Faculty Bibliography

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) is the fourth most common cancer in the USA and second leading cause of cancer deaths. While screening rates have increased and mortality rates have declined, disparities persist. This study investigates the screening rates and mortality correlation over 25 years. METHODS:We analyzed trends in age-adjusted CRC screening and mortality rates (AAMRs) for adults aged ≥ 50 using BRFSS and CDC WONDER databases, respectively. Correlation analysis between CRC screening rates and AAMRs and projected AAMRs at 100% screening rates were calculated using Jamovi and R software. RESULTS:CRC screening rates increased from 41.5% in 1999 to 76.3% in 2023. Non-Hispanic Whites recorded the highest rates (80.1%), while American Indians or Alaskan Natives (AI/AN) had a low screening rate of 48.65% in 2023. Non-insured individuals had a screening rate of 33.02%, while insured recorded 78.13% in 2023. AAMRs of CRC declined significantly over time, from 69.3% to 40.7% per 100,000 (1999-2024). AAMRs demonstrated a strong inverse correlation (- 0.885) with screening rates. Correlation analysis revealed stronger associations between screening and mortality for NH Whites and African Americans (AA) populations (- 0.824 and - 1.19, respectively). The projected AAMR at 100% screening was 18.91 (95% CI 17.92-19.91), versus 40.4 at 76.3% in 2023. CONCLUSION/CONCLUSIONS:CRC screening increased over the past 25 years, achieving 76.3% in 2023, correlating with decrease in AAMRs. Disparities persist across races and different socioeconomic groups. At 100% screening rates, projected AAMR is 18.919. Equity-focused interventions are needed to further increase CRC screening rates.

BACKGROUND:Infliximab (IFX) is commonly used in the management of acute severe ulcerative colitis (ASUC), yet up to 30% of individuals still require colectomy within 1 year. Clinical data characterizing these patients, however, are limited. AIMS/OBJECTIVE:We aimed to determine risk factors for colectomy among patients with ASUC who received in-hospital IFX treatment. METHODS:We performed a retrospective analysis of patients with ASUC who were treated with at least one dose of IFX while admitted between 2014 and 2022. Cox proportional hazards (PH) models were used to assess demographic, clinical, and laboratory risk factors for colectomy within 30 days and 1 year of IFX initiation. RESULTS:Overall, 36/170 (21.2%) patients underwent colectomy within 1 year of IFX initiation, with 22 (12.9%) individuals requiring colectomy within 30 days. On univariable analysis, concomitant Clostridioides difficile infection during admission, a ≤50% decrease in C-reactive protein (CRP) and experiencing 3 or more bowel movements per day within 48 hours after an initial IFX dose were significantly associated with 1-year colectomy. On multivariable Cox PH analysis, C. difficile infection during admission (aHR=2.92, 95% CI: 1.12-7.58) and a higher CRP/albumin ratio on admission (aHR=1.13, 95% CI: 1.01-1.27) were associated with increased colectomy risk within 1 year of IFX initiation. CONCLUSIONS:C. difficile infection and a higher CRP/albumin ratio on admission are associated with decreased time to colectomy within 1 year of IFX among patients presenting with ASUC. These factors may aid in early risk stratification to minimize delays in JAK-inhibitor initiation or surgical referral.

Primary Obesity Surgery Endoluminal 2 (POSE-2) is a minimally invasive endoscopic bariatric procedure. We conducted a systematic review and meta-analysis of one randomized controlled trial (RCT) and three observational studies (N = 210) to evaluate its efficacy, safety, and metabolic outcomes (HbA1c, glucose, cholesterol, triglycerides, LDL, and liver enzymes). Pooled percent total body weight loss (%TBWL) was 13.23% (I² = 87%) at 3 months, 16.22% (I² = 76%) at 6 months, and 16.17% (I² = 0%) at 12 months, showing high heterogeneity early but consistency by 12 months. Percent excess weight loss (%EWL) at 12 months was 56.95% (I² = 0%). HbA1c improved at 6 months (SMD = -0.67, p = 0.036, I² = 0%), exceeding the minimal clinically important difference (-0.5%), and cholesterol decreased significantly (SMD = -0.25, p = 0.013, I² = 0%). Fasting glucose and liver enzymes showed nonsignificant favorable trends with high heterogeneity for ALT/AST (I² > 90%). Adverse events were infrequent (2.5-5%), mostly mild, with rare perforations or bleeding. POSE-2 demonstrates promising weight loss and selected metabolic improvements in HbA1c and cholesterol with a favorable short-term safety profile, though evidence is limited to four studies with small sample size, short follow-up, and variable heterogeneity, highlighting the need for larger, longer RCTs.

INTRODUCTION/BACKGROUND:Obesity is a major public health issue in the U.S., with Black women disproportionately affected. Structural barriers like poverty, limited healthcare access, and lower education hinder weight management. Telehealth may improve health equity, but its effectiveness versus in-person care for Black women with obesity is unclear. This review compares both approaches to guide equitable care. METHODS:We conducted a PRISMA-compliant systematic review and meta-analysis, searching PubMed, Embase, and Cochrane through April 2025. Eligible were randomized controlled trials (RCTs) compared remote ± in-person vs. in-person weight-loss interventions among Black women with obesity. Random-effects models pooled changes in weight, BMI, blood pressure, and lipids. Risk of bias was assessed with RoB-2, and GRADE evaluated evidence certainty. RESULTS:Four RCTs (N = 576) were included. The analysis found no statistically significant differences in primary outcomes of weight change (SMD - 0.22, 95% CI: - 0.68; 0.24), percentage weight loss (SMD - 0.80, 95% CI: - 3.86; 2.26), and BMI (SMD - 0.26, 95% CI: - 1.61; 1.11). Secondary outcomes, such as blood pressure and lipid profiles (HDL, LDL, total cholesterol, triglycerides), also showed no statistically significant difference across intervention formats. Risk of bias was generally low, but evidence certainty ranged from moderate to very low. CONCLUSION/CONCLUSIONS:Remote weight-loss interventions via telehealth showed no significant short-term differences compared with in-person programs among Black women with obesity. Telehealth may offer a comparable alternative, but small sample size and limited follow-up preclude firm conclusions. Larger, longer-term, and culturally tailored trials are needed to confirm long-term impact and address digital equity.

BACKGROUND:The benefits of achieving endoscopic remission among older adults with inflammatory bowel disease (IBD) who have mild persistent disease activity are unknown. METHODS:This was a retrospective study of adults ≥ 60 with IBD who had mild or no disease activity on endoscopy from January 1, 2018-January 1, 2023. The primary outcome was a composite of major IBD-specific adverse events (hospitalizations, surgery, and prescription of corticosteroids for IBD-related symptoms) within 1 year of endoscopic assessment. Our secondary outcome was a composite of 1-year morbidity-related events (mortality, all-cause hospitalization, infection requiring antibiotics, venous thromboembolism, cardiovascular events, and osteoporotic fractures). We also assessed outcomes at 5 years. RESULTS:Among 504 patients, 192 (38.1%) had mild endoscopic disease and 312 (61.9%) were in endoscopic remission, with a median disease duration of 11 years. On multivariable analysis, mild endoscopic disease activity increased the odds of a 1-year adverse IBD-specific outcome (aOR 4.16, 95% CI 2.10-8.24), with similar results at 5 years. Furthermore, mild endoscopic disease was associated with increased odds of experiencing an adverse morbidity-related outcome within 1 year as compared to endoscopic remission (aOR 1.56, 95% CI 1.01-2.43). CONCLUSIONS:Among older adults with prevalent IBD, mild endoscopic disease activity, as compared to endoscopic remission, was associated with increased odds of adverse IBD-specific and morbidity-related outcomes at 1 year, with this risk persisting for IBD-specific outcomes at 5 years. These findings highlight the importance of achieving endoscopic remission, which may confer both short- and longer-term benefits in this population.

BACKGROUND:Emerging blood tests may improve colorectal cancer (CRC) screening uptake and outcomes but are less sensitive for advanced precancerous lesions than some currently recommended tests. We examine whether these tests meet expectations for U.S. Preventive Services Task Force (USPSTF) recommendation. METHODS:A decision-analytic model that informed USPSTF was replicated and used to estimate the lifetime benefits (averted CRC cases & deaths, life-years gained [LYG]), burdens (required screening tests & colonoscopies), and harms (colonoscopy-related complications) for annual, biennial or triennial blood testing through age 45-75 years vs a benchmark of recommended and contemporary stool-based strategies, with colonoscopy screening as the reference. Base-case analyses assumed 100% adherence. Sensitivity analyses evaluated more realistic scenarios. RESULTS:Among benchmark strategies, colonoscopy screening had the most benefit, with an estimated 30 CRC deaths averted, 356 LYG, 4270 colonoscopies required and 15 complications per 1000 adults; stool-based strategies resulted in 81-88% of LYG for colonoscopy, 6829-19,476 screening tests, 1523-1880 colonoscopies, and 9-10 complications. By comparison, annual blood testing resulted in 85-87% of LYG for colonoscopy and an intermediate number of screenings, colonoscopies and complications. Biennial and triennial blood testing provided 57-72% of LYG for colonoscopy but resulted in net population benefit under plausible scenarios for increased utilization vs existing strategies. CONCLUSIONS:The estimated benefits, burdens and harms of annual blood testing are within the range of current CRC screening strategies. Biennial and triennial testing should also be considered for recommendation given potential for increased utilization and net population benefit.

BACKGROUND:Measurement of colorectal polyps is typically performed via visual estimation, which is prone to bias. Studies have evaluated the accuracy of visual estimation and utility of assistive tools, but results have been mixed. This study aims to clarify the accuracy of visual estimation as a measurement tool, and the benefits of artificial intelligence. METHODS:MEDLINE and Embase were searched through October 2024. Extraction and quality assessment were performed independently by two authors. The primary outcome was the pooled absolute mean difference in size between visual estimation and control. Secondary outcomes included subgroup analysis of expert vs trainee status, accuracy of artificial intelligence, study origin (East vs. West), comparator type, definition of accuracy, polyp size, direction of estimation, and image type. RESULTS:35 studies with 42,964 polyp measurements were included in our analysis. All studies were of high quality and there was no evidence of publication bias. The pooled absolute mean difference from comparator was 1.68mm (CI 1.21-2.15) with high variability explained by differences in the comparator, the direction of estimation, image type, and size of the polyp. Overall accuracy was 60% with high variability as well, with increased accuracy with video displayed over photos. Artificial intelligence improved accuracy with an odds ratio of 7.46. CONCLUSION/CONCLUSIONS:Visual estimation is an inaccurate and imprecise way to measure colorectal polyps. Further research is needed to determine the impact on clinical outcomes related to colorectal cancer. Investment in new technology to aid in polyp measurement is an important next step.

BACKGROUND AND AIMS/OBJECTIVE:There is limited information regarding performance of fecal immunochemical test (FIT) in post-polypectomy surveillance, or for screening individuals with a family history of CRC . We conducted a systematic review to assess current evidence regarding diagnostic performance of one time FIT in increased risk populations. METHODS:A comprehensive search of multiple databases was conducted to assess studies reporting performance of a one-time FIT as screening or surveillance tool in individuals at increased risk of CRC. RESULTS:We identified three studies reporting on 8817 individuals with personal history of polyps who underwent FIT testing. For CRC detection, one time FIT showed sensitivity ranging from 27.6% to 100.0% and specificity ranging from 55.9% to 94.1% with variable test thresholds and index polyp histology. We identified 12 studies reporting on 5525 individuals with family history of CRC. One time FIT showed a sensitivity ranging from 25.0% to 100.0% and specificity ranging from 83.1% to 92.0% , with variable test thresholds and family history characteristics. CONCLUSION/CONCLUSIONS:Current evidence is limited to adequately assess diagnostic performance of FIT in individuals with family history of CRC, or as follow up after polypectomy.

BACKGROUND/UNASSIGNED:Several patient and tumor characteristics impact the prognosis of non-metastatic colon cancer. Among those, tumor location is believed to be a significant factor, as proximal lesions are associated with lower overall survival (OS) in modern cohorts. We aimed to validate these findings in a cohort of patients from the Minnesota Colon Cancer Control Study who underwent curative colectomy. METHODS/UNASSIGNED:From 1976 to 1992, 46,551 patients aged 50-80 years were randomized to usual care, annual, or biennial screening with fecal occult blood testing (FOBT). Positive FOBT was followed by colonoscopy. We analyzed participants whose colonoscopy revealed colon adenocarcinoma to estimate the impact of tumor laterality on survival after adjustment for demographic and clinicopathologic characteristics. Proximal tumors were defined as those between the cecum and the splenic flexure. RESULTS/UNASSIGNED:Of 1,486 patients, 796 met inclusion criteria; 57% had proximal cancers. After adjustment, there was no significant difference between proximal and distal tumors in disease-specific mortality [subdistribution hazard ratio (SHR) =0.94, 95% confidence interval (CI): 0.70-1.3], but proximal tumors had lower rates of death from any cause [hazard ratio (HR) =0.9, 95% CI: 0.77-1.00]. CONCLUSIONS/UNASSIGNED:Although lacking granular data, these findings from the pre-modern chemotherapy era raise questions about the generalizability of the association between side of origin and prognosis identified in contemporary, treatment-based trials.