Background
African Americans have the highest incidence and mortality from colorectal cancer (CRC). Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, CRC incidence remains high in this group.
Objective
To examine rates and predictors of CRC screening uptake as well as time-toscreening in a population of African Americans and non-African Americans in a healthcare system that minimizes variations in insurance and access.
Design
Retrospective cohort study.
Setting
Greater Los Angeles Veterans Affairs (VA) Healthcare System.
Patients
Random sample (N=357) of patients eligible for initial CRC screening.
Interventions
NA.
Main Outcome Measurements
Uptake of any screening method, uptake of colonoscopy in particular, predictors of screening, and time-to-screening in African Americans and non-African Americans.
Results
The overall screening rate by any method was 50%. Adjusted rates for any screening were lower among African Americans than non-African Americans (42%v.58%; OR=0.49,95%CI=0.31–0.77). Colonoscopic screening was also lower in African Americans (11%v.23%; adjusted OR=0.43,95%CI=0.24–0.77). In addition to race, homelessness, lower service connectedness, taking more prescription drugs, and not seeing a primary care provider within two years of screening eligibility predicted lower uptake of screening. Time-to-screening colonoscopy screening was longer in African Americans (adjusted HR=0.43,95%CI=0.25–0.75).
Limitations
The sample may not be generalizeable.
Conclusions
We found marked disparities in CRC screening despite similar access to care across races. Despite current guidelines aimed to increase screening in African Americans, participation in screening remained low and use of colonoscopy was infrequent.
Background: Colorectal cancer (CRC) is the second most common cause of cancer related deaths in the United States. Colonoscopy is the gold standard for the detection of CRC. There are many colonoscopy quality measures and among these the adenoma detection rate (ADR) has demonstrated a significant impact in reducing mortality from CRC. The primary aim of our study was to compare ADR and distribution of polyp type in patients undergoing Endocuff-assisted colonoscopy (EAC) versus standard colonoscopy (SC) in a VA system. Methods: Retrospective data was collected from 496 patients who underwent routine screening, surveillance and diagnostic colonoscopies either via SC from January 6, 2014 through March 12, 2014 or EAC from September 24, 2014 through February 19, 2015. A total of 54 patients were excluded based on a personal history of CRC and prior resection, incomplete colonoscopy due to poor bowel preparation, and removal or loss of Endocuff (EC). Primary outcomes measured and compared were ADR and types of polyps found. Results: The overall ADR in the EAC group was higher at 59.91% versus 50.66% for SC, accounting for a 9% increase (P=0.0508). EAC was able to detect a total of 59 sessile serrated adenoma/polyps (SSA/Ps) compared to SC only detecting 8 (P≤0.0001). There was a significant increase in the SSA/P detection rate with EAC at 15% versus 3% in the SC group (P≤0.0001). Conclusions: EAC significantly increases the detection of SSA/P and has shown a trend in improving ADR in our veteran population.
Introduction: Laparoscopic adjustable gastric banding (LAGB) has a potential for long-term complications. We report a case of LAGB slippage with extensive gastric necrosis managed with emergent sleeve gastrectomy.Case Report: A 45-year-old man presented to the emergency department after returning from a distant trip and reported a 3-day history of progressively severe abdominal pain, nausea, vomiting, and fever. He had undergone placement of the LAGB 2 years before this presentation, which resulted in subsequent weight loss of 143 lb and resolution of his comorbidities. On admission, the patient was hypotensive, tachycardic, and oliguric, with evident peritonitis. A computed tomography scan revealed extensive intraperitoneal free air and intra-abdominal fluid. After intravenous fluid resuscitation, he underwent emergent exploratory laparoscopy. A slipped band with gastric prolapse and extensive gastric necrosis were found, with multiple perforations involving most of the greater curvature of the stomach. The LAGB was explanted and a laparoscopic sleeve gastrectomy was performed. A liquid diet was introduced on postoperative day 4. Immediate recovery was prolonged because of acute-onset chronic renal failure and requirement for optimization of nutrition. The patient was discharged home on postoperative day 13 and had a subsequent uneventful recovery.
Conclusion:Gastric prolapse complicated by gastric necrosis is a rare life-threatening complication of LAGB. Once acute LAGB slippage is suspected, urgent attention and treatment are needed to minimize the chance of gastric ischemia. Laparoscopic explanation of LAGB and emergent sleeve gastrectomy may be considered in similar clinical settings to optimize the outcome and minimize the morbidity of near total or total gastrectomy.
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