ABSTRACT
Colorectal cancer (CRC) incidence and mortality are rising in individuals under age 50, termed early age onset (EAO) CRC. Lower endoscopy is recommended for all patients with unexplained iron deficiency anemia (IDA) or hematochezia to assess the EAOCRC. For those without symptoms, professional societies recommend decreasing the age to start screening from 50 to 45. Primary care provider (PCP) knowledge and practices around EAO-CRC risk assessment and screening are unknown. We conducted a survey study in May, 2020 of multi-specialty PCPs from three large medical systems to assess PCP knowledge, risk stratification practices and barriers/facilitators they face to offer CRC screening in patients < 50. We conducted univariate analysis to assess factors associated with knowledge and diagnostic practices. Response rate was 27.7% (196/708). Although 77.6% of respondents were aware that EAO-CRC incidence is increasing, only 42.9% knew that EAO-CRC mortality is also increasing. Of note, 91.8% recommend starting average risk screening at age 50. For 40- to 49-year-old patients present with unexplained IDA or hematochezia, 71.9% and 50.5% of respondents, respectively, recommend a diagnostic colonoscopy. Trainees were less likely to be aware of rising EAO-CRC mortality (odds ratio, 0.42; 95% CI, 0.21 to 0.82) and non-internal medicine providers were less likely to recommend CRC screening in those with a first-degree relative with CRC (odds ratio, 0.82; 95% CI, 0.72 to 0.93). Ongoing education efforts will be required to improve recognition and management of high-risk symptoms, particularly among non-internists and trainees.
ABSTRACT
The push for high quality care in all fields of medicine highlights the importance of establishing and adhering to quality indicators. In response, several gastrointestinal societies have established quality indicators specific to Barrett's esophagus, which serve to create thresholds for performance while standardizing practice and guiding value-based care. Recent studies, however, have consistently demonstrated the lack of adherence to these quality indicators, particularly in surveillance (appropriate utilization of endoscopy and obtaining biopsies using the Seattle protocol) and endoscopic eradication therapy practices. These findings suggest that innovative interventions are needed to address these shortcomings in order to deliver high quality care to patients with Barrett's esophagus.
Subject(s)
Humans , Barrett Esophagus , Biopsy , EndoscopyABSTRACT
BACKGROUND/AIMS: Although the diagnostic accuracy of endoscopic ultrasound with fine needle aspiration (EUS-FNA) in pancreas adenocarcinoma is high, endoscopic ultrasound with fine needle biopsy (EUS-FNB) is often required in other lesions; in these cases, it may be possible to forgo initial EUS-FNA and rapid on-site cytology evaluation (ROSE). The aim of this study was to compare the diagnostic accuracy of EUS-FNB alone (EUS-FNB group) with a conventional sampling algorithm of EUS-FNA with ROSE followed by EUS-FNB (EUS-FNA/B group) in nonpancreas adenocarcinoma lesions. METHODS: Retrospective cohort study of subjects who underwent EUS sampling of nonpancreatic adenocarcinoma lesions between February 2011 and May 2013. RESULTS: Over the study period, there were 43 lesions biopsied in 41 unique patients in the EUS-FNB group and 53 patients in the EUS-FNA/B group. Overall diagnostic accuracy was similar between the EUS-FNB and EUS-FNA/B groups (83.7% vs. 84.9%; p=1.0). In the subgroup of subepithelial mass lesions, diagnostic accuracy remained similar in the EUS-FNB and EUS-FNA/B groups (81.0% and 70.6%; p=0.7). EUS-FNB procedures were significantly shorter than those in the EUS-FNA/B group (58.4 minutes vs. 73.5 minutes; p<0.0001). CONCLUSIONS: EUS-FNB without on-site cytology provides a high diagnostic accuracy in nonpancreas adenocarcinoma lesions. There appears to be no additive benefit with initial EUS-FNA but this requires further study in a prospective study.