Timing of Procedure and Compliance With Outpatient Endoscopy Among an Underserved Population in an Inner-City Tertiary Institution

Purpose: Anecdotal evidence suggests that patient compliance with colonoscopy is poorer with Monday procedures and better during the winter months because there is not much else to do. We examined patients\u27 compliance with scheduled outpatient endoscopy by time of the day, days of the week, and seasons of the year. Methods: We included 2873 patients who were scheduled for endoscopy from September 2009 to August 2010. Compliant patients were those who showed up for their procedures whereas noncompliant patients were those who did not show up without canceling or rescheduling their procedures up to 24 hours before their scheduled procedures. We used logistic regression models to evaluate the association between the timing of the scheduled procedure and compliance. Results: A total of 574 (20%) patients did not show up. There was no difference in compliance by time of day of the procedures. However, when compared with patients scheduled for procedures on Monday, there was a trend towards improved compliance as the week progressed, becoming significant on Friday (odds ratio 1.46; 95% confidence interval 1.06-2.00). There was also better compliance in the warmer months. Conclusions: Noncompliance with outpatient endoscopy is substantial among underserved populations with limited predictive pattern of compliance by the timing of the procedures. © 2012 Elsevier Inc

Obesity, weight change, and risk of adenoma recurrence: a prospective trial

BACKGROUND AND STUDY AIMS: Obesity is a risk factor for colorectal neoplasia. Lifestyle modifications, including weight loss, have been advocated to reduce the risk. However, no prospective study has evaluated whether weight loss actually affects adenoma recurrence. The aim of this study was to examine whether weight change (loss or gain) over 4 years is associated with adenoma recurrence. PATIENTS AND METHODS: A total of 1826 patients with colorectal adenoma in the Polyp Prevention Trial had their height and weight measured at baseline. Adenoma recurrence was determined by end of trial colonoscopy 4 years after study entry when patients\u27 weights were re-measured. Poisson regression models were used to evaluate body mass index (BMI), weight change over 4 years, and the risk of any adenoma and advanced adenoma recurrence. RESULTS: Adenoma recurrence was observed in 723 patients (39.6%), 118 (6.5%) of whom had advanced adenoma recurrence. Among those with baseline BMI \u3c 25 kg/m(2) (n = 466), BMI 25-29 kg/m(2) (n = 868), and BMI \u3e/= 30 kg/m(2) (n = 492), the recurrence rate was 34.5%, 41.0%, and 41.9%, respectively. Obesity was associated with an increased risk of adenoma recurrence (RR = 1.19; 95%CI 1.01-1.39) and advanced adenoma recurrence (RR = 1.62; 95%CI 1.01-2.57). However, when compared with those with relatively stable weight (weight change \u3c 5 lb) over the 4-year trial, weight gain or loss was not associated with adenoma recurrence. This was consistent, regardless of the baseline BMI. CONCLUSIONS: Weight loss or gain over 4 years does not affect adenoma recurrence. This study does not support weight loss alone as an effective intervention for reducing adenoma recurrence

Likelihood of missed and recurrent adenomas in the proximal versus the distal colon

BACKGROUND: Colonoscopy may be less efficacious in reducing colorectal cancer mortality in the proximal compared with the distal colon. A greater likelihood for missed and recurrent adenomas in the proximal colon may contribute to this phenomenon. OBJECTIVE: To examine whether a proximal adenoma is associated with the risk and location of missed and recurrent adenomas. DESIGN: Prospective. SETTING: Polyp Prevention Trial. PARTICIPANTS: A total of 1864 patients with an adenoma at baseline underwent a follow-up colonoscopy 4 years later (adenoma recurrence). Of these, 1731 underwent a clearing colonoscopy 1 year after the baseline examination (missed adenoma). MAIN OUTCOME MEASUREMENTS: Association of baseline adenoma location with the risk and location of adenomas found at colonoscopy performed 1 year and 4 years later. RESULTS: At the year 1 colonoscopy, 598 patients (34.6%) had an adenoma (missed adenoma). Compared with those with a distal-only adenoma at baseline, patients with a proximal-only adenoma at baseline were more likely to have any missed adenomas (relative risk [RR] 1.28; 95% CI, 1.09-1.49) and a proximal-only missed adenoma (RR 2.05; 95% CI, 1.49-2.80). At the year 4 colonoscopy, 733 patients (39.3%) had adenoma recurrence. Patients with a baseline proximal-only adenoma were more likely to have any adenoma recurrence (RR 1.14; 95% CI, 1.00-1.31) and a proximal-only adenoma recurrence (RR 1.52; 95% CI, 1.15-2.02). Sensitivity analyses involving missed adenomas did not materially affect the risk or location of recurrent adenomas at year 4 colonoscopy. LIMITATION: Lesions may still be missed on repeated colonoscopies. CONCLUSIONS: Missed and recurrent adenomas are more likely to be in the proximal colon. Published by Mosby, Inc. All rights reserved