Recurrence will develop in 30–50% of colorectal cancer (CRC) cases despite apparent clearance following treatment. Carcinoembryonic antigen (CEA) is the only guideline‐recommended blood test for monitoring cases for recurrence, but its sensitivity and specificity are suboptimal. This observational study compared a novel 2‐gene (methylated BCAT1 and IKZF1 DNA) blood test with CEA for detection of recurrent CRC. We conducted a paired comparison of the BCAT1/IKZF1 test with CEA (cut‐off 5 ng/mL) in blood from patients in remission after treatment for primary CRC and undergoing surveillance. Blood collected in the 12 months prior to or 3 months after complete investigational assessment of recurrence status were assayed and the results compared by McNemar's test. Of 397 patients enrolled, 220 underwent satisfactory assessment for recurrence and 122 had blood testing performed within the prescribed period. In 28 cases with recurrent CRC, CEA was positive in 9 (32%; 95% CI 16–52%) compared to 19 (68%; 95% CI 48–84%) positive for methylated BCAT1/IKZF1 (P = 0.002). All samples that were CEA positive were also BCAT1/IKZF1 positive. In 94 patients without clinically detectable recurrence, CEA was positive in 6 (6%, 95% CI 2–13%) and BCAT1/IKZF1 in 12 (13%, 95% CI 7–21%), P = 0.210. The odds ratio of a positive CEA test for recurrence was 6.9 (95% CI 2–22) compared to 14.4 (5–39) for BCAT1/IKZF1. The BCAT1/IKZF1 test was more sensitive for recurrence than CEA and the odds of recurrence given a positive test was twice that of CEA. The BCAT1/IKZF1 test should be further considered for monitoring cases for recurrence.
Reversal of loop ileostomy may be associated with significant morbidity and mortality. Increasing the delay from creation to closure may result in fewer complications.There is an increased risk in older patients with more comorbidity, particularly when the primary procedure is for diverticular disease with significant peritoneal contamination.
495 Background: Annual computed tomography (CT) scans and periodic carcinoembryonic antigen (CEA) testing are monitoring methods for colorectal cancer (CRC) recurrence. We have previously described a 2-gene blood test for CRC (methylated BCAT1 and IKZF1) that may indicate tumour DNA shedding into the blood. The aim was to compare the 2-gene and CEA blood tests at detecting recurrence in CRC surveillance patients. Methods: Methylated BCAT1/IKZF1and CEA (positive ≥5ng/mL) were measured in patients previously diagnosed with CRC (excluding those undergoing active treatment). McNemar’s test was used for statistical analyses, using clinical findings including CT to diagnose recurrence. Results: At study midpoint, 340 patients were enrolled (64% men, average 64yr at diagnosis), including 59 patients with blood testing done pre- and post-resection, and 105 with CT surveillance scans (median 18 months after primary diagnosis). Following resection (median 2.3 months), 91% of patients who were 2-gene positive prior to treatment showed either no detectable methylated BCAT1/IKZF1(26/35) or significantly reduced levels in blood (6/35). Residual disease was found in two patients (2/3) who remained gene positive post treatment. Recurrence was identified in 30/105 (29%) patients with surveillance CT scans. Of these, 67% and 27% were 2-gene and CEA positive, respectively, with 8 (27%) cases positive by both tests (Table 1, p<0.001). In 13 cases with local recurrence, 54% were 2-gene positive, with only 1 (8%) positive by both tests (p=0.03). In 17 cases with distant recurrence, respective 76% and 41% were 2-gene and CEA positive (p=0.03). In patients with no evident disease, 20% were positive for one test but not the other (2-gene test, 16%; CEA, 4%; p = 0.04). Conclusions: Following resection, most patients had either reduced or no methylated BCAT1/IKZF1 in blood, indicating a correlation with the presence of cancer. Two-gene positivity correlated with local (54%) and distant (76%) recurrence with 2.5-fold more recurrence cases detected than with CEA. The 2-gene test may be better than CEA for recurrence monitoring. [Table: see text]
patients underwent OGDs pre-operatively and for what indication and with what result. Further sub-analysis was performed for each operation type. Results 147 OGDs were done on a total of 116 bariatric surgical patients, with 23 patients having had more than one OGD each. Of these 147 OGDs 44 were pre-operative. 13 (29.5%) OGD referrals were made to investigate anaemia, 12 (27.3%) for pre-surgical screening to investigate existing symptoms of gastric ulceration, and 9 (20.5%) to investigate abdominal pain. The remaining referrals were made for interventional gastric balloon insertions and removals (6¼13.6%) and to investigate symptoms of reflux (3¼6.8%) and dysphagia (1¼2.3%). The majority of patients (50%) were referred prior to having a roux-en-y gastric bypass operation. Most of the pre-operative OGD findings were normal (16¼36.4%), but gastritis (6¼13.6%), hiatal hernias (6¼13.6%), gastric ulceration (2¼4.5%), oesophagitis (1¼2.3%) and duodenitis (1¼2.3%) were noted. Of the 13 patients referred with anaemia, 9 (69.2%) had normal mucosa on OGD, but of the 12 patients who had pre-surgical screening 7 (58.3%) were found to have abnormalities, including a fundic gland polyp and antral erosions. Conclusion Using a selective referral process, only 4% of all bariatric surgery cases performed required preoperative endoscopy. The commonest indication for OGD preoperatively was anaemia and the commonest pathology found was mucosal inflammation (gastritis, oesophagitis and duodenitis).Competing interests None declared. Introduction The Joint Advisory Group on gastrointestinal endoscopy and the National Bowel Cancer Screening Programme (BCSP) have published guidelines on the tattooing of malignant and suspicious lesions at colonoscopy. Our endoscopy department has a local protocol for the tattooing of these lesions based on these guidelines. The BCSP has led to an increase in the number of colonoscopies performed and the number of lesions identified. Aim To assess adherence to a local protocol in a single endoscopy unit and identify if lesions identified through the BCSP are more likely to be tattooed than lesions identified for other reasons. Methods A retrospective review of a prospectively maintained database was performed. All colonoscopies performed between 1 April 2010 and 31 March 2011 were reviewed and screening cases identified. Results 4023 colonoscopies were performed, 307 (8%) as part of the BCSP. Malignancy or polyps were identified in 192 (63%) of BSCP colonoscopies compared to 26% (958/3716) of non-BCSP colonoscopies. Significantly more polyps and malignancies were identified during BCSP colonoscopies than non-BCSP colonoscopies (p<0.0001 PMO-223 TATTOOING OF SUSPICIOUS COLONIC LESIONS AT COLONOSCOPY: IS ADHERENCE TO LOCAL PROTOCOL BETTER IF IDENTIFIED THROUGH THE BOWEL CANCER
BSG abstracts 8 (32%) required segmental colectomy: 5 lesions appeared malignant, 1 was too large, 1 and 2 technically impossible to resect. 2 cases required laparoscopic mobilisation of the colon to aid EMR. 15 patients (60%) avoided any abdominal surgical intervention. Median length of hospital stay was 1 day. 2 patients had significant post-operative bleeding (1 EMR, 1 port-site). 1 patient developed a collection after laparoscopic resection which required radiological drainage. 1 EMR patient had polyp cancer with inadequate resection margins and required subsequent laparoscopic resection. Conclusion Although the number of patients is relatively small, the pathway is a safe and feasible way to reduce the need for colonic resection for complex polyps. A significant number of patients avoided the need for segmental resection, and most did not require any laparoscopic assistance.
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