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82
COLONOSCOPY FINDINGS AT A TERTIARY CARE CENTRE FOLLOWING A FECAL OCCULT BLOOD TEST
B Meyers, J Marshall
Department of Medicine (Gastroenterology), McMaster University, Hamilton, Ontario
Aims: To assess the yield of colonoscopy in patients referred for positive fecal occult blood tests (+FOBT). We assessed the prevalence of advanced neoplasia in consecutive cohorts of patients investigated before and after the Province of Ontario introduced a program to expand colonoscopy access for colorectal screening.
Methods: A retrospective chart review was performed at 3 campuses of Hamilton Health Sciences in Hamilton, Ontario. Out-patients (age 50 to 80) were selected by an electronic search of an endoscopy procedure database (EndoPRO, Pentax) if +FOBT was the primary indication for colonoscopy. Time interval G1 included procedures performed from January 2006 until September 2007 when colonoscopy services were expanded. Time interval G2 extended from January to August 2008. Technical success of colonoscopy and endoscopic findings were described. Proportions were compared using Chi-square.
Results: More males underwent colonoscopy for +FOBT in G2 vs. G1 (N=153 with 64.7% male vs. N=171 with 50.3% male, p<0.01). Technical success did not differ between groups. Cecal intubation was achieved in 311/324 colonoscopies (96.0%). Failure was attributed to: obstructing lesions (N=7), poor preparation (N=4), diverticulosis (N=1), and patient discomfort (N=1). Endoscopic findings are summarized in the Table. Patients in G2 were more likely to have hyperplastic polyps and less likely to have non-polypoid benign abnormalities (diverticulosis and hemorrhoids). Patients in G2 had fewer adenocarcinomas but did not differ from G1 in overall rates of dysplasia. Rates of dysplasia were similar to those reported in large published cohorts (Kronborg 1996; Manfredi 2008).
Conclusions: The prevalence of adenomatous polyps and adenocarcinoma is substantial in patients undergoing colonoscopy for +FOBT at a tertiary care academic centre. Diagnostic yield remained high following expansion of screening colonoscopy access. The reasons for increased reporting of benign and dysplastic polyps after expansion of services could reflect increased operator vigilance but this hypothesis requires further study in larger cohorts.
| |
G1 + G2 |
G1 + G2 |
G1 |
G1 |
G2 |
G2 |
G1 vs. 2 P-value |
| |
N of Patients |
% |
N of Patients |
% |
N of Patients |
% |
|
| Normal |
100 |
30.9 |
56 |
32.7 |
44 |
28.8 |
p=0.07 |
| Diverticulosis |
32 |
9.9 |
22 |
12.9 |
10 |
6.5 |
p<0.01 |
| Hemorrhoids |
45 |
13.9 |
30 |
17.5 |
15 |
9.8 |
p<0.01 |
| Colitis |
8 |
2.5 |
1 |
0.6 |
7 |
4.6 |
-- |
| Vascular ectasias |
8 |
2.5 |
4 |
2.3 |
4 |
2.6 |
-- |
| Any non-polypoid benign pathology |
193 |
59.6 |
113 |
65.5 |
80 |
52.3 |
p<0.01 |
| Adenocarcinoma |
28 |
8.6 |
17 |
9.9 |
11 |
7.2 |
p<0.05 |
| Tubulovillous adenoma(s) |
35 |
10.8 |
11 |
6.4 |
24 |
15.7 |
p<0.01 |
| Tubular adenoma(s) |
68 |
21.0 |
38 |
22.2 |
30 |
19.6 |
NS |
| All dysplasia |
131 |
40.4 |
66 |
38.6 |
65 |
42.5 |
p=0.08 |
| Hyperplastic polyps(s) |
41 |
12.7 |
15 |
8.8 |
26 |
17.0 |
p<0.01 |
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