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W1555: Screening of Symptomatic (SOS) Approach for Colorectal Cancer Screening Above Age 75 in African Americans, Hispanics and Asian Americans
Abstracts 2008 and 2009, there were 872 subjects from 36 companies. The systemic administration of antispastic agent and sedative were not required. We converted a truck (4t) to the medical examination vehicle for transnasal endoscopy that had two examination rooms with two beds. This type of examination vehicle is not only the first of its kind in Japan, but also the first in the world. Results: According to our questionnaire results, we got a favorable reception: 98% considered the examination vehicle convenient, and 86% said they would select the transnasal endoscopy for future upper GI cancer medical checkup. All examinations were safely completed without significant complications. Conclusions: Mobile transnasal endoscopy is a safe, painless and convenient method for medical checkup examinations. Visiting companies directly to perform endoscopies in an examination vehicle may be able to increase the productivity of companies by reducing restrictions to their employees. As a result, we consider that the examination vehicle with transnasal endoscopy is beneficial for patients and companies as well as hospitals. We would like to actively perform more transnasal endoscopies to increase the early detection rate of upper GI cancers as well as the number of cases that are identified as being endoscopically treatable.
health subjects had same-day BDE with undergoing an initial 1-time I-FOBT between August 2007 and July 2009.Main Outcome Measurements: Age, sex, medications, personal habits, H. pylori status, hemogram, I-FOBT results and the significant endoscopic findings pertinent to gastrointestinal hemorrhage were analyzed. Results: A total of 397 subjects (14.2%) had positive I-FOBT with a mean age of 50.5 years. The majority of subjects with positive I-FOBT were males (61.5%). Forty-six of 233 subjects with positive I-FOBT and negative colonoscopy were identified as EGD-positive, including 1 angiodysplasia and 45 peptic ulcer diseases. The clinical significant predictors for positive-EGD are older age, H. pylori infection, low hemoglobin level and alcohol consumption. The specificity and negative predictive value of positive-EGD were 75.4% and 90.4% for H. pylori infection; 90.4% and 82.8% for low hemoglobin level; 78.1% and 83.4% for alcohol consumption. The area under the curve of accumulation receiver operating characteristic of age, H. pylori, low hemoglobin and alcohol consumption was 0.801.Limitation: Sampling bias associated with self-referred, hospital-based design.Conclusion: EGD is advisable for health screening subjects at the age of 50 years or older, H pylori infection, low hemoglobin level, and alcohol consumption, if they have positive I-FOBT and negative colonoscopy. Peptic ulcer disease is the most common EGD finding in this group.
W1555 Screening of Symptomatic (SOS) Approach for Colorectal Cancer Screening Above Age 75 in African Americans, Hispanics and Asian Americans Shashideep Singhal, Siddharth Mathur, Puneet S. Basi, Amir S. Butt, Manpreet Singh, Niket Sonpal, Mojdeh Momeni, Sury Anand
W1553 Diagnostic Yield of Endoscopic Studies in Patients With Cancer of Unknown Primary Daniel Tobal, Federico Tobal BACKGROUND: Cancer of unknown primary accounts for 10% of cancer diagnosis. Most of them arise from lung or pancreas. The initial diagnostic strategy does not include endoscopic studies for upper and lower digestive tract. However, gastroenterologists are commonly asked to perform endoscopic studies in patients with cancer of unknown primary without digestive symptoms, and the yield of endoscopic studies in this group of patients is not well established. AIM: To assess whether endoscopic studies in patients with cancer of unknown primary without digestive symptoms have clinical benefits.PATIENTS AND METHODS: Cross sectional survey of consecutive patients referred to our endoscopic center to perform upper endoscopy, colonoscopy or both because of cancer of unknown primary. Patients with dysphagia, hematochezia, melena, anemia, positive fecal occult blood test, personal or family history of gastrointestinal cancer and imaging study suggesting gastrointestinal abnormality were excluded. A positive finding was defined as digestive cancer confirmed by histopathological analysis. RESULTS: Eighty one studies (45 upper endoscopies and 36 colonoscopies) were performed in the 60 patients included (29 males and 31 females, mean age 63.9 ⫾ 16 yrs). In 21 patients both studies were performed, whereas upper endoscopy alone was realized in 24 and colonoscopy alone in 15 patients. Positive findings were evidenced in 8/45 (17%) upper endoscopies and 3/36 (8%) colonoscopies. In the group of patients with upper gastrointestinal malignancy 6 had gastric and 2 duodenal cancer (2M/6F, mean age 63 yrs.), while the 3 patients with lower gastrointestinal malignancy had colorectal cancer (1M/2F, mean age 62 yrs.). It is important to note that 4 of the 8 upper gastrointestinal malignancies occurred in patients under 55 years old, and 3 of them were women. CONCLUSION: In this study, the diagnostic yield of endoscopic studies in patients with cancer of unknown primary without digestive symptoms is low. These results are consistent with the initial diagnostic strategy suggested in this group of patients. However, the finding of upper gastrointestinal cancers in patients under 55 years old with female predominance might be evaluated in larger studies.
W1554 Clinical Predictors of Significant Esophagogastroduodenoscopy Findings for Asymptomatic Subjects With Positive Immunochemical Fecal Occult Blood Test and Negative Colonoscopy Tsung-Hsien Chiang, Chia-Hung Tu, Yi-Chia Lee, Ming-Shiang Wu Background: Immunochemical fecal occult blood test (I-FOBT) and subsequent bidirectional endoscopy (BDE) is commonly employed for health screening.Objective: Our purpose was to determine the necessity of esophagogastroduodenoscopy (EGD) for subjects with negative results of colonoscopy after undergoing an initial positive I-FOBT.Design: Prospective, cross-sectional study.Setting: One-institutional study.Patients: A total of 2796
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Background: Colorectal cancer (CRC) screening guidelines have suggested against routine screening above age 75. Considerations that support colorectal cancer screening in an individual patient are not well elucidated in this racial subset of elderly. The study objective is to determine yield of colonoscopies in symptomatic elderly and determine factors associated with positive outcomes in minority.Methods: Study included 10,908 subjects who had colonoscopy during the study period. Records of 1676 (15.4%) with age ⱖ 75 years were further reviewed for demographics, colonoscopy characteristics and histopathology findings. Subjects with presence of one or more “generally indicated” indications as per ASGE guidelines were included in study. Colonoscopies with incomplete records were excluded.Results: 986 subjects met the inclusion criteria (Mean age 82.5 years, 65.2% females and 34.8% males). African Americans (AA) constituted 79.8%, Hispanics (H) 14.6% and Asian Americans (As) 5.6%, of the study population. 3.7% had colon resection for CRC in past. Indications for colonoscopy were hematochezia in 40.1%, anaemia in 25.3%, constipation in 8.7%, abnormal CT scan 6.2%, abdominal pain 5.9%, weight loss 2.9% and diarrhea 2.6%. Subjects presenting with both hematochezia and anemia were 7.4% while 0.9% had co-existing anemia and weight loss. Fecal occult blood test (FOBT) was positive in 7.2% of subjects in addition to one of above symptoms. Bowel preparation was good in 51.4%, suboptimal in 25.2% and poor in23.3%. Colonoscopy could not be completed to cecum in 15.8% subjects. Advanced adenoma detection (ADR) rate was 11% (108/986), while 9.7% (96/986) had 1 or 2 tubular adenomas. Of the various indications evaluated, anemia was found to be predictive of advanced adenomas (odds ratio [OR] 1.34 [95% CI, 0.8-2.0], P ⬍ .05). CRC detection rate was 5.2% (51/986) in the study population, which was 2.5 times higher than CRC detection rate during screening colonoscopies in asymptomatic matched controls. Presence of anemia (OR 1.01 [95% CI, 0.5-1.9], P ⬍ .05) and abnormal CT scan (OR 4.2 [95% CI, 2-8.9], P ⬍ .001) were found to be predictors of CRC. Other findings were diverticulosis in 61.9%, hemorrhoids in 56.4%, colitis in 7.9%, AVM in 3% and ulcers in 3%.Conclusions: Screening of Symptomatic (SOS) can be a helpful approach for CRC screening in elderly (age ⱖ 75 years). Presence of anemia is a predictor for both advanced adenoma and CRC in this population, while abnormal CT scan is a strong predictor of CRC. Screening decisions can be individualized based on symptoms in this subset.
W1556 Comparison of a Narrow Band Imaging and Targeted Biopsies Protocol With White Light Endoscopy and the Updated Sydney Protocol for Detection of Gastric Pre-Neoplastic Lesions (MEGANE Study) Elias Xirouchakis, Sotirios D. Georgopoulos, Chariklia A. Spiliadi, Fotini Laoudi, Panagiotis Christoforidis, Lemonia Tsartsali Introduction: Accurate assessment of gastric lesions is crucial for therapeutic and prognostic reasons. Several studies indicate that the new endoscopic method of Narrow band imaging (NBI) can discriminate accurately normal mucosa from gastritis but pre neoplastic lesions (PNL) like atrophy and intestinal metaplasia (IM) are more difficult to detect especially in the early stages.Aims and Methods: Our aim was to compare white light endoscopy and histopathologic findings using the updated Sydney protocol (USP) with NBI findings and targeted biopsies in symptomatic patients referred to our unit for upper GI endoscopy.
Volume 71, No. 5 : 2010 GASTROINTESTINAL ENDOSCOPY AB357
health subjects had same-day BDE with undergoing an initial 1-time I-FOBT between August 2007 and July 2009.Main Outcome Measurements: Age, sex, medications, personal habits, H. pylori status, hemogram, I-FOBT results and the significant endoscopic findings pertinent to gastrointestinal hemorrhage were analyzed. Results: A total of 397 subjects (14.2%) had positive I-FOBT with a mean age of 50.5 years. The majority of subjects with positive I-FOBT were males (61.5%). Forty-six of 233 subjects with positive I-FOBT and negative colonoscopy were identified as EGD-positive, including 1 angiodysplasia and 45 peptic ulcer diseases. The clinical significant predictors for positive-EGD are older age, H. pylori infection, low hemoglobin level and alcohol consumption. The specificity and negative predictive value of positive-EGD were 75.4% and 90.4% for H. pylori infection; 90.4% and 82.8% for low hemoglobin level; 78.1% and 83.4% for alcohol consumption. The area under the curve of accumulation receiver operating characteristic of age, H. pylori, low hemoglobin and alcohol consumption was 0.801.Limitation: Sampling bias associated with self-referred, hospital-based design.Conclusion: EGD is advisable for health screening subjects at the age of 50 years or older, H pylori infection, low hemoglobin level, and alcohol consumption, if they have positive I-FOBT and negative colonoscopy. Peptic ulcer disease is the most common EGD finding in this group.
W1555 Screening of Symptomatic (SOS) Approach for Colorectal Cancer Screening Above Age 75 in African Americans, Hispanics and Asian Americans Shashideep Singhal, Siddharth Mathur, Puneet S. Basi, Amir S. Butt, Manpreet Singh, Niket Sonpal, Mojdeh Momeni, Sury Anand
W1553 Diagnostic Yield of Endoscopic Studies in Patients With Cancer of Unknown Primary Daniel Tobal, Federico Tobal BACKGROUND: Cancer of unknown primary accounts for 10% of cancer diagnosis. Most of them arise from lung or pancreas. The initial diagnostic strategy does not include endoscopic studies for upper and lower digestive tract. However, gastroenterologists are commonly asked to perform endoscopic studies in patients with cancer of unknown primary without digestive symptoms, and the yield of endoscopic studies in this group of patients is not well established. AIM: To assess whether endoscopic studies in patients with cancer of unknown primary without digestive symptoms have clinical benefits.PATIENTS AND METHODS: Cross sectional survey of consecutive patients referred to our endoscopic center to perform upper endoscopy, colonoscopy or both because of cancer of unknown primary. Patients with dysphagia, hematochezia, melena, anemia, positive fecal occult blood test, personal or family history of gastrointestinal cancer and imaging study suggesting gastrointestinal abnormality were excluded. A positive finding was defined as digestive cancer confirmed by histopathological analysis. RESULTS: Eighty one studies (45 upper endoscopies and 36 colonoscopies) were performed in the 60 patients included (29 males and 31 females, mean age 63.9 ⫾ 16 yrs). In 21 patients both studies were performed, whereas upper endoscopy alone was realized in 24 and colonoscopy alone in 15 patients. Positive findings were evidenced in 8/45 (17%) upper endoscopies and 3/36 (8%) colonoscopies. In the group of patients with upper gastrointestinal malignancy 6 had gastric and 2 duodenal cancer (2M/6F, mean age 63 yrs.), while the 3 patients with lower gastrointestinal malignancy had colorectal cancer (1M/2F, mean age 62 yrs.). It is important to note that 4 of the 8 upper gastrointestinal malignancies occurred in patients under 55 years old, and 3 of them were women. CONCLUSION: In this study, the diagnostic yield of endoscopic studies in patients with cancer of unknown primary without digestive symptoms is low. These results are consistent with the initial diagnostic strategy suggested in this group of patients. However, the finding of upper gastrointestinal cancers in patients under 55 years old with female predominance might be evaluated in larger studies.
W1554 Clinical Predictors of Significant Esophagogastroduodenoscopy Findings for Asymptomatic Subjects With Positive Immunochemical Fecal Occult Blood Test and Negative Colonoscopy Tsung-Hsien Chiang, Chia-Hung Tu, Yi-Chia Lee, Ming-Shiang Wu Background: Immunochemical fecal occult blood test (I-FOBT) and subsequent bidirectional endoscopy (BDE) is commonly employed for health screening.Objective: Our purpose was to determine the necessity of esophagogastroduodenoscopy (EGD) for subjects with negative results of colonoscopy after undergoing an initial positive I-FOBT.Design: Prospective, cross-sectional study.Setting: One-institutional study.Patients: A total of 2796
www.giejournal.org
Background: Colorectal cancer (CRC) screening guidelines have suggested against routine screening above age 75. Considerations that support colorectal cancer screening in an individual patient are not well elucidated in this racial subset of elderly. The study objective is to determine yield of colonoscopies in symptomatic elderly and determine factors associated with positive outcomes in minority.Methods: Study included 10,908 subjects who had colonoscopy during the study period. Records of 1676 (15.4%) with age ⱖ 75 years were further reviewed for demographics, colonoscopy characteristics and histopathology findings. Subjects with presence of one or more “generally indicated” indications as per ASGE guidelines were included in study. Colonoscopies with incomplete records were excluded.Results: 986 subjects met the inclusion criteria (Mean age 82.5 years, 65.2% females and 34.8% males). African Americans (AA) constituted 79.8%, Hispanics (H) 14.6% and Asian Americans (As) 5.6%, of the study population. 3.7% had colon resection for CRC in past. Indications for colonoscopy were hematochezia in 40.1%, anaemia in 25.3%, constipation in 8.7%, abnormal CT scan 6.2%, abdominal pain 5.9%, weight loss 2.9% and diarrhea 2.6%. Subjects presenting with both hematochezia and anemia were 7.4% while 0.9% had co-existing anemia and weight loss. Fecal occult blood test (FOBT) was positive in 7.2% of subjects in addition to one of above symptoms. Bowel preparation was good in 51.4%, suboptimal in 25.2% and poor in23.3%. Colonoscopy could not be completed to cecum in 15.8% subjects. Advanced adenoma detection (ADR) rate was 11% (108/986), while 9.7% (96/986) had 1 or 2 tubular adenomas. Of the various indications evaluated, anemia was found to be predictive of advanced adenomas (odds ratio [OR] 1.34 [95% CI, 0.8-2.0], P ⬍ .05). CRC detection rate was 5.2% (51/986) in the study population, which was 2.5 times higher than CRC detection rate during screening colonoscopies in asymptomatic matched controls. Presence of anemia (OR 1.01 [95% CI, 0.5-1.9], P ⬍ .05) and abnormal CT scan (OR 4.2 [95% CI, 2-8.9], P ⬍ .001) were found to be predictors of CRC. Other findings were diverticulosis in 61.9%, hemorrhoids in 56.4%, colitis in 7.9%, AVM in 3% and ulcers in 3%.Conclusions: Screening of Symptomatic (SOS) can be a helpful approach for CRC screening in elderly (age ⱖ 75 years). Presence of anemia is a predictor for both advanced adenoma and CRC in this population, while abnormal CT scan is a strong predictor of CRC. Screening decisions can be individualized based on symptoms in this subset.
W1556 Comparison of a Narrow Band Imaging and Targeted Biopsies Protocol With White Light Endoscopy and the Updated Sydney Protocol for Detection of Gastric Pre-Neoplastic Lesions (MEGANE Study) Elias Xirouchakis, Sotirios D. Georgopoulos, Chariklia A. Spiliadi, Fotini Laoudi, Panagiotis Christoforidis, Lemonia Tsartsali Introduction: Accurate assessment of gastric lesions is crucial for therapeutic and prognostic reasons. Several studies indicate that the new endoscopic method of Narrow band imaging (NBI) can discriminate accurately normal mucosa from gastritis but pre neoplastic lesions (PNL) like atrophy and intestinal metaplasia (IM) are more difficult to detect especially in the early stages.Aims and Methods: Our aim was to compare white light endoscopy and histopathologic findings using the updated Sydney protocol (USP) with NBI findings and targeted biopsies in symptomatic patients referred to our unit for upper GI endoscopy.
Volume 71, No. 5 : 2010 GASTROINTESTINAL ENDOSCOPY AB357