offered the test, 20.6% responded that they don’t have any problems, 11.8%had no insurance, and 11.8% do not want to know if they have cancer.Conclusions: Although more patients are aware of colonoscopy than PSA,less patients under went colonoscopy. The reason for this discrepancycould be embarrassment associated with the colonoscopy and not seeingcolon cancer as a problem. Screening test NEVER offered is still thebiggest problem which can be improved by educating primary care phy-sicians and patients.

351

IS MELANOSIS COLI A RED FLAG?Uma Kantamuneni, M.D., Rajeev Jayadevan, M.D., Ajit Kokkat, M.D.,Mario Ricci, M.D., Edward Norkus, Ph.D., Nejat Kiyici, M.D.,Hilary I. Hertan, M.D.*. Our Lady of Mercy Medical Center, Bronx,NY.

Purpose: To determine the possible association between melanosis coliand colorectal neoplasia.Background: Melanosis coli, a dark pigmentation of the colon, is fre-quently attributed to anthroquinone laxative use. The association betweenconstipation, melanosis coli, and colorectal cancer is controversial. Previ-ous studies have suggested a link between adenomatous polyps and mel-anosis coli. We decided to examine the possible association betweenmelanosis coli and colorectal neoplasia in the endoscopy unit of a univer-sity affiliated city hospital.Methods: In a retrospective study, the colonoscopic findings of 80 patientswith melanosis coli were compared to 80 consecutive controls that under-went screening colonoscopy. Data were collected on demography, indica-tions, colonoscopic findings and pathology reports. Chi Square test wasused for analysis.Results: Our study population with melanosis coli consisted of 50 womenand 30 men, mean age 59.1(range 35–93). Colon polyps were found in 29(36%) patients of which 17 (58%) were tubular adenomas and 12 (42%)were hyperplastic polyps.

The control group consisted of 35 men and 45 women, of mean age 58.0(range 50–86). Polyps were found in 31 (38%) of which 43% were tubularadenomas and 57% were hyperplastic. No tubulovillous or villous adeno-mas were found in either group.

There was no difference in the prevalence of diverticulosis or polypsbetween the two groups. Two of the melanosis coli group had colorectalcancers. One patient had annular sigmoid cancer at 45 cm, and the other hada malignant ulcerated rectal mass, 5 cm from the anal verge. We did notfind any cancers in the control group.Conclusions: Melanosis coli is not associated with increased risk of colonpolyps. However its possible association with colorectal cancer needsfurther evaluation.

352

THE ACCURACY OF DIMINUTIVE POLYPECTOMY INFELLOWSHIP TRAININGGary de la Pena, M.D., Francisco C. Ramirez, M.D.*. Carl T. HaydenVA Medical Center, Phoenix, AZ.

Background: Diminutive polyps (polyps � 5mm) are frequently found oncolonoscopy. 40–50% of diminutive polyps are adenomatous. Diminutivepolyps which are missed at the time of endoscopy may predispose patientsto cancer. It is not known how the accuracy and diagnostic yield ofdiminutive polypectomy is affected by fellow experience.Aim: Perform a retrospective review to compare the accuracy of diminu-tive polypectomy performed by fellows in varying levels of training to thatof attending physicians.Methods: At a Veterans Administration Medical Center, the endoscopicdatabase was surveyed to review the procedure logs of 6 previous GIfellows and five attending physicians. Colonoscopies performed during thefirst and third years of training were reviewed for the presence of dimin-utive polyps. While all procedures performed by first year fellows are

closely supervised, colonoscopies performed by third year fellows weregenerally performed independently. Fellows’ samples were compared tospecimens obtained independently by attending physicians. The pathologyof diminutive polyps was recorded and compared to that of the attendingphysicians. Biopsy yield was classified as being polypoid (hyperplastic oradenomatous) or normal (inflammation, edema, lymphoid). Diagnosticyield was then compared using discreet variable analysis.Results: Results are summarized in table 1. Similar to previous studiesperformed on diminutive polyps, a similar proportion of adenomatous,hyperplastic, and other pathology was found in all three groups. Nostatistically significant difference existed between the three groups regard-ing number of polyps found at each colonoscopy or polyp pathology.

Table 1.

Group ColonoscopiesPolyps per

Colonoscopy%

Adenomas%

Hyperplastic%

Normal

First Year 225 1.51 47.3 44.7 8Third Year 187 1.7 47.9 43.6 8.5Attendings 192 1.68 47 44.9 8.1

Conclusions: Regardless of the level of training, results of diminutivepolypectomy are similar. The accuracy of polypectomy by first year fellowsis most likely increased by the aid of an attending physician; however, bythe end of the third year, attending physician accuracy and fellow accuracyare equal. The performance of supervised colonoscopy does not compro-mise the adequacy of examination and place patients at increased risk ofhaving missed lesions.

353

THE SIGNIFICANCE OF LARGE HYPERPLASTIC POLYPSGary de la Pena, M.D., Masud Shaukat, M.D.*,Francisco C. Ramirez, M.D. Carl T. Hayden VA Medical Center,Phoenix, AZ.

Background: Multiple, small (less than 1 cm) hyperplastic polyps arefrequently found on endoscopy and are thought to be of little clinicalsignificance . Hyperplastic polyps greater than one centimeter in size areuncommonly found. The clinical significance of these polyps is uncertain.Aim: Perform a retrospective review of an endoscopic database to deter-mine the frequency and location of large hyperplastic polyps and determinethe frequency and number of adenomas associated with large hyperplasticpolyps.Methods: The endoscopic database of a Veterans Administration MedicalCenter was reviewed to find colonoscopies in which hyperplastic polypswere found. The reason for endoscopy, age of each patient, location of thelarge polyp, as well as the number of hyperplastic and adenomatous polypson each endoscopy was then recorded. The age and number of polyps werethen compared between patients with large hyperplastic polyps and thosewith only small hyperplastic polyps.Results: A total of 844 colonoscopies were reviewed. 21 of 844 colonos-copies had hyperplastic polyps greater than 1cm in size (2.3%, mean size10.5cm, range 10–12mm). 16 of 21 patients had colonoscopy performedfor screening purposes. 19/21 polyps were located in the sigmoid colon orrectum. No cancers or adenomas with dysplasia were found in any of the21 patients. Patients with large hyperplastic polyps did not differ signifi-cantly in age (59.9y vs. 60.51y) or total number of hyperplastic polyps(1.68 vs. 1.8) from their counterparts. These patients did demonstrate atrend towards an increased number of adenomatous polyps (1.8 vs. 0.69 percolonoscopy) and more frequently had adenomatous polyps (81% vs. 31%).Conclusions: Hyperplastic polyps �1cm are found in less than 2.5% of allcolonoscopies in which hyperplastic polyps are present. The majority arefound on screening and are primarily situated in the sigmoid colon orrectum. Though a statistically significant difference in the number ofadenomatous polyps was not demonstrated, a trend towards an increasednumber of adenomatous polyps was noted. Coexisting adenomas alsoappear to be found more frequently. Although colonoscopy is one method

S119AJG – September, Suppl., 2003 Abstracts