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W1464: Follow-up Outcomes of Endoscopic Mucosal Resection for 94 Cases of Early Colorectal Cancer
Abstracts W1464 Follow-up Outcomes of Endoscopic Mucosal Resection for 94 Cases of Early Colorectal Cancer Hee J. Lee, Hee Seok Moon, Hyun Yong Jeong Background/Aims: Early colorectal cancer is defined as invasive tumor, limited to the mucosa or submucosa. The incidence of early colorectal cancer (ECC) detection has been increased. Thus the detection and removal of early colorectal cancers are important to reduce its related mortality. Endoscopic mucosal resection (EMR) for ECC is increasing. In this study, we reviewed the records of patients with ECC who underwent EMR, and we analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of EMR. Methods: From January 2002 to June 2009, 92 patients underwent EMR for ECC at Chungnam National University Hospital in South Korea and followed for over 6 months. Results: 92 patients with average age of 60 accounted for 94 ECCs. The ratio of male to female patients was 2.5:1. En-bloc resection rate was 64.9%. Submucosal invasion was 30 cases (31.9%). De novo cancer rate was 26.6% and relatively high in submucosal cancer (60%). The complete resection rate was 81.9%. During the mean follow-up period of 22.1 months, 12 incomplete resection cases underwent surgical resections, 2 residual tumors were found in the submucosa out of 12 cases. And 1 case with no residual tumor was noted multiple metastasis on 5 years after operation. No tumor recurred in the other cases. Conclusions: The findings show EMR to be effective for ECC. En-bloc resection provide precise histologic information and prevent of tumor recurrence. In cases of incomplete resection within 3 months, follow-up is essential for the early detection of tumor growth and the decision of the other treatment to remove residual tumor.
W1465 Colonoscopy for CRC Screening in Asymptomatic Elderly African Americans, Hispanics and Asian Americans Shashideep Singhal, Puneet S. Basi, Siddharth Mathur, Manpreet Singh, Amir S. Butt, Mojdeh Momeni, Sury Anand Background: The United States Preventive Services Task Force (USPSTF) recommends against routine screening for colorectal cancer (CRC) in adults more than 75 years of age. There are limited studies on CRC screening in elderly population and minorities are often under-represented. This study is designed to determine considerations which can support screening colonoscopy in an individual patient of this specific racial group. Methods: 10,908 subjects who had colonoscopy during the study period were included. 1676 (15.4%) had age ⱖ 75 years at the time of colonoscopy. Demographics, colonoscopy characteristics and histopathology findings were reviewed. Inclusion criteria: Subjects with colonoscopy done for screening, surveillance or evaluation of fecal occult blood (FOB) were included. Exclusion criteria: Colonoscopies with incomplete records or done for evaluation of symptoms were excluded.Results: Of 510 subjects who met the inclusion criteria 67.1% were females and 32.9% were males, with a mean age of 80.25 (range 75-99). Racial distribution was 76% African Americans (AA), 22% Hispanics (H) and 2% were Asian Americans (AsA). History of CRC was positive in 10% and 23.1% had history of advanced adenomas (AAd). 46/510 (9%) colonoscopies were done for evaluation of FOBT. Bowel preparation was good in 67.9%, suboptimal/fair in 22.3% and poor in 10% subjects. Colonoscopy was incomplete in 4.7% subjects. Advanced adenoma detection rate (ADR) was 19.4%, and 17.5% of subjects had 1 or 2 tubular adenomas. Subjects with prior history of AAd had ADR of 28% in comparison to subjects with no prior history of AAd or CRC (16.1%). ADR in AA (20.1%) and AsA was higher than in H 16.9%. Also in AA a higher proportion of advanced adenomas were detected in right side of colon (66.2%) in comparison to H who had equal distribution on both sides of colon. Combined CRC detection rate was 2%. CRC detection rates in subjects with prior AAd were significantly higher (4.3%) than those without prior AAd or CRC (1.2%). AA had a higher CRC detection rate (2.3%) than H (0.8%). There were no gender differences in ADR or CRC detection rates. Other findings were hemorrhoids 70.8%, diverticulosis 55.7%, AVM 2.9% and colitis 1.8%. Conclusion: ADR and CRC detection rates are higher in subjects with prior history of advanced adenomas and in African Americans in comparison to Hispanics. Elderly African Americans with history of advanced adenomas should be strongly considered for screening. African Americans have higher percentage of advanced adenomas on the right side, hence more likely to benefit from colonoscopy for CRC screening.
adenomas, the “de novo” carcinogenesis. The aim of our study is to evaluate the clinical and pathological natures of small depressed type colorectal lesions according to the period.[Methods] From April 1985 to June 2009, the 28272 colorectal neoplasms (⫽⬍20mm) were resected endoscopically or surgically in our hospital. We divided them into 2 groups; the lesions detected in Akita (April 1985 - March 2001) as ‘A’, and those in Yokohama (April 2001 - June 2009) as ‘B’. We retrospectively compared the submucosal invasive rate between A and B, according to the tumor size. We assorted the tumor size as follows; (a) ⬍⫽5mm, (b) 6-10mm, (c) 11-15mm, and (d) 16-20mm.[Results] The number of submucosal carcinomas was 262/16811 lesions in A and 373/11471 lesions in B. The submucosal invasive rate of depressed type neoplasms was 25.4% (119/469) in A, while that in B reached 61.6% (109/177). B showed a significantly higher invasive rate than A (P⬍0.01). The overall invasive rate of flat and protruded type neoplasms were 0.87% (143/16432) in A, and 2.8% (444/15585) in B. Breakdown of the submucosal invasive rate of depressed type lesions in A, according to their tumor size, were; (a) 8.4%, (b) 34.1%, (c) 57.8%, and (d) 73.7%. Those in B were; (a) 7.7%, (b) 57.1%, (c) 89.6%, and (d) 100%. B showed a significantly higher invasive rate in group (b), (c), and (d), than A (p⬍0.05). The annually-averaged number of the depressed submucosal carcinomas was 29.3 lesions in A and 22.4 lesions in B.[Conclusions] The rate of submucosal invasion in depressed type lesions has increased over the past decade. This leads to the suggestion that the wide-spread understanding of depressed lesions had made it possible to make precise diagnosis of the depressed lesions. Precise observation with magnifying colonoscopy is essential for assessing the depth of lesions and selecting an appropriate therapy.
W1467 Characteristics of Type 0-Is ⴙIIc Colorectal Neoplasms; Protruded Lesions Derived From Depressed Type Colorectal Neoplasms Shin-Ei Kudo, Yuichi Mori, Hideyuki Miyachi, Nobunao Ikehara, Fuyuhiko Yamamura, Kazuo Ohtsuka, Hiroshi Kashida, Shigeharu Hamatani Background & Aims: Depressed type colorectal neoplasms are considered to emerge directly from normal mucosa without going through adenomas, have a marked tendency to exhibit malignant characteristics and are considered to be de novo cancers. On the other hand, almost all protruded colorectal neoplasms are thought to develop through the “adenoma-carcinoma sequence”. However, there are some protruded lesions derived from depressd type lesions which are named type 0-Is ⫹ IIc lesions (Is⫹IIc). They develop from depressed type lesions and elevate as a result of submucosal invasion and desmoplastic reactions, and are often misclassified as normal protruded lesions. The aim of our study is to clarify the characteristics of Is ⫹IIc.Methods: The subjects were 2831 sessile protruded superficial colorectal neoplasms (⬍20mm) resected at our center from April 2001 to June 2009. The lesions were classified according to their form as viewed upon chromoendoscopy into type 0-Is lesions (Is) and Is⫹IIc. Is ⫹ IIc are defined as those having depressed areas and which are elevated above the surrounding normal mucosa. We compared the rate of VN pit pattern which is the sign of submucosal invasion in our classification, the rate of submucosal invasion, and the rate of nodal metastasis between Is and Is⫹IIc. Results: The number of Is were 2819 lesions (2111 cases), while that of Is⫹IIc were 12 lesions (12 cases). The rate of VN pit pattern, submucosal invasion, and nodal metastasis in Is were 0.5% (14/2819), 2.3% (65/2819), and 0.2% (5/2111). Those in Is⫹IIc were 75.0% (8/12), 100% (12/12), and 41.7% (5/12). Comparing the two groups, Is⫹IIc showed a significantly higher rate of VN pit pattern, submucosal invasion, and nodal metastasis (P⬍.01,P⬍.01,and P⬍.01 respectively).Conclusion: Is⫹IIc were similar to Is at a glance, but they showed a much more malignant nature than Is. they all had invaded the submucosal layer, and were indication for surgical operation. Chromoendoscopy is mandatory for an accurate diagnosis of these lesions. Therefore, we should not resect polyps without performing chromoendoscopy.
W1466 The Submucosal Invasive Rate of Depressed Type Colorectal Lesions Over the Past Decade Shin-Ei Kudo, Seiko Hayashi, Nobunao Ikehara, Fuyuhiko Yamamura, Hideyuki Miyachi, Kazuo Ohtsuka, Hiroshi Kashida, Shigeharu Hamatani, Hiro-O Yamano [Background & Aim] More than 20 years have passed since the 0-IIc lesion in the colorectum was first detected in 1985. Depressed type neoplasms are assumed to emerge directly from normal epithelium without going through a stage of
www.giejournal.org
Volume 71, No. 5 : 2010 GASTROINTESTINAL ENDOSCOPY AB335
W1465 Colonoscopy for CRC Screening in Asymptomatic Elderly African Americans, Hispanics and Asian Americans Shashideep Singhal, Puneet S. Basi, Siddharth Mathur, Manpreet Singh, Amir S. Butt, Mojdeh Momeni, Sury Anand Background: The United States Preventive Services Task Force (USPSTF) recommends against routine screening for colorectal cancer (CRC) in adults more than 75 years of age. There are limited studies on CRC screening in elderly population and minorities are often under-represented. This study is designed to determine considerations which can support screening colonoscopy in an individual patient of this specific racial group. Methods: 10,908 subjects who had colonoscopy during the study period were included. 1676 (15.4%) had age ⱖ 75 years at the time of colonoscopy. Demographics, colonoscopy characteristics and histopathology findings were reviewed. Inclusion criteria: Subjects with colonoscopy done for screening, surveillance or evaluation of fecal occult blood (FOB) were included. Exclusion criteria: Colonoscopies with incomplete records or done for evaluation of symptoms were excluded.Results: Of 510 subjects who met the inclusion criteria 67.1% were females and 32.9% were males, with a mean age of 80.25 (range 75-99). Racial distribution was 76% African Americans (AA), 22% Hispanics (H) and 2% were Asian Americans (AsA). History of CRC was positive in 10% and 23.1% had history of advanced adenomas (AAd). 46/510 (9%) colonoscopies were done for evaluation of FOBT. Bowel preparation was good in 67.9%, suboptimal/fair in 22.3% and poor in 10% subjects. Colonoscopy was incomplete in 4.7% subjects. Advanced adenoma detection rate (ADR) was 19.4%, and 17.5% of subjects had 1 or 2 tubular adenomas. Subjects with prior history of AAd had ADR of 28% in comparison to subjects with no prior history of AAd or CRC (16.1%). ADR in AA (20.1%) and AsA was higher than in H 16.9%. Also in AA a higher proportion of advanced adenomas were detected in right side of colon (66.2%) in comparison to H who had equal distribution on both sides of colon. Combined CRC detection rate was 2%. CRC detection rates in subjects with prior AAd were significantly higher (4.3%) than those without prior AAd or CRC (1.2%). AA had a higher CRC detection rate (2.3%) than H (0.8%). There were no gender differences in ADR or CRC detection rates. Other findings were hemorrhoids 70.8%, diverticulosis 55.7%, AVM 2.9% and colitis 1.8%. Conclusion: ADR and CRC detection rates are higher in subjects with prior history of advanced adenomas and in African Americans in comparison to Hispanics. Elderly African Americans with history of advanced adenomas should be strongly considered for screening. African Americans have higher percentage of advanced adenomas on the right side, hence more likely to benefit from colonoscopy for CRC screening.
adenomas, the “de novo” carcinogenesis. The aim of our study is to evaluate the clinical and pathological natures of small depressed type colorectal lesions according to the period.[Methods] From April 1985 to June 2009, the 28272 colorectal neoplasms (⫽⬍20mm) were resected endoscopically or surgically in our hospital. We divided them into 2 groups; the lesions detected in Akita (April 1985 - March 2001) as ‘A’, and those in Yokohama (April 2001 - June 2009) as ‘B’. We retrospectively compared the submucosal invasive rate between A and B, according to the tumor size. We assorted the tumor size as follows; (a) ⬍⫽5mm, (b) 6-10mm, (c) 11-15mm, and (d) 16-20mm.[Results] The number of submucosal carcinomas was 262/16811 lesions in A and 373/11471 lesions in B. The submucosal invasive rate of depressed type neoplasms was 25.4% (119/469) in A, while that in B reached 61.6% (109/177). B showed a significantly higher invasive rate than A (P⬍0.01). The overall invasive rate of flat and protruded type neoplasms were 0.87% (143/16432) in A, and 2.8% (444/15585) in B. Breakdown of the submucosal invasive rate of depressed type lesions in A, according to their tumor size, were; (a) 8.4%, (b) 34.1%, (c) 57.8%, and (d) 73.7%. Those in B were; (a) 7.7%, (b) 57.1%, (c) 89.6%, and (d) 100%. B showed a significantly higher invasive rate in group (b), (c), and (d), than A (p⬍0.05). The annually-averaged number of the depressed submucosal carcinomas was 29.3 lesions in A and 22.4 lesions in B.[Conclusions] The rate of submucosal invasion in depressed type lesions has increased over the past decade. This leads to the suggestion that the wide-spread understanding of depressed lesions had made it possible to make precise diagnosis of the depressed lesions. Precise observation with magnifying colonoscopy is essential for assessing the depth of lesions and selecting an appropriate therapy.
W1467 Characteristics of Type 0-Is ⴙIIc Colorectal Neoplasms; Protruded Lesions Derived From Depressed Type Colorectal Neoplasms Shin-Ei Kudo, Yuichi Mori, Hideyuki Miyachi, Nobunao Ikehara, Fuyuhiko Yamamura, Kazuo Ohtsuka, Hiroshi Kashida, Shigeharu Hamatani Background & Aims: Depressed type colorectal neoplasms are considered to emerge directly from normal mucosa without going through adenomas, have a marked tendency to exhibit malignant characteristics and are considered to be de novo cancers. On the other hand, almost all protruded colorectal neoplasms are thought to develop through the “adenoma-carcinoma sequence”. However, there are some protruded lesions derived from depressd type lesions which are named type 0-Is ⫹ IIc lesions (Is⫹IIc). They develop from depressed type lesions and elevate as a result of submucosal invasion and desmoplastic reactions, and are often misclassified as normal protruded lesions. The aim of our study is to clarify the characteristics of Is ⫹IIc.Methods: The subjects were 2831 sessile protruded superficial colorectal neoplasms (⬍20mm) resected at our center from April 2001 to June 2009. The lesions were classified according to their form as viewed upon chromoendoscopy into type 0-Is lesions (Is) and Is⫹IIc. Is ⫹ IIc are defined as those having depressed areas and which are elevated above the surrounding normal mucosa. We compared the rate of VN pit pattern which is the sign of submucosal invasion in our classification, the rate of submucosal invasion, and the rate of nodal metastasis between Is and Is⫹IIc. Results: The number of Is were 2819 lesions (2111 cases), while that of Is⫹IIc were 12 lesions (12 cases). The rate of VN pit pattern, submucosal invasion, and nodal metastasis in Is were 0.5% (14/2819), 2.3% (65/2819), and 0.2% (5/2111). Those in Is⫹IIc were 75.0% (8/12), 100% (12/12), and 41.7% (5/12). Comparing the two groups, Is⫹IIc showed a significantly higher rate of VN pit pattern, submucosal invasion, and nodal metastasis (P⬍.01,P⬍.01,and P⬍.01 respectively).Conclusion: Is⫹IIc were similar to Is at a glance, but they showed a much more malignant nature than Is. they all had invaded the submucosal layer, and were indication for surgical operation. Chromoendoscopy is mandatory for an accurate diagnosis of these lesions. Therefore, we should not resect polyps without performing chromoendoscopy.
W1466 The Submucosal Invasive Rate of Depressed Type Colorectal Lesions Over the Past Decade Shin-Ei Kudo, Seiko Hayashi, Nobunao Ikehara, Fuyuhiko Yamamura, Hideyuki Miyachi, Kazuo Ohtsuka, Hiroshi Kashida, Shigeharu Hamatani, Hiro-O Yamano [Background & Aim] More than 20 years have passed since the 0-IIc lesion in the colorectum was first detected in 1985. Depressed type neoplasms are assumed to emerge directly from normal epithelium without going through a stage of
www.giejournal.org
Volume 71, No. 5 : 2010 GASTROINTESTINAL ENDOSCOPY AB335