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Sa1142 Clinical Outcomes of Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Multicenter Cohort Study
Abstracts
rate is not high based on pathologic evaluation for EMR, but the local recurrent rate is low. LEMR had highest complete resection rate and no local recurrence during follow-up even compared with surgery. Ligated endoscpic mucosal resection is a safe and effective modality for treating rectal carcinoid tumors.
Sa1141 The Impact of Type 2 Diabetes Control and Related Complications on Outcomes and Health Care Utilization in the Peri-Operative Period of Colorectal Cancer Surgery Hisham Hussan1, Somashekar G. Krishna2, Alice Hinton3, Peter P. Stanich1, Samer El-Dika2, Rohan Modi*4, Darrell M. Gray1 1 INHP, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH; 2Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH; 3 Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH; 4Department of Internal Medicine, The Ohio State University, Columbus, OH Background: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of colorectal cancer (CRC). Little is known about how the control and complications of T2DM influence peri-operative CRC surgery outcomes and health care utilization. Methods: The Nationwide Inpatient Sample (2008-2011) was reviewed to identify inpatients who underwent CRC surgery. Patients were stratified based on the presence or absence of T2DM. We further compared patients with complicated T2DM (CT2DM) and complicated and uncontrolled T2DM (CU-T2DM) to non-diabetics. We excluded other types of diabetes from our analysis. Primary outcomes were CRC peri-operative mortality, length of stay (LOS), total hospital charges and disposition to rehabilitation facilities. Results: There were 404,014 discharges for CRC surgery between 2008 and 2011, of which 84,902 (21%) had T2DM, 12,316 (3%) had C-T2DM and 1,234 (0.3%) had CU-T2DM. T2DM patients undergoing CRC surgery were of older age, male gender, Hispanic or African American, and had more associated comorbidities. On multivariate logistic regression, T2DM was associated with a slightly lower rate of CRC peri-operative mortality (0.80, 95% CI: 0.70 to 0.92) and lower rates of certain surgical complications (intestinal perforations, necessity of colostomies, and accidental lacerations) compared to non-diabetics. T2DM did not lead to a clinically significant increase in LOS or more total hospital charges. There was no difference in mortality when analysis was restricted to C-T2DM or CU-T2DM, as compared to non-diabetics. However, there was a prolonged LOS in patients undergoing CRC resection with C-T2DM (1.12 days, 95% CI: 0.79 to 1.49) and CUT2DM (2.36 days, 95% CI: 1.36 to 3.36). Moreover, total hospital charges increased with more severe diabetes [(C-T2DM: $12,106, 95% CI: 7,733 to 16,480) and (CUT2DM: $24,036, 95% CI: 8,765 to 39,307)]. In regards to disposition to short term rehabilitation facilities, all three diabetic populations had progressively increased rates with worse diabetes (T2DM: 1.22, 95% CI:1.15 to 1.30, C-T2DM: 1.82, 95% CI: 1.57 to 2.11 and CU-T2DM: 3.03, 95%CI: 1.96 to 4.66) Conclusion: Analysis of US inpatient admissions demonstrates a slightly lower CRC peri-operative mortality when comparing T2DM to non-T2DM patients. However, this association was lost when restricting to either C-T2DM or CU-T2DM. There was a significant utilization of health care resources and more disposition to rehab facilities in the CRC preoperative period as T2DM patients develop complications and in complicated, uncontrolled disease. In an era of cost containment, this data suggest that a better control of T2DM and prevention of complications may have a profound impact on outcomes and health care costs in this cohort.
Sa1142 Clinical Outcomes of Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Multicenter Cohort Study Toshio Kuwai*, Shinji Tanaka, Kenjiro Shigita, Taiji Matsuo, Motomi Terasaki, Koichi Nakadoi, Akira Furudoi, Yuko Hiraga, Masaki Kunihiro, Shiro Oka, Shinji Nagata, Kazuaki Chayama Hiroshima Endoscopy Research Group, Hiroshima, Japan Background: In Japan colorectal endoscopic submucosal dissection (ESD) received health insurance approval in April 2010, and it is now one of the most useful methods for treatment of early colorectal neoplasms. Good outcomes of colorectal ESD have been reported in advanced high-volume centers, but these procedures were performed by a limited number of highly skilled experts in specialized centers. The AIM of this study was to investigate the clinical outcomes of colorectal ESD and evaluate the feasibility of the procedure in a multicenter retrospective survey that included non-specialized public hospitals in Hiroshima prefecture in Japan. Patients & Methods: We recruited 1,227 consecutive patients (male:female Z 745:482; mean age Z 6923 years) with 1,259 colorectal lesions treated with ESD at 12 hospitals (1 academic center and 11 community hospitals) between January 2008 and May 2014. We evaluated the clinicopathologic characteristics of cases, procedure time, en bloc resection rate, histological complete resection rate, curative (R0) resection rate, complications, and long-term prognosis, including local recurrence, development of metachronous lesions, and survival rate. Results: Regarding the site of the lesions, 495 lesions (39.3%) were located in the right colon, 264 (21.0%) in the left colon,
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and 500 (39.7%) in the rectum. Of them, LST-G, LST-NG and Polypoid were 607 lesions (48.2%), 440 (34.9%) and 212 (16.8%), respectively. By histological examination, 667 lesions (53.0%) were intramucosal cancers; 104 (8.3%), shallow submucosal invasive cancers (<1000 mm); 153 (12.1%), deep submucosal invasive cancers (>1000 mm); and 335 (26.6%), tubular adenomas. The average tumor size was 3317 mm (range 10–138 mm), and the average procedure time was 9266 minutes (range 5–660 minutes). The en bloc resection, histological complete resection and R0 resection rates were 92.6% (95% confidence interval [CI], 91.0%– 94.0%), 87.4% (95% CI, 85.4%–89.1%) and 83.7% (95% CI, 81.6%–85.7%), respectively. Delayed bleeding, perforation during procedure, and delayed perforation occurred in 3.7% (95% CI, 2.7%–4.8%), 3.4% (95% CI, 2.5%–4.6%), and 0.4% (95% CI, 0.1%–0.9%) of patients, respectively. A total of 894 (72.9%) patients were included in the analysis of long-term outcomes. The median follow-up time was 30 months (range, 6–90 months). Of 894, 2 patients (0.2%) died of colorectal cancer. Local recurrence was observed in only 1.8% of patients (17/894), and metachronous lesions (>5 mm) developed in 6.0% of patients (54/894). The 3- and 5-year overall survival rates were 95% and 92.1%, respectively. Conclusions: We demonstrated the feasibility of colorectal ESD with acceptable complication risks and favorable longterm outcomes in a multicenter survey that included many non-specialized public hospitals.
Sa1143 Enhanced Instructions Improve the Quality of Bowel Preparation for Colonoscopy: A Meta-Analysis of Randomized Controlled Trials Xiaoyang Guo, Zhiping Yang, Hui Jia*, Yanglin Pan, Xuegang Guo Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China Background and Aims: The success of colonoscopy is highly dependent on the quality of bowel preparation (BP). Many patients had poor BP due to non-compliance with regular instructions (RI). Reports concerning the effects of enhanced instructions (EI) on BP quality were inconsistent. The aim of this meta-analysis was to compare BP quality between patients receiving EI in addition to RI and those who only got RI. Methods: MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched to identify the relevant studies published through August 2015. The quality of BP (adequate/inadequate), adenoma detection rate (ADR), polyp detection rate (PDR), willingness to repeat preparation and adverse events were estimated by using odds ratio (OR) and 95% confidence interval (CI) with fixed-effects models. Results: 9 randomized controlled trails (RCTs) (nZ3923) were included in this metaanalysis. Patients who received EI showed significantly better BP quality than those only receiving RI (OR 2.03, 95%CI: 1.71-2.40; p<0.001). Higher ADR (OR 1.49; 95% CI: 1.09-2.04; pZ0.010) and PDR (OR 1.26, 95%CI: 1.05-1.50; pZ0.010) were achieved in patients receiving EI. Patients in the EI group had more willingness to repeat preparation (OR 1.94; 95%CI: 1.44-2.61; p<0.001). Less nausea or vomiting (OR 0.75, 95%CI: 0.61-0.93; pZ0.008) was found in patients receiving EI. Conclusion: EI significantly improved the quality of BP, increased ADR and willingness to repeat preparation in patients undergoing colonoscopy. Further studies are needed to confirm these findings.
Figure 1. Forest blot comparing the BP quality between EI and RI groups
Sa1144 Factors Associated With Adenoma Detection: Analysis of the Japanese Randomized Controlled Trial Yuichi Mori*, Shin-ei Kudo, Atsushi Katagiri, Masashi Misawa, Naoya Toyoshima, Shingo Matsudaira, Toyoki Kudo, Noriyuki Ogata, Tomokazu Hisayuki, Kunihiko Wakamura, Takemasa Hayashi, Yasuharu Maeda, Yuichi Fukami, Katsuro Ichimasa, Koki Kudo, Hiroki Nakamura, Hideyuki Miyachi, Toshiyuki Baba, Yusuke Yagawa, Shinichi Kataoka, Fumio Ishida Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan Introduction: Recently, the adenoma detection rate (ADR) by colonoscopy has been considered an important surrogate marker for evaluating the quality of colonoscopy.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB229
rate is not high based on pathologic evaluation for EMR, but the local recurrent rate is low. LEMR had highest complete resection rate and no local recurrence during follow-up even compared with surgery. Ligated endoscpic mucosal resection is a safe and effective modality for treating rectal carcinoid tumors.
Sa1141 The Impact of Type 2 Diabetes Control and Related Complications on Outcomes and Health Care Utilization in the Peri-Operative Period of Colorectal Cancer Surgery Hisham Hussan1, Somashekar G. Krishna2, Alice Hinton3, Peter P. Stanich1, Samer El-Dika2, Rohan Modi*4, Darrell M. Gray1 1 INHP, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH; 2Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH; 3 Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH; 4Department of Internal Medicine, The Ohio State University, Columbus, OH Background: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of colorectal cancer (CRC). Little is known about how the control and complications of T2DM influence peri-operative CRC surgery outcomes and health care utilization. Methods: The Nationwide Inpatient Sample (2008-2011) was reviewed to identify inpatients who underwent CRC surgery. Patients were stratified based on the presence or absence of T2DM. We further compared patients with complicated T2DM (CT2DM) and complicated and uncontrolled T2DM (CU-T2DM) to non-diabetics. We excluded other types of diabetes from our analysis. Primary outcomes were CRC peri-operative mortality, length of stay (LOS), total hospital charges and disposition to rehabilitation facilities. Results: There were 404,014 discharges for CRC surgery between 2008 and 2011, of which 84,902 (21%) had T2DM, 12,316 (3%) had C-T2DM and 1,234 (0.3%) had CU-T2DM. T2DM patients undergoing CRC surgery were of older age, male gender, Hispanic or African American, and had more associated comorbidities. On multivariate logistic regression, T2DM was associated with a slightly lower rate of CRC peri-operative mortality (0.80, 95% CI: 0.70 to 0.92) and lower rates of certain surgical complications (intestinal perforations, necessity of colostomies, and accidental lacerations) compared to non-diabetics. T2DM did not lead to a clinically significant increase in LOS or more total hospital charges. There was no difference in mortality when analysis was restricted to C-T2DM or CU-T2DM, as compared to non-diabetics. However, there was a prolonged LOS in patients undergoing CRC resection with C-T2DM (1.12 days, 95% CI: 0.79 to 1.49) and CUT2DM (2.36 days, 95% CI: 1.36 to 3.36). Moreover, total hospital charges increased with more severe diabetes [(C-T2DM: $12,106, 95% CI: 7,733 to 16,480) and (CUT2DM: $24,036, 95% CI: 8,765 to 39,307)]. In regards to disposition to short term rehabilitation facilities, all three diabetic populations had progressively increased rates with worse diabetes (T2DM: 1.22, 95% CI:1.15 to 1.30, C-T2DM: 1.82, 95% CI: 1.57 to 2.11 and CU-T2DM: 3.03, 95%CI: 1.96 to 4.66) Conclusion: Analysis of US inpatient admissions demonstrates a slightly lower CRC peri-operative mortality when comparing T2DM to non-T2DM patients. However, this association was lost when restricting to either C-T2DM or CU-T2DM. There was a significant utilization of health care resources and more disposition to rehab facilities in the CRC preoperative period as T2DM patients develop complications and in complicated, uncontrolled disease. In an era of cost containment, this data suggest that a better control of T2DM and prevention of complications may have a profound impact on outcomes and health care costs in this cohort.
Sa1142 Clinical Outcomes of Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Multicenter Cohort Study Toshio Kuwai*, Shinji Tanaka, Kenjiro Shigita, Taiji Matsuo, Motomi Terasaki, Koichi Nakadoi, Akira Furudoi, Yuko Hiraga, Masaki Kunihiro, Shiro Oka, Shinji Nagata, Kazuaki Chayama Hiroshima Endoscopy Research Group, Hiroshima, Japan Background: In Japan colorectal endoscopic submucosal dissection (ESD) received health insurance approval in April 2010, and it is now one of the most useful methods for treatment of early colorectal neoplasms. Good outcomes of colorectal ESD have been reported in advanced high-volume centers, but these procedures were performed by a limited number of highly skilled experts in specialized centers. The AIM of this study was to investigate the clinical outcomes of colorectal ESD and evaluate the feasibility of the procedure in a multicenter retrospective survey that included non-specialized public hospitals in Hiroshima prefecture in Japan. Patients & Methods: We recruited 1,227 consecutive patients (male:female Z 745:482; mean age Z 6923 years) with 1,259 colorectal lesions treated with ESD at 12 hospitals (1 academic center and 11 community hospitals) between January 2008 and May 2014. We evaluated the clinicopathologic characteristics of cases, procedure time, en bloc resection rate, histological complete resection rate, curative (R0) resection rate, complications, and long-term prognosis, including local recurrence, development of metachronous lesions, and survival rate. Results: Regarding the site of the lesions, 495 lesions (39.3%) were located in the right colon, 264 (21.0%) in the left colon,
www.giejournal.org
and 500 (39.7%) in the rectum. Of them, LST-G, LST-NG and Polypoid were 607 lesions (48.2%), 440 (34.9%) and 212 (16.8%), respectively. By histological examination, 667 lesions (53.0%) were intramucosal cancers; 104 (8.3%), shallow submucosal invasive cancers (<1000 mm); 153 (12.1%), deep submucosal invasive cancers (>1000 mm); and 335 (26.6%), tubular adenomas. The average tumor size was 3317 mm (range 10–138 mm), and the average procedure time was 9266 minutes (range 5–660 minutes). The en bloc resection, histological complete resection and R0 resection rates were 92.6% (95% confidence interval [CI], 91.0%– 94.0%), 87.4% (95% CI, 85.4%–89.1%) and 83.7% (95% CI, 81.6%–85.7%), respectively. Delayed bleeding, perforation during procedure, and delayed perforation occurred in 3.7% (95% CI, 2.7%–4.8%), 3.4% (95% CI, 2.5%–4.6%), and 0.4% (95% CI, 0.1%–0.9%) of patients, respectively. A total of 894 (72.9%) patients were included in the analysis of long-term outcomes. The median follow-up time was 30 months (range, 6–90 months). Of 894, 2 patients (0.2%) died of colorectal cancer. Local recurrence was observed in only 1.8% of patients (17/894), and metachronous lesions (>5 mm) developed in 6.0% of patients (54/894). The 3- and 5-year overall survival rates were 95% and 92.1%, respectively. Conclusions: We demonstrated the feasibility of colorectal ESD with acceptable complication risks and favorable longterm outcomes in a multicenter survey that included many non-specialized public hospitals.
Sa1143 Enhanced Instructions Improve the Quality of Bowel Preparation for Colonoscopy: A Meta-Analysis of Randomized Controlled Trials Xiaoyang Guo, Zhiping Yang, Hui Jia*, Yanglin Pan, Xuegang Guo Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China Background and Aims: The success of colonoscopy is highly dependent on the quality of bowel preparation (BP). Many patients had poor BP due to non-compliance with regular instructions (RI). Reports concerning the effects of enhanced instructions (EI) on BP quality were inconsistent. The aim of this meta-analysis was to compare BP quality between patients receiving EI in addition to RI and those who only got RI. Methods: MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched to identify the relevant studies published through August 2015. The quality of BP (adequate/inadequate), adenoma detection rate (ADR), polyp detection rate (PDR), willingness to repeat preparation and adverse events were estimated by using odds ratio (OR) and 95% confidence interval (CI) with fixed-effects models. Results: 9 randomized controlled trails (RCTs) (nZ3923) were included in this metaanalysis. Patients who received EI showed significantly better BP quality than those only receiving RI (OR 2.03, 95%CI: 1.71-2.40; p<0.001). Higher ADR (OR 1.49; 95% CI: 1.09-2.04; pZ0.010) and PDR (OR 1.26, 95%CI: 1.05-1.50; pZ0.010) were achieved in patients receiving EI. Patients in the EI group had more willingness to repeat preparation (OR 1.94; 95%CI: 1.44-2.61; p<0.001). Less nausea or vomiting (OR 0.75, 95%CI: 0.61-0.93; pZ0.008) was found in patients receiving EI. Conclusion: EI significantly improved the quality of BP, increased ADR and willingness to repeat preparation in patients undergoing colonoscopy. Further studies are needed to confirm these findings.
Figure 1. Forest blot comparing the BP quality between EI and RI groups
Sa1144 Factors Associated With Adenoma Detection: Analysis of the Japanese Randomized Controlled Trial Yuichi Mori*, Shin-ei Kudo, Atsushi Katagiri, Masashi Misawa, Naoya Toyoshima, Shingo Matsudaira, Toyoki Kudo, Noriyuki Ogata, Tomokazu Hisayuki, Kunihiko Wakamura, Takemasa Hayashi, Yasuharu Maeda, Yuichi Fukami, Katsuro Ichimasa, Koki Kudo, Hiroki Nakamura, Hideyuki Miyachi, Toshiyuki Baba, Yusuke Yagawa, Shinichi Kataoka, Fumio Ishida Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan Introduction: Recently, the adenoma detection rate (ADR) by colonoscopy has been considered an important surrogate marker for evaluating the quality of colonoscopy.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB229