Wednesday ACG 2010 Plenary Session Highlights

The presentations highlighted here stood out among the studies presented during the second plenary session on Wednesday at ACG 2010.

Complication Rates after Outpatient Colonoscopy in a Medicare Population: A Matched Retrospective Cohort Study

Presenters: M. Fuad Azrak, MD, MPH, Ya-lin Huang, PhD, David Howard, PhD, Florence Tangka, PhD, Laura Seeff, MD

Purpose: “To determine the rate of complications after outpatient colonoscopy and to evaluate if these rates have changed with the increased use of screening colonoscopy.”

Results: Low yet significant gastrointestinal and cardiovascular morbidity is associated with outpatient colonoscopy in people age 65 years and older, but not increased mortality following colonoscopy. It should be noted that with increased numbers of screening colonoscopies in Medicare patients the risk of complications has not changed.

Ocean State Crohn's and Colitis Area Registry (OSCCAR): Incidence of Crohn's Disease and Ulcerative Colitis in a Prospective, Population-Based Inception Cohort in Rhode Island

Presenters: Samir Shah, MD, FACG, Neal Leleiko, MD, PhD, Sheldon Lidofsky, MD, MS, Renee Bright, MS, Stacey Grabert, PharmD, MS, Meaghan Law, BS, Heather Moniz, BS, Barbara Bancroft, RN, Kristina Suorsa, BS, Mitul Patel, MD, Jennifer Vancura, BS, Adam Harris, MD, Bharati Kalasapudi, BA, Elisabeth Cole, MS, and Bruce Sands, MD, MS, FACG

Purpose: To determine and better understand the incidence, natural history, and factors influencing the outcomes of IBD.

Results: The incidence rate of IBD is higher than reported in the US previously, according to preliminary data from the study.

Update: Meta-Analysis of Overall Risk for Lymphoma with Immunomodulators for Inflammatory Bowel Disease

Presenters: David Kotlyar, MD, Colleen Brensinger, MS, James Lewis, MD, MSCE, Wojciech Blonski, MD, PhD, Manuel Van Domselaar, MD, David Porter, MD, Sandeep Sandilya, MD, and Gary Lichtenstein, MD, FACG

Purpose: With IBD treatments azathioprine and 6-mercaptopurine implicated in a four-fold increased risk of lymphoma in a study through which referral data was combined with one population-based study, and the risk of lymphoma in referral centers possibly inflated artificially because of sicker patients who have more comorbidities, Kotlyar and colleagues updated a previous meta-analysis to “directly compare referral center data with population based data to assess if referral bias is operant, and to assess overall risk.”

Results: A four- to five-fold increased risk of lymphoma faces patients with IBD who are treated with thiopurines, compared to the general population, with this risk found to be similar in studies from both referral centers and population-based studies.

2010 ACG IBD Award

Use of Anti-TNF Therapy is Associated with Decreased Utilization of Diagnostic Imaging and Radiation Dose in Crohn's Disease

Presenters: Seema Patil, MD, Ankur Rustgi, MBBS, MPH, Fauzia Vandermeer, MD, and Raymond Cross, MD, MS

Purpose: To determine the impact of anti-TNF therapy on radiation exposure in patients with Crohn’s disease, as the diagnostic imaging that is frequently use in this population possibly exposes patients to high amounts of radiation and anti-TNF therapy is often used in patients with Crohn’s disease and decreases health care utilization.

Results: In the year following the initiation of anti-TNF therapy, decreases are seen in the number of diagnostic and imaging tests performed and radiation doses received by patients with Crohn’s disease, likely due to improved disease activity and fewer disease complications with the use of anti-TNF agents. However, Paril and colleagues note that “it is possible that the results are biased as patients about to initiate anti-TNF therapy are more likely to undergo an extensive diagnostic evaluation.” They feel additional studies are needed to confirm their results and see if diagnostic imaging sue is decreased with prolonged follow-up.

Second-look Endoscopy for Bleeding Peptic Ulcer: A Decision and Cost-Effectiveness Analysis

Presenters: Thomas Imperiale, MD, Nan Kong, PhD

Purpose: To compare routine second-look endoscopy (rSLE) vs. no SLE for patients with bleeding peptic ulcer disease (PUD) through the creation of a decision model that uses literature-based probabilities and Medicare-reimbursed costs, as SLE is not routinely recommended due to “no clear beneficial effect on the need for surgery or on mortality,” despite the potential ability of SLE to decrease risk of recurrent PUD bleeding.

Results: Imperiale says that although “this analysis did not consider comorbidity from recurrent bleeding, effect of rSLE on length of hospital stay, or use of adjuvant therapy with proton pump inhibitors, the results suggest that rSLE is not indicated following therapeutic endoscopy for bleeding PUD. However, if the risk for rebleeding exceeds 20%, then rSLE reduces the risk of rebleeding at no additional cost.”