Mojdeh Momeni

Impact of bowel preparation on surveillance colonoscopy interval

Abstract Background/Aims. Atpresent there are no guidelines for colonoscopy surveillance interval in subjects with unsatisfactory bowel preparation. Study was designed to compare outcomes of repeat colonoscopy at different surveillance intervals in patients with unsatisfactory preparation on index exam. Methods. Ten thousand nine hundred and eight colonoscopies were done during the study period. Patients with index colonoscopy exam complete up to cecum but suboptimal bowel prep were included. Results.Two hundred and ninety-seven patients met the inclusion criteria. The interval for repeat colonoscopy was <1 year in 38.5%, 1–2 years in 33.3%, 2–3 years in 16.7%, and 3–5 years in 11.5% subjects. Adenoma detection rate (ADR) was 24%, high-risk adenoma detection rate (HR-ADR) was 8.4%, and colorectal cancer detection rate was 1.7%. The HR-ADR based on surveillance intervals <1 year, 1–2 years, 2–3 years, and 3–5 years was 8%, 7.9%, 2%, and 19.4%, respectively. The HR-ADR was significantly higher at surveillance interval 3–5 years (p < 0.05). Conclusion. Colonoscopies repeated at interval >3 years showed a significant HR-ADR. The study indicates that a surveillance interval of 3 years can be reasonable for subjects having an index colonoscopy with suboptimal/fair/poor bowel prep and complete colon examination. Colonoscopy should be repeated earlier if symptoms develop.

Prescreening with FOBT Improves Yield and Is Cost-Effective in Colorectal Screening in the Elderly

Background. Utilization of colonoscopy for routine colorectal cancer (CRC) screening in the elderly (patients over 75) is controversial. This study was designed to evaluate if using fecal occult blood test (FOBT) to select patients for colonoscopy can improve yield and be a cost- effective approach for the elderly. Methods. Records of 10,908 subjects who had colonoscopy during the study period were reviewed. 1496 (13.7%) were ≥75 years. In 118 of these subjects, a colonoscopy was performed to evaluate a positive FOBT. Outcomes were compared between +FOBT group (F-Group) and the asymptomatic screening group (AS-Group). The cost-effectiveness was also calculated using a median estimated standardized worldwide colonoscopy and FOBT cost (rounded to closest whole numbers) of 1000 US

Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice

and 10 US

Outcome and Safety of Colonoscopy in Minorities Aged 85 and Older

, respectively. Results. 118/1496 (7.9%) colonoscopies were performed for evaluation of +FOBT. 464/1496 (31%) colonoscopies were performed in AS-Group. In F-Group, high risk adenoma detection rate (HR-ADR) was 15.2%, and 11.9% had 1-2 tubular adenomas. In comparison, the control AS-Group had HR-ADR of 19.2% and 17.7% had 1-2 tubular adenomas. In the FOBT+ group, CRC was detected in 5.1% which was significantly higher than the AS-Group in which CRC was detected in 1.7% (P = 0.03). On cost-effectiveness analysis, cost per CRC detected was significantly lower, that is, 19,666 US

Sa1143 Monitored Anesthesia Care Versus Conscious Sedation for Common Endoscopic Procedures. A Prospective Patient Satisfaction and Procedure Outcome Study

in F-Group in comparison to AS-Group 58,000 US

T1006 Public Awareness and Attitudes Towards Non Alcoholic Fatty Liver Disease (NAFLD)

(P < 0.05). There were no significant differences in other parameters among groups. Conclusion. Prescreening with FOBT to select elderly for colonoscopy seems to improve the yield and can be a cost-effective CRC screening approach in this subset. The benefit in the risk benefit analysis of screening the elderly appears improved by prescreening with an inexpensive tool.

S1967 Mass Spectrometry MALDI Imaging and LCMS Identification of Colon Cancer Proteins in Benign Polyps

AIM To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale (BBPS) in clinical practice. METHODS The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates (AADR). Segmental AADRs were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR. RESULTS Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0 (poor bowel prep, BBPS 0-3) n = 26 (7.3%), Group-1 (Suboptimal bowel prep, BBPS 4-6) n = 121 (34%) and Group-2 (Adequate bowel prep, BBPS 7-9) n = 209 (58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2 (3.8% vs 16.7%, P < 0.05), Group 1 and 2 (14.8% vs 16.7%, P < 0.05) and Group 0 and 1 (3.8% vs 14.8%, P < 0.05). χ(2) method was used to compute P value for determining statistical significance. CONCLUSION Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.

894 Outcome Analysis of Colonoscopy in Elderly African American, Hispanic and Asian Americans Above Age 85

Conflict of Interest: Not directly related to this epidemiological study, but T. Strandberg and A. Strandberg have cooperated with various healthcare companies (also marketing statin drugs) and own a minor amount of stock in Orion Pharma. The study was supported by the Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse, the University Central Hospital of Oulu, and the University Central Hospital of Helsinki. Author Contributions: T. Strandberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: T. Strandberg, Kurimo, A. Strandberg. Acquisition of data: T. Strandberg. Analysis and interpretation of data: T. Strandberg, Kurimo, Kolehmainen, A. Strandberg. Drafting of manuscript: T. Strandberg, Kurimo. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: T. Strandberg. Obtained funding: T. Strandberg, Tilvis. Administrative, technical, or material support: Strandberg, Pitkälä, Tilvis. Sponsor’s Role: The funding sources had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. REFERENCES

Sa1164 Management of Chronic Constipation by the Primary Care Physician: A Survey

Background Sedation for endoscopic procedures induced with opioid and benzodiazepine combination is called conscious sedation (CS) and defined by The American Society of Anesthesiology (ASA) to be moderate sedation.Sedation for endoscopic procedures induced with propofol as the main anesthetic is called Monitored Anesthesia Care (MAC) and defined by the ASA to be deep sedation. This is generally administered by an anesthesiologist.In this prospective study we collected data directly from patients undergoing endoscopic procedures.We compared patient satisfaction and overall procedural outcome in two different modes of sedation. Methods:473 patients were enrolled in this prospective study at two community hospitals. Inclusion criteria were adult patients undergoing EGD or colonoscopy and able to complete the survey form. Patients with ASA score above 3 and undergoing other GI procedures were excluded. Hospital A exclusively used MAC and hospital B exclusively used CS. Group A at Hospital A enrolled 259 patients who received deep sedation with propofol as the main anesthetic, which was administered and monitored by an anesthesiologist. Group B at Hospital B enrolled 214 patients who received conscious sedation (CS) using a combination of midazolam and fentanyl administered by the endoscopist. Patient satisfaction surveys were completed once patients were out of sedation and prior to discharge. Results : Pain at drug administration site in group A was 22% as compared to 7% in group B. However, abdominal discomfort and pain was 20.46% in group A which was higher in group B at 32.71%. Interestingly, there was no difference in gagging/choking sensation during EGD in both groups with incidence of 22%. In Group A, 98.06% patient reported adequate pain control in contrast to 89.71% in comparison group B. It was noted that post procedure recovery time from the conscious sedation group was 13.80 minutes as compared to 23.15 minutes in MAC group. Overall patient satisfaction rate was 96.91% in group A and 97.66% in group B. Regarding revisit, 94.59% and 97.66% patients in group A and B respectively, would consider coming back for the next visit. In terms of periprocedural complications, only one patient showed transient respiratory depression in the CS group and was reversed with IV naloxone and flumazenil. Conclusion:This study compares patient satisfaction and periprocedural complications for the use of CS and MAC for common endoscopic procedures. We did not find any statistical differences between the two groups except for less recovery time in the CS group. In the MAC group there is less incidence of abdominal pain or discomfort while CS group has shown less pain at site of drug administration. Overall patient satisfaction and revisit consideration were the same in both groups.

Su1205 Prevalence of Helicobacter pylori and Intestinal Metaplasia in a Minority Population Registry of Outcomes of Upper Endoscopy in Minorities (ROUM): A Hospital-Based Registry

which were significantly elevated factors in NASH patients than in non-NASH patients by the univariate analysis. Plasma PTX3 level was still significant in the NASH patients as compared with that in non-NASH patients by multiple logistic regression analysis. Conclusions: This is the first study to demonstrate consistent and profound elevation of plasma PTX3 levels in NASH in comparison with non-NASH. The results suggest that plasma PTX3 levels may not only be laboratory values that differentiate NASH from non-NASH, but marker of the severity of hepatic fibrosis in NASH. Plasma PTX3 may be useful for targeted therapy against fibrosis in NASH patients.