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T1051 Low-Volume Polyethylene Glycol and an Adjunct for Bowel Preparation: A Meta-Analysis
combined and rectal cancer only. Randomized control trials designed to test the hypothesis that statins reduce the risk of colorectal neoplasia are warranted.
Impact of Family History of Polyps on Prevalence and Risk Factors for Adenomas in 40-49 Year Old Individuals Akshay Gutpa, Jewel Samadder, Eric E. Elliott, Saurabh Sethi, Philip S. Schoenfeld Aim: Per current multi-society colorectal cancer (CRC) guidelines, patients with a first degree relative (FDR) with adenoma should get colonoscopy at age 40. Repeat scopes should be performed every 5 yrs if the FDR was diagnosed (dx) with adenoma < 60 yrs vs 10yrs if the FDR was dx with adenoma > 60 yrs. No previous study has examined the prevalence of adenomas and advanced adenomas (AA) or risk factors for adenomas in these 40-49 yr olds. Methods: For this retrospective database study, inclusion criteria were: (a) 40-49 yr olds who underwent their 1st screening colonoscopy for a family history (FH) of polyps in a FDR from 2006-09 (cases); or, (b) 40-49 yr olds who underwent colonoscopy in 200609 for abdominal pain or altered bowel habits (controls). Exclusion criteria: personal history of CRC/adenomas/hereditary CRC syndrome/IBD, prior colonoscopy, active GI bleeding, iron deficiency anemia, unexplained weight loss >10 pounds, histology of polyp in FDR confirmed as non-adenoma. Number of adenomas and AA (adenoma > 10mm) were quantified. For risk factor analysis, data was extracted about age, gender, ethnicity, histology of polyp in FDR and age of FDR at dx of polyp, BMI, presence of diabetes, and aspirin/NSAID use. STATA 10.0 was used for statistical analysis. Results: There were 176 individuals in the FH group and 178 controls. Demographic data are summarized below. Histology of FDRs polyp as adenoma was documented in 59.6% (105/176). There was a higher adenoma prevalence in the cases vs controls [26.7% (47/176) vs 13.5% (24/178); p = 0.002], but not for AA [5.7% (10/176) vs 3.4% (6/178), p = 0.3]. Among individuals with FDR dx with polyp < 60 yrs old vs individuals with FDR dx with polyp > 60 yrs old, prevalence of adenoma (29.7% vs 33.3%, p = 0.83) and AA (2.7% vs 11.1%, p = 0.35) were not significantly different. On multiple logistic regression analysis, FH of polyps was independently associated with adenomas (OR = 1.3; p = .005), but FDR dx with polyp < 60 yrs old was not. The endoscopist did not follow current recommendations for repeat colonoscopy in 43.3% of cases. Conclusion: In 40-49 yr old individuals, a FH of polyps in a FDR may be associated with a higher prevalence of adenomas. The age of FDR at the time of diagnosis of polyps may not affect the prevalence of adenomas in this group.
T1048 NSAIDs Accelerated a Risk of Colonic Diverticular Hemorrhage: A CaseControl Study Nanae Tsuruoka, Naoyuki Tominaga, Natsuko Shirahama, Ryo Nakano, Ryo Shimoda, Seiji Tsunada, Hiroyuki Sakata, Ryuichi Iwakiri, Kazuma Fujimoto Background: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) could be a major risk factor for lower intestinal hemorrhage, in addition to the upper gastrointestinal bleeding. The aim of this study is to assess whether use of NSAIDs is a risk factor for ischemic colitis or colonic diverticular hemorrhage, which are well-known causes for lower intestinal hemorrhage. Methods: We enrolled consecutive 98 patients of hemorrhage caused by ischemic colitis (n=47) or colonic diverticulum (n=51), who visited Saga Medical School between January 2000 and December 2008. Gender and age matched control cases (n=196) were selected from patients of other diseases hospitalized during the same period. We evaluated influences of comorbidities (cerebrovascular disease, ischemic heart disease, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and osteoporosis), medications including NSAIDs, duration of hospitalization, and habits (smoking, alcohol, chronic constipation) by using logistic regression analysis. Results: Regarding comorbidities, duration of hospitalization, smoking and alcohol, there was no significant difference between patients of ischemic colitis and of colonic diverticular hemorrhage. NSAIDs (odds ratio = 11.420, 95%CI: 2.222-58.705, p=0.0035), and hyperlipidemia (odds ratio = 2.393, 95%CI: 1.0425.497, p=0.0397) were significant risk factors in colonic diverticular hemorrhage, but not in ischemic colitis, compared to the selected case controls. The acceleration effect of NSAIDs for diverticular bleeding was not observed in patients with low dose aspirin. Use of NSAIDs and anticoagulant prolonged duration of hospitalization of patients of colonic diverticular hemorrhage (odds ratio = 1.1, 95%CI: 1.002-1.098, p=0.042). This study also indicated that use of NSAIDs was a risk factor for re-bleeding of diverticulum (odds ratio = 5.4, 95%CI: 1.01-28.78, p=0.048). Re-bleeding was increased in diverticulum patients with constipation (odds ratio = 10.22, 95%CI: 1.6-64.4, p=0.01). In cases of ischemic colitis patients,no risk factor including NSAIDs was not confirmed compared to the case-controls. Conclusion: This case-control study indicated that use of NSAIDs could be a significant risk factor in colonic diverticular hemorrhage and re-hemorrhage, but not in ischemic colitis.
T1051 Low-Volume Polyethylene Glycol and an Adjunct for Bowel Preparation: A Meta-Analysis Nicholas M. Szary, Todd W. Kilgore, Michelle L. Matteson, Abhishek Choudhary, John B. Marshall, Matthew L. Bechtold Background: Quality of bowel preparation prior to colonoscopy is essential for adequate visualization of mucosa and polyps. However, many patients have a decreased tolerance to the traditional 4 L of polyethylene glycol (PEG). Subsequently, studies have been performed evaluating a reduced volume of PEG with an adjunct (bisacodyl, magnesium, ascorbic acid, olive oil, or cascara-salax) in an effort to improve visualization and tolerability with varying results. Therefore, a meta-analysis was performed to analyze the efficacy of a low-volume PEG bowel preparation with an adjunct for bowel preparation prior to colonoscopy. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, CINAHL, PubMed, and recent abstracts from major conferences were searched (11/09). Only RCTs on adult subjects that compared low-volume PEG with an adjunct versus 4 L PEG were included. Standard forms were used to extract data by two independent reviewers. Meta-analysis for the efficacy of low-volume PEG with an adjunct and 4 L PEG were analyzed by calculating pooled estimates of number of satisfactory, excellent, and poor bowel preparations as well as adverse patient events (abdominal pain, nausea, vomiting, bloating). Separate analyses were performed for each main outcome by using odds ratio (OR) with fixed and random effects models. Heterogeneity was assessed by calculating the I2 measure of inconsistency. RevMan 5 was utilized for statistical analysis. Results: 8 studies (N=1,874) met the inclusion criteria with mean age ranging from 47-63 years. The studies were of adequate quality. No statistically significant differences were noted between low-volume PEG with an adjunct and 4 L PEG for number of satisfactory (OR 0.87, 95% CI: 0.51-1.49, p=0.6), excellent (OR 1.17, 95% CI: 0.76-1.80, p=0.47), or poor bowel preparations (OR 0.94, 95% CI: 0.58-1.54, p=0.82). A statistically significant decrease in nausea (OR 0.5, 95% CI: 0.33-0.75, p<0.01) and vomiting (OR 0.52, 95% CI: 0.36-0.75, p<0.01) were noted for the low-volume PEG with an adjunct as compared to 4 L PEG. No statistically significant differences were noted between the two groups for abdominal pain (p=0.91) and bloating (p=0.23). No publication bias was noted. Significant heterogeneity was observed for most outcomes requiring the use of the random effects model. Conclusions: Low-volume PEG with the addition of an adjunct demonstrates less nausea and vomiting without any significant effects on bowel preparation. Based upon these results, low-volume PEG with an adjunct may be considered as a substitute to the traditional 4 L PEG for bowel preparation prior to colonoscopy.
T1049 Statins and the Risk of Colorectal Cancer: A Meta-Analysis of 22 Observational Studies N. Jewel Samadder, Akshay K. Gupta, Gad Rennert, Stephen B. Gruber Purpose: Colorectal cancer (CRC) is the third most common cause of cancer and the second most common cause of death in the United States. Observational studies have suggested that long-term use of statins is associated with reduced risk of several cancers, including colorectal, breast, prostate, lung, pancreas and liver. We investigated the strength of the association between statins and colon and rectal cancer through a meta-analysis of observational studies. Methods: A comprehensive search for studies published through October 2009 was performed, using MEDLINE, EMBASE and Web of Science databases and abstracts of research presented at national GI conferences. The studies considered in this meta-analysis were either case-control or cohort design that evaluated exposure to statins and risk of colorectal cancer. The studies were evaluated for publication bias and heterogeneity, and pooled relative risk (RR) estimates were calculated using the fixed- and random-effects models. Results: A total of 22 studies (including 5 abstracts) with more than 2.5 million participants contributed to this analysis. They were grouped on the basis of study design (case-control and cohort), publication status (abstract and full publication), tumor location (colorectal and rectal cancer) and separate meta-analysis were conducted prior to pooling all the studies to ensure consistency of results. A funnel plot was symmetrical, suggesting that publication bias is likely minimal. Heterogeneity tests were significant (P<0.01 and I2 of 47%), thus estimates from random effects model were used. Statin use was associated with a statistically significant reduction in risk of colorectal cancer (RR=0.88; 95% CI, 0.840.93; n=22). When the analysis was restricted to those studies published in full (versus abstracts) the association was essentially unchanged (RR=0.86; 95% CI, 0.79-0.94; n=16). We also examined the consistency of results across study design. Both case-control and cohort studies showed a statistically significant reduction in colorectal cancer (RR=0.90; 95% CI, 0.86-0.94; n=17 and RR=0.88, 95% CI, 0.84-0.93; n=5). The risk of rectal cancer in statin users was evaluated and reported in eight studies, with a trend towards reduced risk of rectal cancer amongst those exposed to statins (RR=0.81; 95% CI, 0.62-1.05; n=8). Conclusion: Meta-analysis supports the hypothesis that statins are associated with reduced risk of colorectal cancer. The magnitude of the relative risk was similar for colorectal cancers
S-477
AGA Abstracts
AGA Abstracts
T1050
Impact of Family History of Polyps on Prevalence and Risk Factors for Adenomas in 40-49 Year Old Individuals Akshay Gutpa, Jewel Samadder, Eric E. Elliott, Saurabh Sethi, Philip S. Schoenfeld Aim: Per current multi-society colorectal cancer (CRC) guidelines, patients with a first degree relative (FDR) with adenoma should get colonoscopy at age 40. Repeat scopes should be performed every 5 yrs if the FDR was diagnosed (dx) with adenoma < 60 yrs vs 10yrs if the FDR was dx with adenoma > 60 yrs. No previous study has examined the prevalence of adenomas and advanced adenomas (AA) or risk factors for adenomas in these 40-49 yr olds. Methods: For this retrospective database study, inclusion criteria were: (a) 40-49 yr olds who underwent their 1st screening colonoscopy for a family history (FH) of polyps in a FDR from 2006-09 (cases); or, (b) 40-49 yr olds who underwent colonoscopy in 200609 for abdominal pain or altered bowel habits (controls). Exclusion criteria: personal history of CRC/adenomas/hereditary CRC syndrome/IBD, prior colonoscopy, active GI bleeding, iron deficiency anemia, unexplained weight loss >10 pounds, histology of polyp in FDR confirmed as non-adenoma. Number of adenomas and AA (adenoma > 10mm) were quantified. For risk factor analysis, data was extracted about age, gender, ethnicity, histology of polyp in FDR and age of FDR at dx of polyp, BMI, presence of diabetes, and aspirin/NSAID use. STATA 10.0 was used for statistical analysis. Results: There were 176 individuals in the FH group and 178 controls. Demographic data are summarized below. Histology of FDRs polyp as adenoma was documented in 59.6% (105/176). There was a higher adenoma prevalence in the cases vs controls [26.7% (47/176) vs 13.5% (24/178); p = 0.002], but not for AA [5.7% (10/176) vs 3.4% (6/178), p = 0.3]. Among individuals with FDR dx with polyp < 60 yrs old vs individuals with FDR dx with polyp > 60 yrs old, prevalence of adenoma (29.7% vs 33.3%, p = 0.83) and AA (2.7% vs 11.1%, p = 0.35) were not significantly different. On multiple logistic regression analysis, FH of polyps was independently associated with adenomas (OR = 1.3; p = .005), but FDR dx with polyp < 60 yrs old was not. The endoscopist did not follow current recommendations for repeat colonoscopy in 43.3% of cases. Conclusion: In 40-49 yr old individuals, a FH of polyps in a FDR may be associated with a higher prevalence of adenomas. The age of FDR at the time of diagnosis of polyps may not affect the prevalence of adenomas in this group.
T1048 NSAIDs Accelerated a Risk of Colonic Diverticular Hemorrhage: A CaseControl Study Nanae Tsuruoka, Naoyuki Tominaga, Natsuko Shirahama, Ryo Nakano, Ryo Shimoda, Seiji Tsunada, Hiroyuki Sakata, Ryuichi Iwakiri, Kazuma Fujimoto Background: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) could be a major risk factor for lower intestinal hemorrhage, in addition to the upper gastrointestinal bleeding. The aim of this study is to assess whether use of NSAIDs is a risk factor for ischemic colitis or colonic diverticular hemorrhage, which are well-known causes for lower intestinal hemorrhage. Methods: We enrolled consecutive 98 patients of hemorrhage caused by ischemic colitis (n=47) or colonic diverticulum (n=51), who visited Saga Medical School between January 2000 and December 2008. Gender and age matched control cases (n=196) were selected from patients of other diseases hospitalized during the same period. We evaluated influences of comorbidities (cerebrovascular disease, ischemic heart disease, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and osteoporosis), medications including NSAIDs, duration of hospitalization, and habits (smoking, alcohol, chronic constipation) by using logistic regression analysis. Results: Regarding comorbidities, duration of hospitalization, smoking and alcohol, there was no significant difference between patients of ischemic colitis and of colonic diverticular hemorrhage. NSAIDs (odds ratio = 11.420, 95%CI: 2.222-58.705, p=0.0035), and hyperlipidemia (odds ratio = 2.393, 95%CI: 1.0425.497, p=0.0397) were significant risk factors in colonic diverticular hemorrhage, but not in ischemic colitis, compared to the selected case controls. The acceleration effect of NSAIDs for diverticular bleeding was not observed in patients with low dose aspirin. Use of NSAIDs and anticoagulant prolonged duration of hospitalization of patients of colonic diverticular hemorrhage (odds ratio = 1.1, 95%CI: 1.002-1.098, p=0.042). This study also indicated that use of NSAIDs was a risk factor for re-bleeding of diverticulum (odds ratio = 5.4, 95%CI: 1.01-28.78, p=0.048). Re-bleeding was increased in diverticulum patients with constipation (odds ratio = 10.22, 95%CI: 1.6-64.4, p=0.01). In cases of ischemic colitis patients,no risk factor including NSAIDs was not confirmed compared to the case-controls. Conclusion: This case-control study indicated that use of NSAIDs could be a significant risk factor in colonic diverticular hemorrhage and re-hemorrhage, but not in ischemic colitis.
T1051 Low-Volume Polyethylene Glycol and an Adjunct for Bowel Preparation: A Meta-Analysis Nicholas M. Szary, Todd W. Kilgore, Michelle L. Matteson, Abhishek Choudhary, John B. Marshall, Matthew L. Bechtold Background: Quality of bowel preparation prior to colonoscopy is essential for adequate visualization of mucosa and polyps. However, many patients have a decreased tolerance to the traditional 4 L of polyethylene glycol (PEG). Subsequently, studies have been performed evaluating a reduced volume of PEG with an adjunct (bisacodyl, magnesium, ascorbic acid, olive oil, or cascara-salax) in an effort to improve visualization and tolerability with varying results. Therefore, a meta-analysis was performed to analyze the efficacy of a low-volume PEG bowel preparation with an adjunct for bowel preparation prior to colonoscopy. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, CINAHL, PubMed, and recent abstracts from major conferences were searched (11/09). Only RCTs on adult subjects that compared low-volume PEG with an adjunct versus 4 L PEG were included. Standard forms were used to extract data by two independent reviewers. Meta-analysis for the efficacy of low-volume PEG with an adjunct and 4 L PEG were analyzed by calculating pooled estimates of number of satisfactory, excellent, and poor bowel preparations as well as adverse patient events (abdominal pain, nausea, vomiting, bloating). Separate analyses were performed for each main outcome by using odds ratio (OR) with fixed and random effects models. Heterogeneity was assessed by calculating the I2 measure of inconsistency. RevMan 5 was utilized for statistical analysis. Results: 8 studies (N=1,874) met the inclusion criteria with mean age ranging from 47-63 years. The studies were of adequate quality. No statistically significant differences were noted between low-volume PEG with an adjunct and 4 L PEG for number of satisfactory (OR 0.87, 95% CI: 0.51-1.49, p=0.6), excellent (OR 1.17, 95% CI: 0.76-1.80, p=0.47), or poor bowel preparations (OR 0.94, 95% CI: 0.58-1.54, p=0.82). A statistically significant decrease in nausea (OR 0.5, 95% CI: 0.33-0.75, p<0.01) and vomiting (OR 0.52, 95% CI: 0.36-0.75, p<0.01) were noted for the low-volume PEG with an adjunct as compared to 4 L PEG. No statistically significant differences were noted between the two groups for abdominal pain (p=0.91) and bloating (p=0.23). No publication bias was noted. Significant heterogeneity was observed for most outcomes requiring the use of the random effects model. Conclusions: Low-volume PEG with the addition of an adjunct demonstrates less nausea and vomiting without any significant effects on bowel preparation. Based upon these results, low-volume PEG with an adjunct may be considered as a substitute to the traditional 4 L PEG for bowel preparation prior to colonoscopy.
T1049 Statins and the Risk of Colorectal Cancer: A Meta-Analysis of 22 Observational Studies N. Jewel Samadder, Akshay K. Gupta, Gad Rennert, Stephen B. Gruber Purpose: Colorectal cancer (CRC) is the third most common cause of cancer and the second most common cause of death in the United States. Observational studies have suggested that long-term use of statins is associated with reduced risk of several cancers, including colorectal, breast, prostate, lung, pancreas and liver. We investigated the strength of the association between statins and colon and rectal cancer through a meta-analysis of observational studies. Methods: A comprehensive search for studies published through October 2009 was performed, using MEDLINE, EMBASE and Web of Science databases and abstracts of research presented at national GI conferences. The studies considered in this meta-analysis were either case-control or cohort design that evaluated exposure to statins and risk of colorectal cancer. The studies were evaluated for publication bias and heterogeneity, and pooled relative risk (RR) estimates were calculated using the fixed- and random-effects models. Results: A total of 22 studies (including 5 abstracts) with more than 2.5 million participants contributed to this analysis. They were grouped on the basis of study design (case-control and cohort), publication status (abstract and full publication), tumor location (colorectal and rectal cancer) and separate meta-analysis were conducted prior to pooling all the studies to ensure consistency of results. A funnel plot was symmetrical, suggesting that publication bias is likely minimal. Heterogeneity tests were significant (P<0.01 and I2 of 47%), thus estimates from random effects model were used. Statin use was associated with a statistically significant reduction in risk of colorectal cancer (RR=0.88; 95% CI, 0.840.93; n=22). When the analysis was restricted to those studies published in full (versus abstracts) the association was essentially unchanged (RR=0.86; 95% CI, 0.79-0.94; n=16). We also examined the consistency of results across study design. Both case-control and cohort studies showed a statistically significant reduction in colorectal cancer (RR=0.90; 95% CI, 0.86-0.94; n=17 and RR=0.88, 95% CI, 0.84-0.93; n=5). The risk of rectal cancer in statin users was evaluated and reported in eight studies, with a trend towards reduced risk of rectal cancer amongst those exposed to statins (RR=0.81; 95% CI, 0.62-1.05; n=8). Conclusion: Meta-analysis supports the hypothesis that statins are associated with reduced risk of colorectal cancer. The magnitude of the relative risk was similar for colorectal cancers
S-477
AGA Abstracts
AGA Abstracts
T1050