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W1453: Single-Balloon Assisted Colonoscopy in Patients With Previously Failed Conventional Colonoscopy
Abstracts W1451 A Randomized Tandem Colonoscopy Trial of Transparent Hood Attached Versus Conventional Examination to Compare Polyp Miss Rate Yil Sik Hyun, Dong Soo Han, Joong Ho Bae, Hye Sun Park, Sang Bong Ahn, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Joo Hyun Sohn Background and Aims: Colonoscopy, the gold standard screening test for colorectal cancer, is not a perfect examination for detecting all neoplasia. Several studies for reducing polyp miss rate with advanced image techniques have been conducted; however, none of the trials demonstrated a significant reduction in polyp miss rate. The transparent hood makes it easy to observe the proximal side of the folds and flexures, increasing the incidence of polyp detection. We aimed to compare the usefulness of the transparent hood attached colonoscopy with conventional colonoscopy in terms of polyp miss rate by applying tandem colonoscopy. Methods: Patients for colonoscopy between May 2009 and September 2009 in Hanyang University Guri Hospital were enrolled to this randomized controlled trial, and assigned to colonoscopy with a transparent hood or no hood. All patients underwent a second examination with conventional endoscopy for evaluating missed polyps. The polyp miss rate per lesion, polyp miss rate per patient and characteristics of missed polyps were compared. Results: Seventy six patients were enrolled. There was no statistically significant difference in polyp miss rate between transparent hood attached or conventional colonoscopy. Of the 38 patients in the transparent hood group, 10 patients (26.3%) had at least one missed polyp as compared with 14 out of 38 patients (36.8%) in the no hood group. Of the 64 polyps in the transparent hood group, 14 polyps (21.9%) were missed as compared with 22 out of 75 polyps (29.3%) in the no hood group. In the case of missed polyps, there was no characteristic difference between the two groups. There was no independent risk factor for missed polyp according to the multivariate analysis. Conclusion: The transparent hood attached procedure may have advantage in reducing polyp miss rate during colonoscopy. However, basic principles in colonoscopy including good bowel preparation or adequate withdrawal time will always be the most fundamental factors concerning the reduction in polyp miss rate.
W1452 Colonoscopic Findings in Symptomatic HIV Positive African American Patients: A Retrospective Case Control Study From an Inner City Hospital Ramakrishna Chakilam, Samyukta Chava, Rajesh Chintala, Satya Chalasani, Andrew Sanderson, Duane T. Smoot Background: HIV is a significant health problem with about 1 million people currently living with HIV in the United States. There are several studies which have reported increased incidence of malignant colon cancers in this group, but the current guidelines recommend colorectal cancer screening similar to the general population. However, no studies are available in the African-American (AA) HIV population. In this study we investigated the colonoscopic findings in AA HIV patients (pts) for colonic neoplasms.Methods: We conducted a retrospective, case-controlled study of AA pts infected with HIV who had colonoscopy for a variety of gastrointestinal complaints, and compared them to age and sex matched African-American non-HIV controls over the same period of time between 2003 -2008. Results: A total of 135 symptomatic HIV patients and 277 controls matched for age, sex, and family history underwent colonoscopy. 55 % were males. The age range was 17 - 83. Mean age of HIV patients and controls was 48 yrs of age and 50 yrs of age, respectively. 75 pts were on HAART and 55 pts had CD4 ⬎ 200. Benign colonic adenomas were found in 9% (13) of the HIV patients vs. 7.2% (20) in controls, p ⫽ 0.410. Interestingly, more HIV pts had polyps greater than 10mm (46% vs 25%, p ⫽ 0.208) and the distribution of polyps was more diffuse as compared with the controls (38.5% vs. 10%, p ⫽ 0.357). However this did not reach statistical significance. In the control group polyps were mainly seen in the distal colon. No adenocarcinomas were found in the HIV patients, however one patient had a malignant cecal lymphoma and another had Kaposi’s sarcoma. There were 14 adenocarcinomas found in the controls (5%). Conclusion: Despite several studies recently reporting increased incidence of colorectal cancers in HIV pts, we did not find any increase in adenocarcinomas in our African American HIV positive group. In HIV positive pts the colon polyps were found to be more diffusely distributed in the colon and tended to be larger (⬎1cm), but this was not significantly different, possibly due to our sample size. Larger, prospective studies are needed to clarify which groups of patients with HIV are at increased risk for colorectal cancers, including the effect of HAART therapy and CD4 counts.
AB332 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
W1453 Single-Balloon Assisted Colonoscopy in Patients With Previously Failed Conventional Colonoscopy Christopher W. Teshima, Huseyin Aktas, Jelle Haringsma, Ernst J. Kuipers, Peter Mensink BACKGROUND: Complete examination of the colon is important for all patients undergoing colonoscopy. However, there are certain patients for whom completing colonoscopy to cecal intubation is particularly difficult, resulting in incomplete procedures. Double balloon endoscopy (DBE) has been successfully used to complete colonoscopy in these patients. Single balloon endoscopy (SBE) has become established for small bowel enteroscopy, including retrograde procedures via the colon. However, it has yet to be studied for use in colonoscopy. AIMS: To assess the efficacy, performance and safety of singleballoon colonoscopy in patients with previously failed conventional colonoscopy.METHODS: A prospective analysis of SBE colonoscopies performed at a single, tertiary referral center in the Netherlands.RESULTS: 23 single-balloon colonoscopy procedures were performed in 22 patients since January 2008: median age 53 (range 19-75) years, 14 females. In all cases SBE-assisted colonoscopy was performed because of previously failed attempt(s) by conventional colonoscopy. The indications for colonoscopy were a significant family history of colorectal cancer (n⫽2), polyps suspected on radiology imaging or previous endoscopy (n⫽4), abdominal pain or obstructive complaints (n⫽3), anemia (n⫽3), a rising carcinoembryonic antigen after previously treated colon cancer (n⫽1), evaluation of Crohn’s disease activity (n⫽7) or suspected IBD (n⫽3). The SBE colonoscopy succeeded in cecal intubation in 22 (96%) cases, with a median total procedure time of 30 (range 20-60) minutes. In one patient, endoscope advancement beyond the hepatic flexure failed because of colonic debris such as seeds that impaired the smooth movement of the overtube over the endoscope, combined with progressive patient complaints with only conscious sedation. The terminal ileum was intubated in 12 (53%) cases, although not attempted in all procedures. The median depth of insertion of the distal ileum in these cases was 28 (range 5-80) cm. SBE colonoscopy was normal in 9 cases but resulted in a positive diagnosis in 13 (57%) procedures, including polyps (n⫽6), active Crohn’s disease (n⫽4), Crohn’s-related stricture (n⫽1), and diverticulosis (n⫽2). Seven (30%) procedures were therapeutic and included 1 case with balloon dilation and 6 cases with polypectomy. No complications were encountered.CONCLUSION: Single-balloon assisted colonoscopy seems a safe and effective method for completing colonoscopy in patients with previously failed or difficult colonoscopy. The outcomes are similar compared to previous studies with DBE colonoscopy in this patient group.
W1454 Colon Polyp Miss Rate on Colonoscopy - On Patients Diagnosed As Early Colon Cancer After Polypectomy Hyun Gun Kim, Jin-Oh Kim, Tae Hee Lee, Won Young Cho, Seong Ran Jeon, Wan Jung Kim, Bong Min Ko, Joo Young Cho, Moon Sung Lee, Joon Seong Lee Background: Colonoscopy (CFS) is the most sensitive screening tool for colon cancer. However, the polyp miss rate by CFS was reported with wide range (14⬃30%) by tandem CFS studies. Studies that investigate the polyp miss rate in patients diagnosed as early colon cancer after polypectomy are limited. We investigated the polyp miss rate in early colon cancer patients and the characteristics of missed-polyps. Method: From January 2004 to November 2008, 209 patients were diagnosed with early colon cancer after polypectomy at a single, tertiary referral center. Of these 209 patients, 115 patients who underwent follow-up CFS (2nd examination) within 3 months were enrolled. Accompanying polyps as well as cancerous lesions were all removed during the 1st CFS. Newly detected polyps on 2nd CFS were considered as missed-polyps. We analyzed endoscopic appearance, shape, location and histology of missed polyps, retrospectively. Polyps less than 3 mm were excluded to rule out the possibility of newly developed polyps. Results: The mean age (M:F⫽2.8:1) was 60.9⫾8.6. The number of polyps removed on 1st CFS including 134 colon cancer lesions were 623. 13.7% (16/115) of patients had more than 2 lesions of cancer. The mean duration of interval to 2nd CFS was 2.1⫾0.9 months. 216 additional polyps were detected on 2nd CFS and the miss rate was 24.2%. The miss rate was the highest for sessile polyps (30.9%) by comparison according to the endoscopic appearance, right colon polyps (30.4%) by the location and polyps less than 1cm by size (p⬍0.05). According to histological differentiation, the miss rate of adenoma, advanced adenoma, and carcinoma in-situ was 22.4%, 18.6% and 4.3% respectively. Particularly, the miss rate of adenoma more than 1cm in size was 13.8%. Conclusions: The polyp miss rate in patients with early colon cancer was similar to previous studies. However, characteristics of missed-polyps by histology and size could be more aggressive than non-cancer patients. Hence, 1st surveillance CFS after endoscopic removal of early colon cancer should be performed more early for considering premalignant or malignant missing polyp and requires more careful observation.
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W1452 Colonoscopic Findings in Symptomatic HIV Positive African American Patients: A Retrospective Case Control Study From an Inner City Hospital Ramakrishna Chakilam, Samyukta Chava, Rajesh Chintala, Satya Chalasani, Andrew Sanderson, Duane T. Smoot Background: HIV is a significant health problem with about 1 million people currently living with HIV in the United States. There are several studies which have reported increased incidence of malignant colon cancers in this group, but the current guidelines recommend colorectal cancer screening similar to the general population. However, no studies are available in the African-American (AA) HIV population. In this study we investigated the colonoscopic findings in AA HIV patients (pts) for colonic neoplasms.Methods: We conducted a retrospective, case-controlled study of AA pts infected with HIV who had colonoscopy for a variety of gastrointestinal complaints, and compared them to age and sex matched African-American non-HIV controls over the same period of time between 2003 -2008. Results: A total of 135 symptomatic HIV patients and 277 controls matched for age, sex, and family history underwent colonoscopy. 55 % were males. The age range was 17 - 83. Mean age of HIV patients and controls was 48 yrs of age and 50 yrs of age, respectively. 75 pts were on HAART and 55 pts had CD4 ⬎ 200. Benign colonic adenomas were found in 9% (13) of the HIV patients vs. 7.2% (20) in controls, p ⫽ 0.410. Interestingly, more HIV pts had polyps greater than 10mm (46% vs 25%, p ⫽ 0.208) and the distribution of polyps was more diffuse as compared with the controls (38.5% vs. 10%, p ⫽ 0.357). However this did not reach statistical significance. In the control group polyps were mainly seen in the distal colon. No adenocarcinomas were found in the HIV patients, however one patient had a malignant cecal lymphoma and another had Kaposi’s sarcoma. There were 14 adenocarcinomas found in the controls (5%). Conclusion: Despite several studies recently reporting increased incidence of colorectal cancers in HIV pts, we did not find any increase in adenocarcinomas in our African American HIV positive group. In HIV positive pts the colon polyps were found to be more diffusely distributed in the colon and tended to be larger (⬎1cm), but this was not significantly different, possibly due to our sample size. Larger, prospective studies are needed to clarify which groups of patients with HIV are at increased risk for colorectal cancers, including the effect of HAART therapy and CD4 counts.
AB332 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
W1453 Single-Balloon Assisted Colonoscopy in Patients With Previously Failed Conventional Colonoscopy Christopher W. Teshima, Huseyin Aktas, Jelle Haringsma, Ernst J. Kuipers, Peter Mensink BACKGROUND: Complete examination of the colon is important for all patients undergoing colonoscopy. However, there are certain patients for whom completing colonoscopy to cecal intubation is particularly difficult, resulting in incomplete procedures. Double balloon endoscopy (DBE) has been successfully used to complete colonoscopy in these patients. Single balloon endoscopy (SBE) has become established for small bowel enteroscopy, including retrograde procedures via the colon. However, it has yet to be studied for use in colonoscopy. AIMS: To assess the efficacy, performance and safety of singleballoon colonoscopy in patients with previously failed conventional colonoscopy.METHODS: A prospective analysis of SBE colonoscopies performed at a single, tertiary referral center in the Netherlands.RESULTS: 23 single-balloon colonoscopy procedures were performed in 22 patients since January 2008: median age 53 (range 19-75) years, 14 females. In all cases SBE-assisted colonoscopy was performed because of previously failed attempt(s) by conventional colonoscopy. The indications for colonoscopy were a significant family history of colorectal cancer (n⫽2), polyps suspected on radiology imaging or previous endoscopy (n⫽4), abdominal pain or obstructive complaints (n⫽3), anemia (n⫽3), a rising carcinoembryonic antigen after previously treated colon cancer (n⫽1), evaluation of Crohn’s disease activity (n⫽7) or suspected IBD (n⫽3). The SBE colonoscopy succeeded in cecal intubation in 22 (96%) cases, with a median total procedure time of 30 (range 20-60) minutes. In one patient, endoscope advancement beyond the hepatic flexure failed because of colonic debris such as seeds that impaired the smooth movement of the overtube over the endoscope, combined with progressive patient complaints with only conscious sedation. The terminal ileum was intubated in 12 (53%) cases, although not attempted in all procedures. The median depth of insertion of the distal ileum in these cases was 28 (range 5-80) cm. SBE colonoscopy was normal in 9 cases but resulted in a positive diagnosis in 13 (57%) procedures, including polyps (n⫽6), active Crohn’s disease (n⫽4), Crohn’s-related stricture (n⫽1), and diverticulosis (n⫽2). Seven (30%) procedures were therapeutic and included 1 case with balloon dilation and 6 cases with polypectomy. No complications were encountered.CONCLUSION: Single-balloon assisted colonoscopy seems a safe and effective method for completing colonoscopy in patients with previously failed or difficult colonoscopy. The outcomes are similar compared to previous studies with DBE colonoscopy in this patient group.
W1454 Colon Polyp Miss Rate on Colonoscopy - On Patients Diagnosed As Early Colon Cancer After Polypectomy Hyun Gun Kim, Jin-Oh Kim, Tae Hee Lee, Won Young Cho, Seong Ran Jeon, Wan Jung Kim, Bong Min Ko, Joo Young Cho, Moon Sung Lee, Joon Seong Lee Background: Colonoscopy (CFS) is the most sensitive screening tool for colon cancer. However, the polyp miss rate by CFS was reported with wide range (14⬃30%) by tandem CFS studies. Studies that investigate the polyp miss rate in patients diagnosed as early colon cancer after polypectomy are limited. We investigated the polyp miss rate in early colon cancer patients and the characteristics of missed-polyps. Method: From January 2004 to November 2008, 209 patients were diagnosed with early colon cancer after polypectomy at a single, tertiary referral center. Of these 209 patients, 115 patients who underwent follow-up CFS (2nd examination) within 3 months were enrolled. Accompanying polyps as well as cancerous lesions were all removed during the 1st CFS. Newly detected polyps on 2nd CFS were considered as missed-polyps. We analyzed endoscopic appearance, shape, location and histology of missed polyps, retrospectively. Polyps less than 3 mm were excluded to rule out the possibility of newly developed polyps. Results: The mean age (M:F⫽2.8:1) was 60.9⫾8.6. The number of polyps removed on 1st CFS including 134 colon cancer lesions were 623. 13.7% (16/115) of patients had more than 2 lesions of cancer. The mean duration of interval to 2nd CFS was 2.1⫾0.9 months. 216 additional polyps were detected on 2nd CFS and the miss rate was 24.2%. The miss rate was the highest for sessile polyps (30.9%) by comparison according to the endoscopic appearance, right colon polyps (30.4%) by the location and polyps less than 1cm by size (p⬍0.05). According to histological differentiation, the miss rate of adenoma, advanced adenoma, and carcinoma in-situ was 22.4%, 18.6% and 4.3% respectively. Particularly, the miss rate of adenoma more than 1cm in size was 13.8%. Conclusions: The polyp miss rate in patients with early colon cancer was similar to previous studies. However, characteristics of missed-polyps by histology and size could be more aggressive than non-cancer patients. Hence, 1st surveillance CFS after endoscopic removal of early colon cancer should be performed more early for considering premalignant or malignant missing polyp and requires more careful observation.
www.giejournal.org