Kimura-Takemoto Classification: A Tool to Predict Gastric Intestinal Metaplasia Progression to Advanced Gastric Neoplasia.

BACKGROUND AND AIMS: Gastric cancer is a leading cause of morbidity and mortality worldwide. Gastric intestinal metaplasia (GIM) has been described as a key histologic step in the development of gastric adenocarcinoma. However, not all people with GIM develop malignancy. We studied the factors associated with progression to dysplasia and advanced gastric neoplasia (aGN) in patients with baseline GIM. METHODS: Retrospective cohort analysis of patients with baseline GIM and subsequent endoscopic evaluation at Cleveland Clinic Florida and Ohio Main Campus between 2005 and 2017. Demographic and exposure risk factors, as well as Kimura-Takemoto classification (KTc), were used as variables for hazards ratio (HR) and Kaplan-Meier survival-free analysis for aGN and any form of dysplasia progression. RESULTS: There were 708 patients identified with GIM; 29 patients (4.1%) progressed to any degree of dysplasia. From these, LGD was present in 12 cases (1.7%), HGD in 4 cases (0.6%), and gastric cancer in 13 cases (1.8%), for a total of 17 aGN cases. KTc was associated with dysplasia and aGN progression (p < 0.001), and no cases progressed if KTc findings were absent. Open-type KTc was associated with aGN (HR 6.36, p < 0.001) and any dysplasia progression (HR 13.34, p < 0.001) compared to closed-type or absent KTc features. No other factors were associated with aGN or dysplasia progression. Open-type KTc was also associated with shorter cancer survival-free progression. CONCLUSION: Patients with baseline GIM present a higher progression risk to aGN, dysplasia, or cancer if concomitant KTc findings are present, particularly an open-type KTc pattern.

The safety of same-day CT colonography following incomplete colonoscopy with polypectomy.

BACKGROUND: Concerns about the risk of bowel perforation for same-day computed tomography colonography (CTC) following an incomplete colonoscopy with polypectomy may lead to unnecessarily postponing the CTC. OBJECTIVE: The objective of this article is to describe the complications including colon perforations associated with same-day CTC in a cohort who had polypectomies but an incomplete colonoscopy. DESIGN: We conducted a retrospective study. SETTING: Our study took place in a single, tertiary referral center. PATIENTS: We studied consecutive patients who had CTC the same day as an incomplete colonoscopy with polypectomy. INTERVENTIONS: Interventions included optical colonoscopy (OC), endoscopic polypectomies, and same-day CTC. MAIN OUTCOME MEASUREMENTS: Our main outcome measurements included perforation rate with long-term follow-up. RESULTS: A total of 3% of patients undergoing colonoscopy from January 2008 to December 2012 had same-day CTC following incomplete OC, and 72 polypectomies were performed in 34 (or 17%) of these patients. Incomplete colonoscopies were due to colon tortuosity and looping (25), severe angulations (five), colon mass (two), colon stenosis (one), bradycardia (one). Fifty-three percent of the OCs were screening for colon neoplasia, 29% diagnostic and 18% were surveillance of colon polyps. Most polyps were ≤ 5 mm, and found in the left colon. There were no reported complications or perforations associated with same-day CTCs during short- and long-term follow-up. LIMITATIONS: Limitations of our analysis included retrospective single-center design, small number of patients for the occurrence, referral to same-day CTC was not standardized, inability to establish safety of CTC for specific scenarios such as after complex polypectomies, strictures, or advanced IBD. CONCLUSIONS: Radiologists' apprehension to perform a CTC the same day as an incomplete colonoscopy following polypectomies because of perceived risk of perforation may be unfounded. More data are needed to determine the safety of same-day CTC in patients with high-risk findings during colonoscopy such as a stricture, severe IBD, and after complex polypectomies.

The day of the week does not affect the adenoma detection rate.

BACKGROUND: The role of operator fatigue on adenoma detection rate (ADR) is still controversial. AIMS: The purpose of this study was to determine if fatigue towards the end of the week affects the ADR. METHODS: A retrospective chart review of consecutive colonoscopies was done at a tertiary care teaching institution. Patients 45 years of age or older undergoing screening or surveillance colonoscopy from June 2007 to August 2010 were included in the study. RESULTS: A total of 3,085 patients were included in the study, with an overall 31 % ADR. ADR was between 31 and 32 % throughout the week, with no statistically significant variation (p = 0.8697). The total number of adenomas and advanced adenomas was also similar throughout the week (p = 0.8, p = 0.59, respectively). CONCLUSIONS: ADR is not influenced by the day of the week in which a colonoscopy is performed.

Comparison of adenoma detection rate in Hispanics and whites undergoing first screening colonoscopy: a retrospective chart review.

BACKGROUND: Current guidelines recommend screening colonoscopy beginning at age 50 in the average-risk population. Race has been shown to influence the risk of colorectal cancer, thus leading to the recommendation of initiating screening in blacks at the age of 45. Few data exist on the prevalence of colon polyps among U.S. Hispanics. OBJECTIVES: To compare the adenoma detection rate (ADR) between Hispanics and whites undergoing a first screening colonoscopy at our referral center. DESIGN: Observational study. SETTING: Single endoscopy unit, tertiary care teaching hospital. PATIENTS: Patients 50 years of age or older undergoing their first screening colonoscopy whose race was determined as white or Hispanic from June 2007 to August 2010. MAIN OUTCOME MEASUREMENT: ADR by race. RESULTS: There was no statistically significant difference in the ADR among Hispanics and whites (45% and 48%, respectively; P = .2). No difference was found when comparing the ADR in Hispanic and white males (50% and 55%, respectively; P = .2), Hispanic and white females (40% in both groups), or in the 50- to 59-year-old subgroup (42% in Hispanics, 45% in whites, P = .4). There was no difference in the prevalence of advanced adenomas (3% in Hispanics, 4% in whites, P = .3). The prevalence of proximal polyps in Hispanics and whites was similar (18% and 19%, respectively, P = .8). LIMITATIONS: Retrospective design, self-identification of race/ethnicity, underrepresentation of certain Hispanic subgroups. CONCLUSIONS: We found a similar ADR among Hispanics and whites undergoing their first screening colonoscopy. These findings have important implications for colorectal cancer screening recommendations, suggesting that the current guidelines are appropriate for Hispanics.