Abstract
1052 The Finding of Heme Positive Stool Should Prompt Investigation, Despite Prior Normal Colonoscopy Jonathan D. Siegel, M.D. * , D. Shane Pendley, M.D. * , Jack A. DiPalma, M.D. * Internal Medicine: Division of Gastroenterology, University of South Alabama, Mobile, AL. Purpose: Current ACG guidelines recommend screening colonoscopies (CS) in average risk people every 10 years beginning at age 50. However, no guidelines or data address the most appropriate evaluation of patients who had normal baseline CS but subsequently presented for the evaluation of hemoccult positive stool (HPS). Methods: Retrospective chart review of patients who had previously undergone CS with normal findings and were then re-evaluated because of a HPS prior to scheduled screening CS date. Results: Of the 3184 CS performed at our facility between August 2002 and November 2004, 651 were normal. Seventy four of these were repeated before their scheduled screening interval because of the finding of a HPS. The study population included 48/74 (65%) men, 36/74 (49%) Caucasians, 33/74 (45%) African Americans. The average age at index CS was 54 years. The average interval between procedures was 47 months. Findings at subsequent CS done for HPS were: 60/74 (81%) normal, 8/74 (11%) adenomas < 1.0cm, 4/74 (5%) advanced adenomas, and 2/74 (3%) had invasive adenocarcinoma. For those with advanced polyps, the procedure intervals were 18, 24, 33, and 56 months, and only one of these had a FH of colon cancer. For the two subjects with cancer, the intervals were 64 and 84 months, with only the former having a FH of colon polyps. Conclusions: The finding of a subsequent HPS after a prior normal CS should prompt re-evaluation, regardless of the interval since the prior normal procedure.