comparison of Computed Tomographic Colonography With Colonoscopy for Colorectal Cancer Screening Yosuke Otake*1,2, Yasuo Kakugawa1,2, Minori Matsumoto1,2, Chihiro Tsunoda1,2, Yutaka Saito1, Gen Iinuma3, Yukio Muramatsu2, Noriyuki Moriyama2 1 Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; 2 Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan; 3Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan Background and Aim: Computed tomographic colonography (CTC) continues to evolve and is becoming a more widely used modality for colorectal cancer (CRC) screening internationally. Although some screening centers in Japan are now using CTC for CRC screening, the extent CTC can actually detect lesions that should be treated remains unclear. The aim of this retrospective study involving a group of asymptomatic patients was to determine the ability of screening CTC to detect neoplastic lesions ⱖ5mm and then compare the results with the findings from screening colonoscopy for CRC. Method: Consecutive asymptomatic patients, who underwent either CTC or colonoscopy for CRC screening from November 2010 to September 2011, were enrolled in this study. Patients were excluded who had previously undergone CRC screenings such as CTC, colonoscopy or Barium enema examinations at our screening facility. We retrospectively analyzed the ability of CTC and colonoscopy to detect neoplastic lesions ⱖ5mm that should be treated as well as the histopathological findings for any such detected lesions. In addition, we evaluated the rates of examination completion for both modalities and their safety with respect to recorded complications and problems subsequently reported by patients. Results: A total of 1,252 asymptomatic patients (male/female, 782/470) (CTC, 256; median age, 65 years [range, 40-85]) (colonoscopy, 996; median age, 55 years [40-83]) were included in this study. CTC was successfully performed on all 256 (100%) patients with only mild complications of abdominal distension that improved spontaneously reported in three (1.2%) cases. Colonoscopy was successfully completed on 995 patients (99.9%) immediately following esophagogastroduodenoscopy screening with complications requiring treatment reported in 14 (1.4%) cases (nausea and/or vomiting, 8; low blood pressure, 6) and mild complications reported in five (0.5%) cases (abdominal discomfort, 4; abdominal pain, 1). Lesions ⱖ5mm were detected in 35 (13.7%) CTC patients, however, such lesions were not detected in nine of those patients during subsequent colonoscopy for treatment (CTC positive predictive value (PPV), 74.3%). Neoplastic lesions ⱖ5mm were detected in 113 (11.4%) patients who received colonoscopy examinations. All such detected lesions was successfully treated during subsequent colonoscopy (110 patients) or surgery (three patients) and histopathologically diagnosed as either adenomas or carcinomas (colonoscopy PPV, 100%). Conclusion: CTC was a safe modality with a 100% completion rate, however, its PPV for neoplastic lesions ⱖ5mm that should be treated was significantly lower than such PPV for colonoscopy (p⬍0.001). Detection and the differential diagnosis of lesions using CTC needs to be improved before further expansion of CRC screening using this modality is advisable.
Volume 75, No. 4S : 2012
GASTROINTESTINAL ENDOSCOPY
AB420
Korea between December 2007 and November 2008 to compare guaiac-based and quantitative immunochemical fecal occult blood tests. Serrated polyps included hyperplastic polyps, sessile serrated adenomas, and traditional serrated adenomas. Results: A total of 926 subjects were analyzed. The mean age was 59.3 ⫾ 7.3 (SD) years and 492 subjects (52.1%) were male. Of these, 454 subjects (49.0%) and 356 (38.4%) had a total of 859 polyps and 709 adenomas, respectively. One hundred ten subjects (11.9%) had a total of 150 SPs and 49 (5.3%) had a total of 60 proximal SPs. The average number of SPs per patient was 1.36 ⫾ 0.77; 85 subjects (77.3%) had one SP, 14 (12.7%) had two, and 10 (10.0%) had three or more. The majority of SPs (95.3%) were less than 10mm in size; 107 (71.3%) were 1-5mm, 36 (24.0%) were 6-10mm, and 7 (4.7%) were ⱖ10mm in size. In comparison between subjects with and without proximal SP, there were no differences with respect to procedure related variables including endoscopic training, day of week, time of day, and elapsed time as well as demographic features such as age and sex. Conclusions: In average-risk people underwent screening colonoscopy, the prevalence of proximal SP was 5.3% in Korea. The prevalence of proximal SP in Korea was lower than previously reported in Western countries.
Mo1421 Not Antithrombotic Agents, but Chronic Constipation Increases Risk of Severe Diverticular Bleeding Kazuko Beppu*, Taro Osada, Kenshi Matsumoto, Tomoyoshi Shibuya, Naoto Sakamoto, Akihito Nagahara, Tatsuo Ogihara, Sumio Watanabe Gastroenterology, Juntendo University, Tokyo, Japan Background and Aim: Diverticular bleeding is a common cause of lower gastrointestinal hemorrhage and is a potentially serious problem. Although some reports showed that antithrombotic agents were a risk factor for diverticular bleeding, controversy still exists as to whether antithrombotic agents is a main risk of bleeding. Therefore, we performed a case-control study to ascertain the risk of severe diverticular bleeding, including analysis of patients’ background and medications. Method: Between January 2010 to October 2011, 31 cases were diagnosed with severe colonic diverticular hemorrhage at our hospital according to the following criteria: admission to the hospital because of massive bleeding and observation of active bleeding from a colonic diverticulum. We randomly selected from our database 93 non-bleeding diverticular cases matched for age and gender as control subjects. We investigated the influences of background factors (hypertension, diabetes mellitus, ischemic heart disease, cerebral vessel disease, chronic constipation) and medication (anticoagulants, antiplatelet agents with aspirin and thienopyridine) on diverticular hemorrhage by univariate and multivariate logistic regression analysis. Results: The diverticular bleeding cases were aged 68.5⫾23.2 (mean⫾SD) and 71% were males. Nine cases required endoscopic hemostasis, 10 cases required blood transfusions and 2 cases required surgery. Chronic constipation had only significant association with diverticular bleeding (OR 3.1; 11/31 vs 14/93; p⫽0.01). Hypertension (OR 1.1; 14/31 vs 40/93; p⫽0.83) and ischemic heart disease (OR 1.1; 8/31 vs 23/93; p⫽0.90) were not found to be a significant risk factor for bleeding. Neither anticoagulants (OR 2.2; 4/31 vs 6/93; p⫽0.25) nor antiplatelet agents such as aspirin (OR 0.9; 5/31 vs 19/93; p⫽0.90) and thienopyridine (OR 1.2; 3/31 vs 10/ 93; p⫽0.74) were found to increase the risk of bleeding. Multivariate analysis of factors influencing bleeding revealed that the significant independent risk factor was chronic constipation (OR 3.1; 95%CI 1.2-8.3; p⫽0.02). Conclusions: Chronic constipation was a significant independent risk factor for severe diverticular bleeding whereas anticoagulants and antiplatelet agents were not associated with such bleeding. Our results suggest that the fragile mucosa induced by chronic constipation could be a cause of severe diverticular bleeding. Therefore, the avoidance of constipation might prevent severe diverticular bleeding.
Mo1422 Colorectal Cancer Surveillance in Inflammatory Bowel Disease: a Retrospective Audit of Primary and Secondary Care Elizabeth A. Arthurs*, Kate L. Burley, Bethan K. Gholkar, Melanie J. Lockett Gastroenterology, North Bristol NHS Trust, Bristol, United Kingdom Background: Patients with colitis are at increased risk of colorectal cancer (CRC). Colonoscopic surveillance to detect dysplasia and early cancers has been advocated by the British Society of Gastroenterology since 2002 (1). The aim was to assess whether patients with colitis had received appropriate surveillance. Methods: A 3 stage audit was performed in 3 primary care practices and a secondary care trust. Patients with IBD were identified from primary care computerised records and secondary care coding databases. Patients with colitis who developed CRC were identified from cancer multidisciplinary team summaries and histopathology records. Paper records were retrospectively reviewed. Individualised recommendations were made according to the 2010 BSG guidelines for CRC surveillance (2). Detailed reports were issued. Results: 166 patients (0.6%) were identified with IBD from 29,054 patients in primary care. 100 patients (60%) had colitis extent requiring surveillance; 59 (59%) had
www.giejournal.org
symptom onset ⬎10 years; 10 (17%) underwent colonoscopy at 8-10 years; 19 (32%) had not; 6 (10%) were due in 2010. 11 (19%) had unknown disease extent but no clear surveillance; 13 (22%) had no record of colonoscopy within their record. Of 59 patients, 37 (63%) were eligible for repeat colonoscopy; 3 (8%) underwent this, 27 (73%) had not, and in 7 (19%) records were unclear. 45 colitis patient records in secondary care were reviewed. 35 (78%) had colitis extent requiring surveillance. 26 patients (58%) had symptom onset ⬎10 years; 11 patients (42%) underwent screening colonoscopy at 8-10 years; 15 (58%) did not. 1 patient underwent colonoscopy but date of diagnosis was unclear. 9 patients (35%) underwent inconsistent surveillance, in 6 patients (23%) there was no record of a colonoscopy. Of 26 patients, 24 patients were eligible for repeat colonoscopy; 3 (13%) underwent this at the advised interval; 1 patient was due in 2011; 11 (46%) underwent inconsistent surveillance. 9 (38%) patients did not undergo any surveillance. 16 cases of colitis and CRC were identified from our IBD patient cohort of 1820. 12 patients (75%) had symptom onset of ⬎10 years; 3 patients (25%) underwent screening colonoscopy at 8 - 10 years. 8 patients (75%) underwent surveillance; 2 (25%) had surveillance in accordance with 2002 BSG guidelines; in 6 (75%) it was inconsistent. 4 patients (33%) did not undergo any surveillance. 1 CRC (8.3%) was diagnosed by surveillance; the remaining 11 cases were interval cancers. Conclusions: Patients with colitis in primary and secondary care have not received appropriate CRC surveillance according to the BSG guidelines. These results emphasise the need for a coordinated surveillance programme and a reliable interface between primary and secondary care. References: (1)Eaden JA, Mayberry JF Gut v10-v12 51 Suppl V (2) Cairns SR et al. Gut 2010;59:666e690.
Mo1423 Comparison of Computed Tomographic Colonography With Colonoscopy for Colorectal Cancer Screening Yosuke Otake*1,2, Yasuo Kakugawa1,2, Minori Matsumoto1,2, Chihiro Tsunoda1,2, Yutaka Saito1, Gen Iinuma3, Yukio Muramatsu2, Noriyuki Moriyama2 1 Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; 2 Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan; 3Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan Background and Aim: Computed tomographic colonography (CTC) continues to evolve and is becoming a more widely used modality for colorectal cancer (CRC) screening internationally. Although some screening centers in Japan are now using CTC for CRC screening, the extent CTC can actually detect lesions that should be treated remains unclear. The aim of this retrospective study involving a group of asymptomatic patients was to determine the ability of screening CTC to detect neoplastic lesions ⱖ5mm and then compare the results with the findings from screening colonoscopy for CRC. Method: Consecutive asymptomatic patients, who underwent either CTC or colonoscopy for CRC screening from November 2010 to September 2011, were enrolled in this study. Patients were excluded who had previously undergone CRC screenings such as CTC, colonoscopy or Barium enema examinations at our screening facility. We retrospectively analyzed the ability of CTC and colonoscopy to detect neoplastic lesions ⱖ5mm that should be treated as well as the histopathological findings for any such detected lesions. In addition, we evaluated the rates of examination completion for both modalities and their safety with respect to recorded complications and problems subsequently reported by patients. Results: A total of 1,252 asymptomatic patients (male/female, 782/470) (CTC, 256; median age, 65 years [range, 40-85]) (colonoscopy, 996; median age, 55 years [40-83]) were included in this study. CTC was successfully performed on all 256 (100%) patients with only mild complications of abdominal distension that improved spontaneously reported in three (1.2%) cases. Colonoscopy was successfully completed on 995 patients (99.9%) immediately following esophagogastroduodenoscopy screening with complications requiring treatment reported in 14 (1.4%) cases (nausea and/or vomiting, 8; low blood pressure, 6) and mild complications reported in five (0.5%) cases (abdominal discomfort, 4; abdominal pain, 1). Lesions ⱖ5mm were detected in 35 (13.7%) CTC patients, however, such lesions were not detected in nine of those patients during subsequent colonoscopy for treatment (CTC positive predictive value (PPV), 74.3%). Neoplastic lesions ⱖ5mm were detected in 113 (11.4%) patients who received colonoscopy examinations. All such detected lesions was successfully treated during subsequent colonoscopy (110 patients) or surgery (three patients) and histopathologically diagnosed as either adenomas or carcinomas (colonoscopy PPV, 100%). Conclusion: CTC was a safe modality with a 100% completion rate, however, its PPV for neoplastic lesions ⱖ5mm that should be treated was significantly lower than such PPV for colonoscopy (p⬍0.001). Detection and the differential diagnosis of lesions using CTC needs to be improved before further expansion of CRC screening using this modality is advisable.
Volume 75, No. 4S : 2012
GASTROINTESTINAL ENDOSCOPY
AB420