Tarun K. Narang

Increasing Incidence of Rectal Cancer in Patients Aged Younger Than 40 Years An Analysis of the Surveillance, Epidemiology, and End Results Database

The incidence of rectal cancer in the United States in young patients is considered to be low. Underestimating this incidence may result in a failure to diagnose younger patients with rectal cancer in a timely manner.

Coronary artery stents and antiplatelet therapy in patients with cirrhosis.

Goals: To describe our experience with coronary artery stenting and antiplatelet therapy in cirrhotic patients and compare rates of bleeding with a control group. Background: Although there are data on cardiac evaluation and perioperative cardiac risk in cirrhotic patients, there is a paucity of information on outcomes in cirrhotic patients with coronary artery stents. Cirrhotic patients may be at increased risk for complications, including gastrointestinal bleeding as a result of antiplatelet therapy prescribed after stenting. Study: We performed a retrospective study of complications in cirrhotics that received a coronary artery stent followed by clopidogrel and aspirin prescribed to prevent stent occlusion. Cirrhotics with stents were compared with an age and sex-matched control group with cirrhosis without stents and not on aspirin. Results: Among 423 cirrhotic patients who underwent liver transplant evaluation, 16 patients (3.8%) received a stent of which 9 underwent liver transplant. Two patients with varices (12.5%) in the stent group had fatal variceal bleeding and 2 controls (6.3%) had nonfatal variceal bleeding during follow-up while on antiplatelet therapy (P=0.86). There were no significant differences in transfusion requirements between the 9 liver transplant recipients with stents compared with the control group, P=0.69 for packed red blood cells. Conclusions: In our experience, it is safe for cirrhotic patients without varices to receive a coronary artery stent and for cirrhotic patients with coronary artery stents to be considered for liver transplantation. Larger prospective studies are needed to confirm these results and evaluate the risk of bleeding in cirrhotics with varices who receive coronary artery stents and antiplatelet therapy.

A rare case of duodenal immunoglobulin m infiltration in a patient with chronic lymphocytic leukemia.

A Rare Case of Duodenal Immunoglobulin M Infiltration in a Patient With Chronic Lymphocytic Leukemia

S2082 Disparities in Screening and Immunization in Hispanics and African Americans with Chronic Hepatitis C

Purpose:Patients with Chronic Hepatitis C (CHC) may develop fulminant hepatitis if coinfected with Hepatitis A virus (HAV) or Hepatitis B virus (HBV). We sought to determine if our African-American (AA) and Hispanic population with CHC were tested and vaccinated as per AASLD guidelines. We also studied immunity patterns in HIV co-infected patients. Methods:We conducted a retrospective study at our university affiliated community health care center involving CHC patients seen in the hepatitis clinic from January 2004 to December 2007. Data on demographics, HIV status, HAV and HBV serology and vaccination was recorded. Patients with decompensated liver disease, acute HAV and active HBV were excluded. Results:Among 174 patients with CHC, 131 (75.2%) were Hispanics and 38 (21.8%) were AA. The prevalence of HAV immunity was higher than that of HBV (65% vs.40%,p 0.05). AA subjects were more likely to be tested for HAV and HBV immunity compared to Hispanics (76% vs. 59% p=NS; 92% vs. 82% p=NS respectively), though this difference did not reach statistical significance. Among 28 subjects co-infected with HIV (16%, n=174), the likelihood of being tested for immunity to HAV was higher than non-HIV subjects (93% vs. 61% p<0.0001). The prevalence of immunity to HAV or HBV did not differ in the two groups (p=NS). Conclusion:Among AA and Hispanics with CHC, we found a significantly higher prevalence of immunity to HAV than previously reported. Interestingly, immunity to HAV was higher than that to HBV. There is a disparity in the practice of testing for immunity to HAV compared to HBV. Despite established AASLD vaccination guidelines, HAV and HBV vaccination rates are yet sub-optimal. Increased physician awareness is necessary to ensure implementation of AASLD vaccination guidelines for HAV and HBV in minority patients with Chronic hepatitis C.

S1301 Role of Repeat Endoscopic Ultrasonography with Fine Needle Aspiration in the Diagnosis of Indeterminant Pancreatic Cysts

BACKGROUND: The current Consensus Guidelines for management of IPMN-Br recommend surgical resection of suspected IPMN-Br with cyst size >3 cm cysts irrespective of symptoms, and 3 cm, and 65% <3 cm in size. Among IPMN <3 cm, 72 % (28/39) had associated worrisome features. The prevalence of high-risk lesions in our study was 35% (21/60). A total of 82 % (49/60) of IPMN-Br met guidelines recommendation for surgical resection including 57% (18 of 26) of low-risk lesions and 100% (21/21) of highrisk lesions. All 11 cases of IPMN-Br that would have been recommended for conservative management were low-risk lesions. Sensitivity, specificity, positive predictive value, negative predictive value consensus guidelines for correctly defining high and low risk IPMN-Br was 100%, 28%, 43 %, 100%, respectively. CONCLUSIONS: Application of Consensus Guidelines to our patients would have recommended surgical resection to all histology proven high-risk IPMN-Br. All IPMN-Br which would have recommended for conservative management, were histologically low-risk lesions. The risk of high risk pathology among <3 cm IPMN without other worrisome features, is almost nonexistent and these lesions may selected for observation.