Joseph C Anderson

Factors that predict incomplete colonoscopy: thinner is not always better

Abstract OBJECTIVE: The aim of this study was to determine whether anatomic factors such as body mass index (BMI) impacts the success rate of cecal intubation during colonoscopy. METHODS: We retrospectively reviewed the cecal intubation rate of 2000 colonoscopies performed at our institution from March 1997 to March 1999. The analysis sample was composed of charts for all incomplete procedures and a sample (23%) of complete examinations that were randomly selected. Data collected included age, gender, height, weight, bowel habits, abdominal surgery, psychiatric medication use, the presence of diverticular disease, amount of sedation administered, and location and reason for halting the examination. Patients were divided by BMI: thin (BMI ≤22.1), average weight (BMI >22.1–25.0), overweight (BMI = 25.1–29.9), and obese (BMI >30). RESULTS: Colonoscopies in women had a lower adjusted completion rate (94.8%) than in men (98.2%) (p CONCLUSIONS: Women with a low BMI (especially

Reduction of False Positives by Internal Features for Polyp Detection in CT-Based Virtual Colonoscopy

In this paper, we present a computer-aided detection (CAD) method to extract and use internal features to reduce false positive (FP) rate generated by surface-based measures on the inner colon wall in computed tomographic (CT) colonography. Firstly, a new shape description global curvature, which can provide an overall shape description of the colon wall, is introduced to improve the detection of suspicious patches on the colon wall whose geometrical features are similar to that of the colonic polyps. By a ray-driven edge finder, the volume of each detected patch is extracted as a fitted ellipsoid model. Within the ellipsoid model, CT image density distribution is analyzed. Three types of (geometrical, morphological, and textural) internal features are extracted and applied to eliminate the FPs from the detected patches. The presented CAD method was tested by a total of 153 patient datasets in which 45 patients were found with 61 polyps of sizes 4-30 mm by optical colonoscopy. For a 100% detection sensitivity (on polyps), the presented CAD method had an average FPs of 2.68 per patient dataset and eliminated 93.1% of FPs generated by the surface-based measures. The presented CAD method was also evaluated by different polyp sizes. For polyp sizes of 10-30 mm, the method achieved mean number of FPs per dataset of 2.0 with 100% sensitivity. For polyp sizes of 4-10 mm, the method achieved 3.44 FP per dataset with 100% sensitivity.

Prevalence of Colorectal Neoplasia in Smokers

OBJECTIVES:Smoking has been linked with colorectal neoplasia. Previous colonoscopy screening studies have omitted smoking and have examined only gender, age, and family history. Our aim was to use a screening population to measure the prevalence of neoplasia in smokers, the anatomic location of these lesions, and the strength of this association relative to other risk factors.METHODS:Data collected from the charts of 1988 screening colonoscopy patients included colonic findings, histology, risk factors for colorectal neoplasia, and smoking pattern. Current smokers were defined as those who had smoked more than 10 pack-years and were currently smoking or who had quit within the past 10 yr. Our outcomes were any adenomatous lesion and significant colonic neoplasia, which included adenocarcinoma, high grade dysplasia, villous tissue, large (>1 cm) adenomas, and multiple (more than two) adenomas.RESULTS:Multivariate analysis revealed that current smokers were more likely to have any adenomatous lesion (odds ratio [OR] = 1.89; 95% CI = 1.42–2.51; p < 0.001) as well as significant neoplasia (OR = 2.26; 95% CI = 1.56–3.27; p < 0.001) than those who had never smoked. The increased risk for smokers was predominantly for left-sided neoplasia. The risk for significant neoplasia was greater for smokers than for patients with a family history of colorectal cancer (OR = 1.20; 95% CI = 0.75–1.92; p > 0.05).CONCLUSIONS:Smoking is a significant risk factor for colorectal neoplasia in a screening population, especially for significant left-sided lesions. In our sample population, smoking posed a greater risk than family history of colorectal cancer.

A prospective randomized placebo-controlled double-blinded pilot study of misoprostol rectal suppositories in the prevention of acute and chronic radiation proctitis symptoms in prostate cancer patients

OBJECTIVE:Radiation proctitis is a known complication of radiation therapy for prostate cancer. Available medical treatment is usually ineffective and has focused on relieving symptoms after damage has occurred. Our study aimed at evaluating the use of misoprostol rectal suppositories in the prevention of acute as well as chronic radiation proctitis symptoms.METHODS:A prospective, randomized, placebo-controlled, double-blinded trial was conducted in patients with recently diagnosed stages B and C prostate cancer who underwent external beam irradiation. Patients received either a misoprostol or a placebo suppository 1 h before each radiation session. Misoprostol suppositories were made from two 200-μg tablets (Cytotec, Searle Pharmaceuticals, Skokie, IL), whereas the placebo was made from cocoa butter. A 12-point radiation proctitis symptom score was obtained from each patient at 4, 8, 12, and 36 wk after radiation therapy.RESULTS:A total of 16 patients were enrolled. Seven patients received placebo, and nine patients received misoprostol. Mean radiation proctitis symptom scores in the placebo group were 4.86, 5.86, 5.71, and 3.83 at 4, 8, 12, and 36 wk, respectively. The mean scores in the misoprostol group were 0.78, 0.67, 0.33, and 0.37 at 4, 8, 12, and 36 wk, respectively. The difference between the two groups was statistically significant (p < 0.05) at 4, 8, 12, and 36 wk.CONCLUSIONS:Misoprostol rectal suppositories significantly reduce acute and chronic radiation proctitis symptoms in patients receiving radiation therapy for prostate cancer.

Prevalence and risk of colorectal neoplasia in consumers of alcohol in a screening population.

BACKGROUND AND AIMS:Although studies suggest a positive association between alcohol consumption and risk for colorectal neoplasia, the impact on screening has not been fully examined. It is also unclear whether all types of alcohol are associated with an increased risk. We performed a cross-sectional study to examine the impact of regular alcohol consumption on the detection of significant colorectal neoplasia in a screening population.METHODS:Data collected for 2,291 patients presenting for screening colonoscopy: known risk factors for colorectal neoplasia and alcohol drinking pattern. Our outcome was the endoscopic detection of significant colorectal neoplasia, which included adenocarcinoma, high-grade dysplasia, villous tissue, adenomas 1 cm or greater and multiple (>2) adenomas of any size.RESULTS:When compared to abstainers, we found an increased risk for significant neoplasia in those patients who consumed more than eight drinks of spirits alcohol (26.3%; OR = 2.53; 95% CI = 1.10–4.28; p < 0.01) and those who drank more than eight servings of beer per week (21.7%; OR = 2.43; 95% CI = 1.11–5.32; p= 0.02). Consuming one to eight glasses of wine per week was associated with a decreased risk for significant neoplasia (OR = 0.55; 95% CI = 0.34–0.87; p < 0.01).CONCLUSIONS:While there was a more than twofold increased risk of significant colorectal neoplasia in people who drink spirits and beer, people who drank wine had a lower risk. In our sample, people who drank more than eight servings of beer or spirits per week had at least a one in five chance of having significant colorectal neoplasia detected by screening colonoscopy.

Predictors of proximal neoplasia in patients without distal adenomatous pathology

BACKGROUND:Previous colorectal cancer screening studies have observed that some patients may have advanced proximal neoplasia without distal findings. Since these studies have included only gender, age, and family history as risk factors, they are limited in their ability to identify predictors of isolated proximal neoplasia.METHODS:Data were collected from the charts of 1,988 patients who presented for colonoscopy. Information gathered included endoscopic findings, histology, known risk factors for colorectal neoplasia, and smoking pattern. Our main outcome was the presence of proximal adenomatous neoplasia in patients who had no distal adenomas. We defined significant neoplasia as adenocarcinoma, high-grade dysplasia, villous polyps, adenomas 1 cm or greater or more than two adenomas of any size.RESULTS:Fifty-five patients had isolated significant proximal neoplasia that would have been missed on a flexible sigmoidoscopy. While patients older than 60 yr had a greater risk for this neoplasia (odds ratio = 3.01: 95% CI = 1.66–4.23; p < 0.001), those who took a daily aspirin had a reduced risk (OR = 0.60; 95% CI = 0.30–0.88; p < 0.05). A family history of colorectal cancer increased the patients risk of having any adenomas (OR = 2.01; 95% CI = 1.33–3.40; p < 0.01) or villous tissue (OR = 2.03; 95% CI = 1.27–3.51; p < 0.05) in the proximal colon without distal findings. Smoking was associated with an increased risk of large (> 1 cm) isolated proximal tubular polyps (OR = 2.71; 95% CI = 1.64–4.46; p < 0.01) as well as isolated significant proximal neoplasia (OR = 2.30; 95% CI = 1.59–3.31; p < 0.01).CONCLUSIONS:Age greater than 60 yr, a history of at least 10 pack-years of smoking, and a family history of colorectal cancer increased the risk of finding significant proximal polyps in patients without distal pathology.

Body mass index as a predictor of colorectal neoplasia in ethnically diverse screening population.

BackgroundRecent guidelines from the American College of Gastroenterology for screening for colorectal cancer have included obesity as an important risk factor. The recommendation for screening obese people at earlier age was tempered by the need for more data regarding obesity and colorectal neoplasia.AimsWe designed a cross-sectional study to further examine the predictive value of obesity for colorectal adenomas in asymptomatic patients.MethodsWe prospectively collected demographic, medical, lifestyle, and dietary history from asymptomatic patients presenting for screening colonoscopy. Patients underwent complete colonoscopy using high-definition colonoscope to detect colorectal adenomas. We defined advanced neoplasia as large (≥1xa0cm) adenoma, villous adenoma, high-grade dysplasia or cancer.ResultsSix hundred patients with median age of 56xa0years completed the study. Over 40% of these patients did not consider themselves Caucasian, and less than 5% had a first-degree relative with colorectal cancer. Overall, 40 patients (6.7%) had advanced neoplasia and 216 (36.3%) had any adenoma. There were 185 obese patients (30.8%), who had a prevalence of 44.3% for any adenoma and 13.0% for advanced neoplasia. After multivariate analysis, obesity [body mass index (BMI)xa0≥xa030xa0kg/m2] was significantly associated with increased risk of advanced neoplasia [odds ratio (OR)xa0=xa03.83; 95% confidence interval (CI): 1.94–7.55].ConclusionsObesity was associated with advanced neoplasia in this screening population. Our data regarding the association of colorectal neoplasia with this modifiable risk factor has implications for screening and prevention of colorectal cancer.

Delivering colonoscopy screening for low-income populations in Suffolk County: strategies, outcomes, and benchmarks.

Current and pending legislation provides colorectal cancer screening reimbursement for previously uninsured populations. Colonoscopy is currently the screening method most frequently recommended by physicians for insured patients. The experience of the SCOPE (Suffolk County Preventive Endoscopy) demonstration project (Project SCOPE) at Stony Brook University Medical Center provides a model for delivering colonoscopy screening to low‐income populations to meet anticipated increasing demands.

Computer-aided detection and diagnosis of colon polyps with morphological and texture features

In this paper, we propose a new technique to utilize both the morphological and the texture information of the colon wall for detection of colonic polyps. Firstly this method can quickly identify suspicious patches of the colon wall by employing special local and global geometrical information, different from other methods of utilizing local geometry only. By our edge-detection technology, the growing region of suspected polyps is identified and its internal textures are quantitatively analyzed based on an assumed ellipsoid polyp model. Both the extracted texture and morphological information are then applied to eliminate the false positives from the identified suspicious patches. With all the extracted geometrical, morphological and texture features, this presented computer-aided detection method have demonstrated significant improvement in detection of the colonic polyps for virtual colonoscopy.

A pilot study on less-stressful bowel preparation for virtual colonoscopy screening with follow-up biopsy by optical colonoscopy

Objective: To investigate a less stressful bowel preparation for polyp screening by virtual colonoscopy (VC) with follow-up biopsy on the positive findings by optical colonoscopy (OC). Materials and Methods: Fifty-eight volunteers of age older than 40 -- receiving low-residue diet and laxatives of magnesium citrate, bisacodyl tablets and suppository -- were divided into three groups. In Group I, 16 volunteers took three 40cc oral doses of MD-Gastroview with the three meals respectively, the day prior to VC procedure. In Group II, 18 volunteers ingested barium sulfate suspension (2% w/v, 250 cc/dose) at bedtime and in the next day morning of VC. In Group III, 24 volunteers received 60 cc of MD-Gastroview at bedtime and in the next day morning of VC. Following colon inflation with CO2, computer tomography (CT) abdominal images were acquired by a standard single-slice detector-band VC protocol, i.e., 5 mm collimation, 1 mm reconstruction, 1.5-2.0:1.0 pitch, 120 kVp and 100-150 mA. The CT density of the tagged residual fluid was measured. An image segmentation algorithm was applied to remove electronically the residue fluid. Results: The average fluid density was 97 HU for Group I, 221 HU for Group II2, and 599 HU for Group III. These three groups’ density means are significantly different (p < 0.001 one-way ANOVA). After the electronic cleansing, the % of cleansed fluid regions was 5.5%, 16.5% and 93.1% (p<0.0001 Chi square) for these groups respectively. Conclusion: A less-stressful bowel preparation with low residue diet and MD-Gastroview oral contrast is feasible for VC screening with follow-up biopsy on the positive findings by OC.