Younger Patients Do Not Develop More Advanced Polyps on Surveillance Colonoscopy Than Their Index Colonoscopy When Compared With Older Patients.

BACKGROUND AND GOALS: Colonic polyp surveillance guidelines are based on data from patients 50 and above. Given the recent lowering for colorectal cancer (CRC) screening to age 45, the aim of this study was to assess whether existing colonic polyp surveillance guidelines are appropriate to use in younger patients. MATERIALS AND METHODS: We performed a retrospective cohort study of patients who underwent 2 colonoscopies within a 10-year period. Five Risk Stratification Groups (RSG) were developed based on surveillance colonoscopy interval times recommended by the US Multi-Society Task Force (USMSTF) on CRC, and changes in RSG from index to surveillance colonoscopy were compared between 3 age cohorts-those below 45, those 45 to 49, and those 50 and above. Further analysis was performed for patients whose RSG worsened from index to surveillance colonoscopy, as this was defined as an inappropriate surveillance interval. RESULTS: A total of 1895 patients were included in the final analysis. A multivariate regression model showed that a worsened RSG was not significantly associated with age group, both when comparing below 45 to those 50 and above [odds ratio (OR)=0.840, 95% confidence interval (CI): 0.504-1.399, P=0.50] and when comparing those 45 to 49 to those 50 and above (OR=1.416, 95% CI: 0.905-2.216, P=0.13). Only being female was found to be statistically associated with worsened RSG after controlling for other variables (OR=0.652, 95% CI: 0.486-0.875, P<0.01). CONCLUSIONS: Our study found that younger cohorts of patients, both below 45 and those 45 to 49, are not statistically more likely to develop more advanced polyps necessitating a shorter time to surveillance colonoscopy compared with patients 50 years and above. This finding supports using existing colonic polyp surveillance colonoscopy guidelines that were developed for patients 50 years and above in both patients below 45 and those 45 to 49 years old.

Endoscopic Evaluation of Radiologic Distal Esophageal Thickening.

GOALS: We aim to determine the incidence of esophagogastroduodenoscopies (EGDs) primarily performed for imaging findings of distal esophageal thickening (DET). We also aim to determine if patients with imaging findings of DET have a higher incidence of cancer, and to evaluate the risk factors associated with findings of malignancy. BACKGROUND: The growth of diagnostic imaging has led to an increase in incidental findings of DET. This nonspecific finding frequently prompts an EGD for evaluation-many of which demonstrate benign conditions. There may be a misuse of valuable resources. STUDY: We performed a retrospective chart review of 1080 EGDs from January 2016 to July 2018 at the Veterans Affairs Medical Center, comparing EGDs for the indication of imaging report of DET with EGDs for other indications. Patient demographics, clinical history, imaging, procedure, and pathology reports were collected. Descriptive analysis and biostatistical analysis with χ2, Fisher exact, Wilcoxon rank sum, and Kruskal-Wallis tests were utilized in analyzing the data. RESULTS: Of the 1080 total endoscopies, 8.2% (n=88) were done specifically because of the imaging findings of DET. Those who had EGDs performed because of DET had a higher percentage of abnormal esophageal findings and of cancer. A history of Barrett's esophagus, tobacco use, and having gastrointestinal symptoms were not significant predictors of abnormal findings or of cancer for EGDs done for DET. CONCLUSIONS: There may be a role for EGDs performed for radiologic findings of DET. Even those without risk factors for malignancy should have EGDs performed for DET. Radiologists should consider reporting the DET size in order to determine if significant endoscopic findings correlate with wall thickness.

Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy.

Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices.