AG

AA

bst

ract

s

Su1042

Race and Colon Cancer Disparity: A Comparison of the Prevalence andRecurrence of Adenoma in the Polyp Prevention TrialAdeyinka O. Laiyemo, Chyke A. Doubeni, Hassan Brim, Hassan Ashktorab, Robert E.Schoen, Elaine Lanza, Elizabeth A. Platz, Amanda J. Cross

Background: Blacks suffer a disproportionately higher incidence of and mortality fromcolorectal cancer in the United States. It is unclear if this public health problem is due toan increased biological susceptibility. No prospective study has evaluated differences inpostpolypectomy recurrence risk by race. Aim: To examine the prevalence, recurrence andthe location of colorectal neoplasia by race during a four-year follow-up in the PolypPrevention Trial (PPT). Methods: The PPT was a 4-year, multicenter, randomized controlledtrial which evaluated the effect of a low fat, high fiber, fruits and vegetable diet on the riskof colorectal adenoma recurrence. A total of 1,821 participants, which included 1,668(91.6%) whites and 153 (8.4%) blacks, had information on location of colorectal adenomaat baseline and underwent end-of-trial colonoscopy 4 years later. We used Poisson regressionmodels to evaluate the association between race and advanced adenoma (defined as anadenoma that is 1 cm or more in size, or with villous component or high grade dysplasia)at baseline and recurrent adenoma and advanced adenoma at 4 years. Results: Black andwhite participants did not differ on mean age (60.8 versus 61.3 years; P value = 0.53) orsex (66.7% versus 64.0% male; P value = 0.52). At baseline, blacks had higher prevalenceof any advanced adenoma compared to whites (44.4% versus 37.0%; P value = 0.07) andproximal advanced adenoma (14.4% versus 8.8%; P value = 0.02); but not distal advancedadenoma (32.0% versus 29.9%, P value = 0.58). At the year 4 examination, 717 (39.4%)had adenoma recurrence and 120 (6.6%) had advanced adenoma recurrence. Blacks wereas likely as whites to have any adenoma and advanced adenoma recurrence after adjustingfor age, sex, body mass index, use of non steroidal anti-inflammatory drugs, smoking andfamily history of colorectal cancer (Table). There was no difference in adenoma recurrenceby location. Conclusions: Despite higher prevalence of advanced adenoma at baseline, blackshave similar colorectal neoplasia recurrence risk as whites. Our study does not provide anyevidence to support more frequent surveillance for blacks with personal history of adenomaas an intervention to reduce colorectal cancer disparity.The risk of adenoma and advanced adenoma recurrence by race

Adjusted for age, sex, BMI, NSAIDs use, smoking and family history of colorectal cancer

Su1043

Prognostic Significance of Socio-Economic Deprivation in UpperGastrointestinal CancerNicola C. Tanner, David S. Chan, Andrew J. Beamish, Tom D. Reid, Xavier Escofet,Timothy Havard, Geoffrey W. Clark, Tom Crosby, Wyn G. Lewis

Objective: To assess the influence of socio-economic deprivation (SED) on the presentation,diagnosis, management, outcome and survival of patients with esophageal (EC) and gastric(GC) cancer within a UK regional cancer network serving a population of 1.4 million.Methods: Three hundred and sixty-nine consecutive patients diagnosed with upper GI cancer[222 EC (166 adenocarcinoma, 56 squamous cell carcinoma), 139 GC] over twelve calendarmonths were studied prospectively. Socio-economic deprivation scores were calculated usingthe Welsh Index of Multiple Deprivation (WIMD) 2008. An overall score was calculatedusing 8 domains of deprivation weighted accordingly (income 23.5%, employment 23.5%,health 14%, education 14%, access to services 10%, housing 5%, environment 5% andcommunity safety 5%). Patients were subclassified into geographical deprivation quintilesfor analysis, and further sub-grouped into the least deprived areas (quintiles 1 & 2) tofacilitate comparison with the most deprived areas (quintiles 3, 4 & 5). Results: Age,radiological TNM stage at presentation and treatment intent were not associated with SED.One-hundred and twenty-nine patients (35%) were treated with curative intent; 32 patientsreceived definitive chemoradiotherapy (dCRT), 13 endoscopic mucosal resection (EMR) and86 patients underwent potentially curative surgery (34 esophagectomy and 52 gastrectomy).Assessment of operative risk in terms of cardiopulmonary exercise testing (CPX) demonstrateda significant association with SED. Patients from the most deprived areas had a loweranaerobic threshold (AT <11ml/kg/min, p=0.014). Open and close laparotomy was signific-antly commoner in patients residing in the most deprived areas (11, 24% vs. 1, 3%, p=

S-408AGA Abstracts

0.022). Operative morbidity and mortality in the least deprived areas were 50% and 0%,respectively compared to 40% and 2% in the most deprived areas (p=0.393, p=0.411).Patients from more deprived areas had a significantly shorter length of hospital stay (12 vs.15.5 days, p=0.026). Cumulative one-year survival in EC patients was significantly shorterin patients residing in the most deprived geographical areas (48% vs. 59%, Log Rank 4.553,p=0.033). One-year survival in GC patients was unrelated to deprivation. Conclusion:SED was associated with higher anaesthetic and operative risk, an increase likelihood ofinoperability despite full radiological staging, and shorter durations of survival in EC patients.The relationship between SED and UGI cancer presentation, diagnosis and outcome iscomplex and diverse, and deserves further research if geographical inequalities in healthcare are to be addressed.

Su1044

Endoscopic Hemostasis for Severe Hematochezia in the Elderly: Population-Based Data From a Large Consortium of Diverse Endoscopy Practices in theUnited StatesOsnat Ron-Tal Fisher, Ian M. Gralnek, Glenn M. Eisen, Jennifer L. Holub, Jeffrey L.Williams

Background: Lower GI bleeding (LGIB), presenting as severe hematochezia, is associatedwith poor outcomes, especially in older patients with co-morbidities. As compared to acuteupper GIB, there are limited data describing endoscopic hemostasis therapies in older (≥60yrs) LGIB patients. Aims / Methods: We used the CORI endoscopic database to describeand compare patients ≥60 yrs with severe hematochezia who received hemostasis withthose who did not. CORI has been demonstrated to be a valid reflection of communityendoscopic practice. To better risk-stratify for severe hematochezia, we limited our analysisto patients who underwent in-patient colonoscopy for the lone indication of hematocheziabetween 1/1/02 and 12/31/08, and had no endoscopic diagnosis of hemorrhoids. We furthercharacterized this patient population by age (60-69 yrs, 70-79 yrs, ≥80 yrs), demographics,co-morbidity, practice setting, endoscopic diagnosis, extent of colonoscopy examination,hemostasis type, need for repeat endoscopy, and adverse events (AE). Results: We identifiedn=2,316 patients ≥60 yrs (26.9% 60-69 yrs, 35.2% 70-79 yrs, & 37.9% ≥80 yrs) whohad in-patient colonoscopy for hematochezia and no endoscopic diagnosis of hemorrhoids.Endoscopic hemostasis was performed in only n=112 (4.8%); n=2,204 (95.2%) received nohemostasis. In both cohorts, the majority were male (65.2% & 54.5%), White (87.5% &76.0%), with mean ages 76.2 and 76.5 yrs, respectively. Most had colonoscopy in a commun-ity hospital (66.1%& 73.9%) and had ASA Scores II / III (81.3%& 78.3%). In the hemostasiscohort, endoscopic findings* included: diverticulosis (72.3%), polyp/multiple polyps(42.9%), angiodysplasia (32.1%), mucosal abnormality/colitis (20.5%), tumor (7.1%), andsolitary ulcer (6.3%). Hemostasis therapy included**: injection (33.0%), APC (31.3%),bipolar coagulation (28.6%), clips (12.5%), heater probe (3.6%), other (2.7%), and bandligation (0.9%). Serious AEs were uncommon, bleeding in n=3 (2.7%). The two cohortsdiffered significantly with regard to gender, race, depth of colonoscopy exam, and AEs. Thehemostasis cohort had significantly more males (p=0.03), Whites (p=0.014), colonoscopiesthat reached the cecum (95.5% vs. 87.3%, p=0.009), and serious AEs (2.7% vs 0.1%, p=0.002). Endoscopic diagnosis was significantly more often AVMs & solitary ulcer, p<0.0001and p=0.004, respectively. Conclusions: In older patients with severe hematochezia under-going in-patient colonoscopy in a community hospital, it was rare for patients to receiveendoscopic hemostasis. Those who did, usually received injection, APC or bipolar coagulationtherapy. These are novel population-based data, largely from community practice that contrastpublished data from tertiary care centers. *more than one endoscopic diagnosis was allowed**more than one endoscopic therapy may have been performed

Su1045

Disparities in the Application of Practice Guidelines in Patients WithCirrhosis Reflect Site of CareSeth N. Sclair, Olveen Carrasquillo, Frank Czul, Paul Martin

Background: Practice Guidelines (PG) from the American Association for the Study of LiverDisease for the care of cirrhotic patients include vaccination against hepatitis A and B,surveillance for hepatocellular carcinoma (HCC) and gastroesophageal varices (GEV), antibi-otic prophylaxis for spontaneous bacterial peritonitis (SBP) in high risk patients, and referralfor liver transplant (LT) evaluation. In this study we examine Guideline Adherence accordingto site of care. We compare hepatology clinic patients seen at a faculty practice (FP) withthose cared for at a public hospital (PH) where care is provided by trainees supervised byfaculty. Methods: Claims data was used to identify 596 patients with cirrhosis seen at FPand PH hepatology clinics from 10/1/10-3/31/11. From these we selected 210 consecutivecharts for review and 153 met study inclusion criteria (FP=74, PH=79). Using our ElectronicMedical Records, we conducted a structured retrospective chart review to determine adher-ence to specific guidelines. Results: Patients at both sites were similar in age, gender, ethnicity,number of visits, and cirrhosis etiology. PH patients were more likely to be uninsured andnon-English speakers. PH patients were more likely than FP patients to have met vaccinationguidelines (proven immunity or completion of vaccination series);81% vs 46% and 76% vs29% for hepatitis A and B, respectively (p<.01 for both). PH patients were more likely tohave received annual HCC screening by serum AFP and imaging, 90% vs 70% (p<.01).However, patients at the FP practice were more likely than PH patients to have had endoscopicscreening for GEV, 97% vs 87% (p<.05). Further, excluding patients with a prior indexvariceal bleed, 71% of FP patients underwent primary GEV screening within 6 months ofestablishing care vs 43% of PH patients (p<.01). Among those with varices, B blockerutilization was similar, but PH patients were less likely to receive prophylactic endoscopicbanding therapy. Documentation of and scores for Model for End Stage Liver Disease weresimilar at both sites, but FP patients were more likely than PH patients to have had adocumented discussion about LT with their provider and to have been referred for LTevaluation; 81% vs 53%, and 42% vs 20%, p <.01 for both. The number of patients withan indication for antibiotic prophylaxis for SBP was small (14 at FP and 13 at PH), however,the proportion of PH patients (1/13) receiving antibiotics was lower than FP patients (6/14). Conclusions: Disparities in the adherence to cirrhosis PG varied across sites. In general,