J. Lucas Williams

Race, Ethnicity, and Sex Affect Risk for Polyps >9 mm in Average-Risk Individuals

BACKGROUND & AIMS Colorectal cancer risk differs based on patient demographics. We aimed to measure the prevalence of significant colorectal polyps in average-risk individuals and to determine differences based on age, sex, race, or ethnicity. METHODS In a prospective study, colonoscopy data were collected, using an endoscopic report generator, from 327,785 average-risk adults who underwent colorectal cancer screening at 84 gastrointestinal practice sites from 2000 to 2011. Demographic characteristics included age, sex, race, and ethnicity. The primary outcome was the presence of suspected malignancy or large polyp(s) >9 mm. The benchmark risk for age to initiate screening was based on white men, 50-54 years old. RESULTS Risk of large polyps and tumors increased progressively in men and women with age. Women had lower risks than men in every age group, regardless of race. Blacks had higher risk than whites from ages 50 through 65 years and Hispanics had lower risk than whites from ages 50 through 80 years. The prevalence of large polyps was 6.2% in white men 50-54 years old. The risk was similar among the groups of white women 65-69 years old, black women 55-59 years old, black men 50-54 years old, Hispanic women 70-74 years old, and Hispanic men 55-59 years old. The risk of proximal large polyps increased with age, female sex, and black race. CONCLUSIONS There are differences in the prevalence and location of large polyps and tumors in average-risk individuals based on age, sex, race, and ethnicity. These findings could be used to select ages at which specific groups should begin colorectal cancer screening.

Epidemiologic characteristics of patients with inflammatory bowel disease undergoing colonoscopy

Background: The aim was too describe the demographic characteristics of patients with inflammatory bowel disease (IBD) undergoing colonoscopy. Methods: The Clinical Outcomes Research Initiative (CORI) maintains a database of endoscopic procedures in diverse clinical practices distributed throughout the US. The data from 2000‐2007 were used to analyze the demographic characteristics of patients with Crohns disease (CD) and ulcerative colitis (UC). Results: During the period 2000‐2007, 4631 patients with CD and 6619 patients with UC were compared to a control population of 826,207 patients without IBD. CD and UC patients were significantly (P < 0.0001) younger than controls: 41.7 ± 18.4, 47.3 ± 17.4, 59.2 ± 14.0 years, respectively. CD and UC were less common among nonwhite than white endoscopy patients: odds ratio (OR) = 0.64 (0.58‐0.70) for CD and OR = 0.71 (0.66‐0.77) for UC. Endoscopy for IBD was only slightly less common among female than male CD patients (0.94, 0.89‐1.00), but significantly less common among female than male UC patients (0.72, 0.68‐0.75). Compared with community/private practices, relatively more endoscopies were performed among IBD patients in academic institutions: OR = 1.68 (1.56‐1.81) for CD and OR = 1.27 (1.19‐1.36) for UC. The race‐, sex‐, and age‐adjusted rates of CD and UC were both significantly higher in the northern than southern regions of the US, with a significant correlation of r = 0.89, degrees of freedom = 4, P = 0.017 between the geographic distributions of the two diagnoses. Conclusions: The endoscopy patterns of IBD patients may be influenced in part by the epidemiology of these two diagnoses, as well as by underlying trends in the utilization of colonoscopy. (Inflamm Bowel Dis 2011;)

Practice patterns of sedation for colonoscopy

BACKGROUND Sedative and analgesic medications have been used routinely for decades to provide patient comfort, reduce procedure time, and improve examination quality during colonoscopy. OBJECTIVE To evaluate trends of sedation during colonoscopy in the United States. SETTING Endoscopic data repository of U.S. gastroenterology practices (Clinical Outcomes Research Initiative, CORI database from 2000 until 2013). PATIENTS The study population was made up of patients undergoing a total of 1,385,436 colonoscopies. INTERVENTIONS Colonoscopy without any intervention or with mucosal biopsy, polypectomy, various means of hemostasis, luminal dilation, stent placement, or ablation. MAIN OUTCOME MEASUREMENTS Dose of midazolam, diazepam, fentanyl, meperidine, diphenhydramine, promethazine, and propofol used for sedation during colonoscopy. RESULTS During the past 14 years, midazolam, fentanyl, and propofol have become the most commonly used sedatives for colonoscopy. Except for benzodiazepines, which were dosed higher in women than men, equal doses of sedation were given to female and male patients. White patients were given higher doses than other ethnic groups undergoing sedation for colonoscopy. Except for histamine-1 receptor antagonists, all sedative medications were given at lower doses to patients with increasing age. The dose of sedatives was higher in colonoscopies associated with procedural interventions or of long duration. LIMITATIONS Potential for incomplete or incorrect documentation in the database. CONCLUSION The findings reflect on colonoscopy practice in the United States during the last 14 years and provide an incentive for future research on how sex and ethnicity influence sedation practices.

Diagnostic yield of colonoscopy to evaluate melena after a nondiagnostic EGD

BACKGROUND Melena can be caused by bleeding from lower GI sources. Colonoscopy is frequently used to investigate melena after a nondiagnostic EGD. OBJECTIVE To determine the diagnostic yield and rate of therapeutic intervention during colonoscopy in patients with melena and a nondiagnostic EGD. DESIGN Retrospective case-control study. SETTING Community and academic centers over a diverse geographic area in the United States. PATIENTS This study involved patients in the Clinical Outcomes Research Initiative database with a colonoscopy performed to investigate melena within 30 days of a nondiagnostic EGD for the same indication. A control group had colonoscopies performed for average-risk screening. MAIN OUTCOME MEASUREMENTS The endoscopic finding of a suspected bleeding source defined as right-sided arteriovenous malformation, colitis, polyp ≥ 20 mm, tumor, or ulcer. Rate of therapeutic intervention during colonoscopy. RESULTS Colonoscopy found a suspected bleeding source in 4.8% of patients with melena, more frequently than in the control group (odds ratio [OR] 2.17; 95% confidence interval [CI], 1.65-2.86; P < .0001). The rate of therapeutic intervention during melena-related colonoscopy was 1.7%. Patients with melena were more likely to have a colon tumor (OR 2.87; 95% CI, 1.82-5.51; P < .0001) than were control patients. LIMITATIONS Retrospective design, conclusions being dependent on the accuracy of database input, and lack of pertinent clinical data (eg, hemoglobin). CONCLUSION The diagnostic yield of colonoscopy to investigate melena after nondiagnostic EGD is low. The need for therapeutic intervention during colonoscopy for this indication is very low. This population should undergo colonoscopy because they are at increased risk of colorectal cancer. Colonoscopy can potentially be performed electively in stable patients without continued bleeding.