Faculty Bibliography

BACKGROUND:Cholecystectomy (CCY) is one of the most commonly performed abdominal surgeries in the USA. However, limited population-level data are available that evaluate the long-term risk of colorectal cancer (CRC) following CCY. In this study, we aimed to assess the association between CCY and the risk of developing CRC. METHODS:We conducted a retrospective cohort study using the TriNetX research network. We identified adult patients (≥ 18 years) with a history of CCY between 2010 and 2024. These patients were matched using propensity score matching with adult patients without a history of CCY. Matching was based on demographics, comorbidities, and CRC risk factors. The primary outcome was the risk of first diagnosis of CRC that occurred after the index event (cholecystectomy). Secondary outcomes assessed included colon cancer, rectal cancer, and subsite-specific cancers involving the right-sided, transverse, and descending/sigmoid colon. Subgroup analyses were performed by gender and age categories. With censoring applied, Kaplan-Meier analysis with adjusted hazard ratios (aHRs) and 95% CIs was used to compare time-to-event rates at daily time intervals. RESULTS:A total of 613,396 patients with a history of CCY were matched 1:1 to controls (mean age 48.5 ± 18.1 years; 68.1% female; 71.2% White). CRC was more common in the CCY group (1.11 vs 0.61%; aHR 2.16, 95% CI 2.08-2.25; p < 0.001). CRC risk was elevated in both sexes, with a stronger association in males (aHR 2.57, 95% CI 2.41-2.73; p < 0.001) than females (aHR 1.93, 95% CI 1.83-2.04; p < 0.001). CRC risk following CCY was elevated across all age groups, with the highest overall CRC risk observed in patients aged 18-45 years (aHR 2.41, 95% CI 2.01-2.87), with a notably elevated risk for right-sided colon cancer (aHR 4.08, 95% CI 2.91-5.74). DISCUSSION/CONCLUSIONS:Our study showed an association between CCY and increased CRC risk, especially right-sided colon cancer. This risk was higher in males and younger adults, but elevated across all age and sex subgroups.

BACKGROUND AND AIMS/OBJECTIVE:Colorectal cancer screening reduces mortality, yet uptake remains suboptimal. Various interventions aim to improve screening rates, but their comparative effectiveness is unclear. We aim to evaluate the effectiveness of colorectal cancer screening uptake interventions using a systematic review and network meta-analysis. METHODS:We analyzed data from 76 randomized clinical trials across eight intervention strategies: patient navigation, mailed FIT outreach, educational multimedia, reminder-only, choice-based outreach, colonoscopy outreach, multistep, and usual care. Network meta-analysis compared interventions using risk ratios (RRs) and 95% confidence intervals (CIs). P-scores and rankograms assessed intervention rankings. Risk of bias was assessed, and certainty of evidence was graded using the GRADE framework. RESULTS:Patient navigation (RR 1.58, 95% CI 1.23-2.02; P-score 0.81) and mailed FIT outreach (RR 1.36, 95% CI 1.07-1.74; P-score 0.79) were the most effective strategies, significantly outperforming usual care. Educational multimedia (RR 1.27, 95% CI 0.91-1.78) and reminder-only interventions (RR 1.24, 95% CI 0.98-1.57) showed modest effects. Choice-based outreach and colonoscopy outreach were not significantly more effective than usual care. Mailed FIT outreach was superior to colonoscopy outreach (RR 1.35, 95% CI 1.11-1.63), and patient navigation outperformed reminder-only interventions (RR 1.48, 95% CI 1.14-1.94). In low baseline uptake settings (<30%), mailed FIT outreach was most effective (RR 3.12, 95% CI 1.70-5.71), while educational multimedia performed best in higher uptake populations (≥30%) and in recent studies (2021-2024). Majority of studies were at low risk of bias while the certainty of evidence mostly ranged from moderate to low. CONCLUSION/CONCLUSIONS:Patient navigation and mailed FIT outreach are the most effective strategies for increasing colorectal cancer screening uptake, particularly in low baseline uptake populations. Educational multimedia shows promise in recent years and high baseline uptake settings, offering a scalable alternative.

BACKGROUND/UNASSIGNED:Early-onset colorectal cancer (EOCRC), diagnosed in adults under the age of 50 years, is a significant public health challenge in the United States (US). While traditional colorectal cancer (CRC) incidence in older populations has declined due to screening, rates among younger adults are rising, likely driven by shifting birth cohort exposures to modifiable risk factors. This study aims to quantify the longitudinal burden of EOCRC and evaluates the contribution of dietary and metabolic risks from 1990 to 2023. METHODS/UNASSIGNED:Using data from the Global Burden of Disease (GBD) 2023 study, we analyzed age-specific incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for EOCRC. Trends were evaluated using joinpoint regression to calculate annual percent changes (APCs). Risk factor attribution was performed for dietary, metabolic, and behavioral exposures. Future burdens were projected to 2050 using mixed-effects and autoregressive integrated moving average (ARIMA) models. RESULTS/UNASSIGNED:Between 1990 and 2023, the age-specific incidence rate (ASIR) of EOCRC increased by 47.1%, rising from 8.01 to 11.79 per 100,000. Age-specific mortality rose from 2.48 to 3.00, and DALYs increased from 125.41 to 150.82. Males consistently carried a higher burden, with widening sex disparities in incidence by 2023 (13.10 in males versus 10.44 in females). By 2023, diet high in processed meat (18.4%) surpassed diet low in whole grains (17.6%) as the leading modifiable contributor to EOCRC mortality, followed by high body-mass index and smoking. Under a risk-reduction scenario, projected mortality could decline by more than 50% by 2050 (1.14 per 100,000) compared to the reference trend (2.42 per 100,000). CONCLUSIONS/UNASSIGNED:The EOCRC burden in the US has intensified over three decades. The shifting dominance toward processed meat and metabolic dysfunction highlights a critical need for targeted primary prevention. Achieving significant mortality reductions by 2050 will require population-level interventions addressing dietary quality and metabolic health early in life.

BACKGROUND:Colorectal cancer (CRC) outcomes vary by both race and ethnicity, and screening test use may contribute to this variation. We examined the association of race, ethnicity, and associated factors with CRC screening test use in a setting where financial barriers to screening are mitigated. METHODS:Survey information was gathered from US Veteran participants (N = 50,125) when enrolled into a randomized trial comparing screening colonoscopy to annual fecal immunochemical testing (FIT) in the prevention of CRC mortality. The primary exposures of interest were the participants' self-identified race and ethnicity, with adjustment for variables capturing access to care. Multivariable logistic regression, stratified by site and age, was used to assess the relationship between exposures of interest and prior use of any CRC screening test, prior colonoscopy, and prior fecal occult blood test (FOBT, including FIT) use. RESULTS:Screening test use was common (N = 28,330, 56.5%) with more Veterans reporting prior FOBT (N = 20,386, 40.7%) than prior colonoscopy (N = 12,671, 25.3%). In multivariable analysis, Black participants were more likely (odds ratio (OR), 1.06; 95% confidence interval (CI) 1.01-1.12) to have had any prior screening relative to White persons and this finding was driven by more frequent FOBT use relative to White persons (OR, 1.16; 95% CI 1.10-1.23). There was no association between Hispanic ethnicity (relative to White persons) on the primary outcomes. CONCLUSIONS:In this cohort, prior screening test use was common, with observed variation in overall test use by race, but not ethnicity. Further study of CRC screening test use in diverse populations are needed. CLINICALTRIALS.GOV ID/BACKGROUND:NCT#05612347.

BACKGROUND AND AIMS/OBJECTIVE:Incomplete resection of colorectal polyps can lead to polyp recurrence and post-colonoscopy colorectal cancer. At present, standardized methods for assessing resection completeness and calculating the incomplete resection rate (IRR) are lacking. This study aimed to establish expert consensus on optimal strategies and protocols for standardized evaluation of resection completeness for resections of polyps <20 mm in size. METHODS:An international modified Delphi consensus process consisting of three rounds of anonymized surveys was conducted. A total of 103 gastrointestinal endoscopy experts were invited. Agreement was defined as consensus among >80% of participants for each statement. Based on expert consensus, standardized assessment protocols were established for daily clinical practice, and for quality assurance and research. RESULTS:Sixty-seven experts from 18 countries participated, with 53 (51%) from 16 countries completing all three rounds. Consensus was achieved for 18 of 20 (90%) statements after three rounds. Key agreements included: (1) primary assessment of resection completeness using high-definition white-light inspection, supplemented by image-enhanced inspection for polyps 10-19 mm; (2) routine post-resection photo documentation for polyps 10-19 mm; (3) standard histopathological margin assessment for all non-fragmented and en bloc resected polyps; (4) preferential IRR measurement using extended margin resection; and (5) the need for endoscopists to know and monitor their personal IRR for polyps 10-19 mm. CONCLUSION/CONCLUSIONS:This study presents international expert consensus on evaluation of resection completeness for colorectal polyps <20 mm in size. Provided recommendations could guide more consistent and standardized evaluation of polyp resections and support establishment of the IRR as a valuable quality parameter for colonoscopy.

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) remains one of the leading causes of cancer-related morbidity and mortality in the United States. Despite the wide availability of effective screening tools, adherence to screening modalities and recommendations remains a significant challenge, influenced by various sociodemographic factors. This study examines the disparities and factors related to adherence to CRC screening methods. METHODS:Participants aged 45 to 75 years were selected from the 2022-2023 BRFSS dataset. The key variables extracted included CRC screening modalities and test frequencies (colonoscopy, sigmoidoscopy, stool testing, and virtual colonoscopy), as well as sociodemographic characteristics. Multivariate logistic regression was performed to explore associations between social factors and up-to-date adherence to specific screening tests. RESULTS:A total of 239,512,188 (Weighted frequency) adults were included in this study, with the majority identifying as White (63.90%), female (51.92%), having access to a primary care provider (PCP; 90.64%), married (61.36%), reporting a yearly income of $50,000 or greater (69.17%), and residing in urban areas (93.11%). The most reportedly used screening options were colonoscopy (27.34%) and stool-based tests (8.67%). Up-to-date adherence to colonoscopy was more likely among adults who are Black non-Hispanic (aOR = 1.86, 95% CI [1.57-2.19], p < .0001), had access to PCPs (aOR = 2.13, 95% CI [1.80-2.52], p < .0001), and urban residents (aOR = 1.18, 95%CI [1.04-1.34], p = 0.0105) among cohorts with colonoscopy. Up-to-date adherence to stool test was more likely among Hispanic (aOR = 1.37, 95%CI [1.03-1.81], p = 0.0296), those with access to a PCP (aOR 1.63, 95%CI [1.21-2.21], p = 0.0014), individuals who were divorced (aOR = 1.15, 95%CI [1.00-1.32], p = 0.0431), and uneducated ( aOR = 1.58, 95%CI [1.15-2.16], p = 0.0046) among cohorts with stool test. CONCLUSION/CONCLUSIONS:Racial/ethnic background, socioeconomic status, and marital status were associated with whether individuals adhered to a particular screening modality among their cohorts with the same screening test. We recommend creating specific and culturally aware programs to overcome obstacles and targeted interventions among patients, which may help improve adherence rates.

Stool tests are an essential component of colorectal cancer (CRC) screening. Patients with positive test results are at increased risk of CRC, and a timely follow-up with colonoscopy is recommended. Follow-up colonoscopy rates remain suboptimal. The current article reviews the barriers to timely colonoscopy, highlights evidence-based interventions, and provides actionable recommendations for endoscopists, health systems, and policymakers. By implementing coordinated strategies, including patient navigation, digital tools, and open access colonoscopy, health care organizations can close critical gaps in the CRC screening continuum and decrease CRC incidence and mortality.