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Background: Screening colonoscopy aims to interrupt the adenoma-carcinoma sequence by removing all precancerous adenomatous polyps. Adenomatous polyp detection rate (ADR) can vary between endoscopists as well as between race, age, and risk of colorectal cancer (CRC). The purpose of this study was to compare ADR among academic gastroenterologists (A-GI), non-A-GI, and surgeons for endoscopies performed in the same endoscopic suite of a large medical center with a predominately African American (AA) population.Methods: All screening colonoscopies performed in 2014 for patients aged 62-76 years were identified using the electronic medical records data. Patients with average risk and high risk of CRC defined as having a 'personal history of polyps' or 'family history of CRC', and history of ulcerative colitis and Fecal Occult Blood Test/Fecal Immunochemical Test (FOBT/FIT) positivity were included. Patients with incomplete colonoscopy (defined as failing to achieve cecal intubation or poor preparation) and unrecovered tissue biopsy were excluded. ADR was calculated for three groups of endoscopists: A-GIs, non-A-GIs, and surgeons.Results: A total of 573 screening colonoscopies was analyzed. The endoscopists comprised five A-GIs, eight non-A-GIs, and six surgeons. The majority of patients were of AA decent (71%), female (54%) with an average age of 66 years. Patients classified as average risk comprised 79% of the population. Most of the colonoscopies were performed by A-GI (n=339), followed by non-A-GI (n=144), and surgeons (n=90). The ADR for A-GI was 50% as compared to 32% for non-A-GI (p<0.001) and 25% for surgeons (p<0.001). Also, A-GI were more likely to identify ≥3 adenomas during screening colonoscopies. Significant differences were observed (p<0.001) in the mean time of colonoscopy for A-GI (30 mins) non-A-G (14 mins), and surgeons (18 mins).Conclusion: Significant variation in the ADR between endoscopists belonging to different specialties were observed. Although all appear to achieve acceptable ADR (ie at least 25 for men and 15 for women), academic gastroenterologists had better performance than non-academic GI and surgeons. This may be explained by a significantly longer average duration of procedures for the highest ADR group.

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31 Background: The incidence of early-onset colorectal cancer (EOCRC) is rising. Left-sided colorectal cancer (LCC) is associated with better survival and response to therapy compared to right-sided colon cancer (RCC) in the metastatic setting. Current NCCN guidelines recommend the addition of EGFR inhibitors to KRAS/NRAS wild-type metastatic CRC originating from the left-side only. Whether primary tumor sidedness impacts survival in loco-regional disease and in EOCRC is of clinical interest. Methods: Data from the National VA Cancer Cube Registry was studied. 65,940 cases of CRC were diagnosed between 2001 and 2015. EOCRC (2,096 cases) was defined as CRC diagnosis at age <50 years. ICD codes C18 to C20 were used to delineate patients with RCC vs. LCC. RCC was defined as cancer from the cecum to the hepatic flexure (C18.0-C18.3), LCC from the splenic flexure to the rectum (C18.5-18.CRC; C19 & C20). Transverse cancer (C18.4), overlapping and unidentified sites (C18.8; C18.9) were excluded. Results: EOCRC is more likely to originate from the left-side (66.65% LCC in EOCRC vs. 58.77% in the whole CRC dataset). Overall, LCC has better 5-year OS than RCC in Stage I, III and better 1-year OS in stage IV (Table). Stage II RCC has better 5-year OS than LCC (RC 53.39% vs LC 49.28%). In EOCRC, there is no statistically significant difference between LCC and RCC in Stages I-III. Stage IV EOCRC patients with LCC and RCC have a 1-year OS of 73.23% and 59.84%, respectively. Conclusions: EOCRC is more likely than CRC to originate from the left side. In EORCRC patients, LCC is associated with better OS than RCC only in patients with metastatic disease. In the overall population, LCC is associated with better OS in all states except Stage II. The better prognosis of Stage II RCC might be due to the reported high incidence of MSI-high tumors in this subpopulation. [Table: see text]