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.

Detection of colorectal neoplasia by colonoscopy in average-risk patients age 40-49 versus 50-59 years.

BACKGROUND: The USPSTF recommends beginning colorectal cancer screening at age 50. A recent study showed prevalence of colorectal adenomas among individuals aged 40-49 was similar to that among those aged 50-59. AIM: To assess the prevalence of colorectal neoplasia, detected during colonoscopy, by age among average-risk patients. METHODS: Nine-hundred and ninety-four colonoscopies were analyzed (247 ages 40-49, 747 ages 50-59). We included consecutive patients of ages 40-59 undergoing their first colonoscopy. Colonoscopies that did not reach the cecum and patients at increased risk of colorectal cancer were excluded. The primary endpoint was the prevalence of colorectal neoplasia by age. Secondary endpoints included the prevalence of colorectal neoplasia by gender, ethnicity, and BMI. RESULTS: The prevalence of colorectal neoplasia was 12.1% in patients aged 40-49 and 22.6% in those aged 50-59. Compared with individuals aged 40-49 there was a significantly greater prevalence of adenomas (chi-squared = 12.72, P = 0.0004) and of advanced adenomas or cancer (chi-squared = 5.73, P = 0.01) in individuals aged 50-59. After adjusting for gender, race, and BMI the effect of age remained significant (OR 0.5, 95% CI 0.33-0.76). Higher BMI was associated with increased risk of colorectal neoplasia (OR 1.03, 95% CI 1.00-1.06). The number that had to be screened to detect one advanced lesion in the 40-49 age group was 49 compared with 20 in those aged 50-59. CONCLUSION: Individuals aged 40-49 have a lower but measurable risk of colorectal neoplasia compared with those aged 50-59. Although there may be population subgroups for which screening below the age of 50 may be indicated, our results do not support lowering the age threshold for colonoscopy in the general population.

Metastatic colorectal cancer to the small bowel-an uncommon cause of obscure GI bleeding: a three-case experience with review of the literature.

PURPOSE: Metastatic colorectal cancer to the small intestine is a rare condition presenting with nonspecific symptoms such as obscure gastrointestinal bleeding (OGIB). We report our experience with the use of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) to identify and diagnose the metastatic colorectal cancer to the small bowel. The aim was to demonstrate the approach to the diagnosis of metastatic colorectal cancer to the small bowel including literature review. METHODS: This is a retrospective case series from an academic tertiary referral center. Three patients with a history of colorectal cancer referred for OGIB underwent CE and subsequent DBE. RESULTS: All patients underwent evaluation including esophagogastroduodenoscopy and colonoscopy prior to referral. In each case, CE was performed revealing the source of bleeding which was confirmed as metastatic colorectal cancer to the small bowel by DBE. Significant lag time was noted from the initial diagnosis of colorectal cancer to the onset of symptomatic small bowel metastasis in this series (1.3-7 years). CONCLUSIONS: We found the incidence of metastatic colorectal cancer to the small intestine of those with small intestine tumors to be 6%. Clinicians should be suspicious of this condition in any patient with OGIB and prior history of colorectal cancer. The approach to this diagnosis is varied but one algorithm includes the combined use of CE for tumor localization and balloon-assisted enteroscopy for confirmation.