Sharon Worcester

NEW ORLEANS – The proportion of American College of Obstetricians and Gynecologists fellows practicing in private settings has declined steadily over the past 2 decades, survey data show.

Between 1992 and 2012, the percentage of fellows in solo practice decreased from 32% to 19%, while the percentage employed by hospitals increased steadily from 5% to 15%, and those employed as academic faculty increased from 9% to 12%, Jeffrey C. Klagholz reported in a poster at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG). Three percent were employed by HMOs, and 2% by the government; these remained basically static over time.

The percentage of fellows in private practice groups ranged from 44% to 52% (median of 48%) across the seven ACOG surveys on professional liability administered during the study period, according to Mr. Klagholz of ACOG in Washington, who noted that the findings were confirmed, and expanded upon, by data from a recent Socioeconomic Survey of ACOG Fellows.

During a session on workforce issues affecting ACOG fellows at the annual meeting, poster coauthor William Rayburn expanded on this report, and outlined a number of other recent and predicted changes in workforce trends and demand for obstetric and gynecologic care.

Of note, the proportion of resident graduates has not kept pace with increases in the population, and the proportion moving on to an accredited fellowship program – such as female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, or reproductive endocrinology – more than doubled, increasing from 7% to 17% between 2000 and 2009. The percentage increases to 27% when minimally invasive surgery, pediatric and adolescent gynecology, and family planning and reproductive health fellowship programs are included, said Dr. Rayburn, chair of obstetrics and gynecology at the University of New Mexico, Albuquerque.

"We’re getting the message here that ... our graduates are moving more in the direction of subspecializing, and that concerns me with regard to the number of general obstetricians and gynecologists for our growing population, with there not being an increase in the number of residents," he said.

Adding to the shortage problem is the fact that a greater number of ACOG fellows are physicians aged 60 years or older, who are reaching "very senior status," compared with those who are aged 39 years or younger (about 5,500 vs. about 4,000 in 2012), he said.

Traditionally, the drop off in the number of ob.gyns. actually practicing obstetrics begins at about age 55 years. In fact, only one in three ACOG fellows and junior fellows in practice is aged 55 years or older.

"I daresay, anyone who is that age or older, at some time, is thinking of what they will do down the road and when they will eventually retire," he said, adding, "I think this is an important concept, because we have what’s called a static pipeline. That is, the number of resident graduates, which is not increasing, is actually lower than the number who are entering retirement age," Dr. Rayburn said.

If those residents are subspecializing more, the value that general ob.gyns. bring to the health care of women is tremendous, he added.

As for where women’s health care is most needed, it appears that while there is a shortage of ob.gyns., the bigger problem is "maldistribution," Dr. Rayburn said, explaining that the vast majority of ob.gyns. practice in metropolitan areas.

Generally speaking, one full-time ob.gyn. equivalent is needed per 10,000 population, but 49% of the more than 3,300 counties in the United States have no ob.gyn.

This affects about 10 million women who will be eligible for health care coverage under the Affordable Care Act, if they aren’t covered already, Dr. Rayburn said.

Reaching these patients will require "getting creative" about finding ways to deliver care. Outreach clinics, greater use of physician extenders, and collaborative efforts with primary care physicians are among the approaches he mentioned.

A related concept – demand for care – is an important one, especially considering the aging of the population, but it can be difficult to predict. Although 80% of ob.gyn. care is provided to reproductive-age women, and little is provided to those over age 65 years, ob.gyns. are "still a significant player in taking care of women who are aged 40-64 years," he said.

Given shortages in the primary care fields, it is likely that ob.gyns. will play an increasing role in taking care of these women.

Data from a recent study, which Dr. Rayburn hopes to publish soon, suggest that demand for women’s health care services will grow by about 6% by 2020.

"In other words, you’re going to be working 6% harder than you are right now in terms of meeting the demand of your patients," he said, noting that the estimate is a conservative one and that demand will vary greatly by geographic region.

For example, areas such as Montana, North Dakota, and West Virginia will likely see decreasing demand, which may be a good thing since these areas have general ob.gyn. shortages, he said.

Texas and Florida, as well as areas in the Intermountain West are expected to experience booming demand, with increases of more than 10%.

"So we’ve got to think of alternative modes of treating patients, with probably more of a collaborative, team-based effort in which you and I as physicians are team leaders," he said.

Dr. Rayburn and Mr. Klagholz reported having no disclosures.

NEW ORLEANS – The proportion of American College of Obstetricians and Gynecologists fellows practicing in private settings has declined steadily over the past 2 decades, survey data show.

Between 1992 and 2012, the percentage of fellows in solo practice decreased from 32% to 19%, while the percentage employed by hospitals increased steadily from 5% to 15%, and those employed as academic faculty increased from 9% to 12%, Jeffrey C. Klagholz reported in a poster at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG). Three percent were employed by HMOs, and 2% by the government; these remained basically static over time.

The percentage of fellows in private practice groups ranged from 44% to 52% (median of 48%) across the seven ACOG surveys on professional liability administered during the study period, according to Mr. Klagholz of ACOG in Washington, who noted that the findings were confirmed, and expanded upon, by data from a recent Socioeconomic Survey of ACOG Fellows.

During a session on workforce issues affecting ACOG fellows at the annual meeting, poster coauthor William Rayburn expanded on this report, and outlined a number of other recent and predicted changes in workforce trends and demand for obstetric and gynecologic care.

Of note, the proportion of resident graduates has not kept pace with increases in the population, and the proportion moving on to an accredited fellowship program – such as female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, or reproductive endocrinology – more than doubled, increasing from 7% to 17% between 2000 and 2009. The percentage increases to 27% when minimally invasive surgery, pediatric and adolescent gynecology, and family planning and reproductive health fellowship programs are included, said Dr. Rayburn, chair of obstetrics and gynecology at the University of New Mexico, Albuquerque.

"We’re getting the message here that ... our graduates are moving more in the direction of subspecializing, and that concerns me with regard to the number of general obstetricians and gynecologists for our growing population, with there not being an increase in the number of residents," he said.

Adding to the shortage problem is the fact that a greater number of ACOG fellows are physicians aged 60 years or older, who are reaching "very senior status," compared with those who are aged 39 years or younger (about 5,500 vs. about 4,000 in 2012), he said.

Traditionally, the drop off in the number of ob.gyns. actually practicing obstetrics begins at about age 55 years. In fact, only one in three ACOG fellows and junior fellows in practice is aged 55 years or older.

"I daresay, anyone who is that age or older, at some time, is thinking of what they will do down the road and when they will eventually retire," he said, adding, "I think this is an important concept, because we have what’s called a static pipeline. That is, the number of resident graduates, which is not increasing, is actually lower than the number who are entering retirement age," Dr. Rayburn said.

If those residents are subspecializing more, the value that general ob.gyns. bring to the health care of women is tremendous, he added.

As for where women’s health care is most needed, it appears that while there is a shortage of ob.gyns., the bigger problem is "maldistribution," Dr. Rayburn said, explaining that the vast majority of ob.gyns. practice in metropolitan areas.

Generally speaking, one full-time ob.gyn. equivalent is needed per 10,000 population, but 49% of the more than 3,300 counties in the United States have no ob.gyn.

This affects about 10 million women who will be eligible for health care coverage under the Affordable Care Act, if they aren’t covered already, Dr. Rayburn said.

Reaching these patients will require "getting creative" about finding ways to deliver care. Outreach clinics, greater use of physician extenders, and collaborative efforts with primary care physicians are among the approaches he mentioned.

A related concept – demand for care – is an important one, especially considering the aging of the population, but it can be difficult to predict. Although 80% of ob.gyn. care is provided to reproductive-age women, and little is provided to those over age 65 years, ob.gyns. are "still a significant player in taking care of women who are aged 40-64 years," he said.

Given shortages in the primary care fields, it is likely that ob.gyns. will play an increasing role in taking care of these women.

Data from a recent study, which Dr. Rayburn hopes to publish soon, suggest that demand for women’s health care services will grow by about 6% by 2020.

"In other words, you’re going to be working 6% harder than you are right now in terms of meeting the demand of your patients," he said, noting that the estimate is a conservative one and that demand will vary greatly by geographic region.

For example, areas such as Montana, North Dakota, and West Virginia will likely see decreasing demand, which may be a good thing since these areas have general ob.gyn. shortages, he said.

Texas and Florida, as well as areas in the Intermountain West are expected to experience booming demand, with increases of more than 10%.

"So we’ve got to think of alternative modes of treating patients, with probably more of a collaborative, team-based effort in which you and I as physicians are team leaders," he said.

Dr. Rayburn and Mr. Klagholz reported having no disclosures.

NEW ORLEANS – The proportion of American College of Obstetricians and Gynecologists fellows practicing in private settings has declined steadily over the past 2 decades, survey data show.

Between 1992 and 2012, the percentage of fellows in solo practice decreased from 32% to 19%, while the percentage employed by hospitals increased steadily from 5% to 15%, and those employed as academic faculty increased from 9% to 12%, Jeffrey C. Klagholz reported in a poster at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG). Three percent were employed by HMOs, and 2% by the government; these remained basically static over time.

The percentage of fellows in private practice groups ranged from 44% to 52% (median of 48%) across the seven ACOG surveys on professional liability administered during the study period, according to Mr. Klagholz of ACOG in Washington, who noted that the findings were confirmed, and expanded upon, by data from a recent Socioeconomic Survey of ACOG Fellows.

During a session on workforce issues affecting ACOG fellows at the annual meeting, poster coauthor William Rayburn expanded on this report, and outlined a number of other recent and predicted changes in workforce trends and demand for obstetric and gynecologic care.

Of note, the proportion of resident graduates has not kept pace with increases in the population, and the proportion moving on to an accredited fellowship program – such as female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, or reproductive endocrinology – more than doubled, increasing from 7% to 17% between 2000 and 2009. The percentage increases to 27% when minimally invasive surgery, pediatric and adolescent gynecology, and family planning and reproductive health fellowship programs are included, said Dr. Rayburn, chair of obstetrics and gynecology at the University of New Mexico, Albuquerque.

"We’re getting the message here that ... our graduates are moving more in the direction of subspecializing, and that concerns me with regard to the number of general obstetricians and gynecologists for our growing population, with there not being an increase in the number of residents," he said.

Adding to the shortage problem is the fact that a greater number of ACOG fellows are physicians aged 60 years or older, who are reaching "very senior status," compared with those who are aged 39 years or younger (about 5,500 vs. about 4,000 in 2012), he said.

Traditionally, the drop off in the number of ob.gyns. actually practicing obstetrics begins at about age 55 years. In fact, only one in three ACOG fellows and junior fellows in practice is aged 55 years or older.

"I daresay, anyone who is that age or older, at some time, is thinking of what they will do down the road and when they will eventually retire," he said, adding, "I think this is an important concept, because we have what’s called a static pipeline. That is, the number of resident graduates, which is not increasing, is actually lower than the number who are entering retirement age," Dr. Rayburn said.

If those residents are subspecializing more, the value that general ob.gyns. bring to the health care of women is tremendous, he added.

As for where women’s health care is most needed, it appears that while there is a shortage of ob.gyns., the bigger problem is "maldistribution," Dr. Rayburn said, explaining that the vast majority of ob.gyns. practice in metropolitan areas.

Generally speaking, one full-time ob.gyn. equivalent is needed per 10,000 population, but 49% of the more than 3,300 counties in the United States have no ob.gyn.

This affects about 10 million women who will be eligible for health care coverage under the Affordable Care Act, if they aren’t covered already, Dr. Rayburn said.

Reaching these patients will require "getting creative" about finding ways to deliver care. Outreach clinics, greater use of physician extenders, and collaborative efforts with primary care physicians are among the approaches he mentioned.

A related concept – demand for care – is an important one, especially considering the aging of the population, but it can be difficult to predict. Although 80% of ob.gyn. care is provided to reproductive-age women, and little is provided to those over age 65 years, ob.gyns. are "still a significant player in taking care of women who are aged 40-64 years," he said.

Given shortages in the primary care fields, it is likely that ob.gyns. will play an increasing role in taking care of these women.

Data from a recent study, which Dr. Rayburn hopes to publish soon, suggest that demand for women’s health care services will grow by about 6% by 2020.

"In other words, you’re going to be working 6% harder than you are right now in terms of meeting the demand of your patients," he said, noting that the estimate is a conservative one and that demand will vary greatly by geographic region.

For example, areas such as Montana, North Dakota, and West Virginia will likely see decreasing demand, which may be a good thing since these areas have general ob.gyn. shortages, he said.

Texas and Florida, as well as areas in the Intermountain West are expected to experience booming demand, with increases of more than 10%.

"So we’ve got to think of alternative modes of treating patients, with probably more of a collaborative, team-based effort in which you and I as physicians are team leaders," he said.

Dr. Rayburn and Mr. Klagholz reported having no disclosures.

ORLANDO – Triple-drug therapy with the protease inhibitor telaprevir plus ribavirin and peg-interferon alpha 2a provides higher sustained virologic response than traditional dual-drug therapy in chronic hepatitis C patients on hemodialysis, according to findings from the randomized, placebo-controlled Target C Trial.

Sustained virologic response after 24 months was 63% in 12 patients treated with telaprevir for weeks 0-12 plus ribavirin and peg-IFN alpha 2a for weeks 0-24 (group A) and 50% in 12 patients treated with telaprevir for weeks 0-12 plus ribavirin for weeks 13-36 and peg-IFN alpha 2a for weeks 0-36 (group B), compared with 25% in 12 patients treated with placebo plus standard dual therapy with ribavirin and peg-IFN alpha 2a for weeks 0-24 and weeks 37-48 (group C, reference arm), Dr. Patrick Basu reported at the annual Digestive Disease Week.

Telaprevir in groups A and B was given as two 750-mg tablets three times daily for 4 days and three 750-mg tablets given twice daily for 3 days after dialysis. The ribavirin dose in group A was 200 mg for weeks 0-12 and 400 mg for weeks 13-24; for group B it was 400 mg for weeks 13-36 (with placebo given for weeks 0-12). All ribavirin doses in group C were 400 mg, and peg-IFN alpha 2a doses in all three groups were 135 mcg, said Dr. Basu of Columbia University College of Physicians and Surgeons, New York.

Patients in the study included 26 men and 10 women with a mean age of 58 years, a mean body mass index of 26.6 kg/m², and a mean viral load of 869,000 IU/mL who were treated between May 2011 and November 2012. All had end-stage renal disease and were on hemodialysis for a mean of 6 years. The groups were well balanced with respect to BMI, race, viral load, and disease genotype.

Adverse events that occurred more often in the telaprevir groups (A and/or B), compared with group C, included anemia, neutropenia less than 750 ANA, thrombocytopenia, skin rash, anorectal dysfunction, dysgeusia, depression, and constipation. Neuropathy was more common in group C.

Protease inhibitors are now part of the standard of care for treatment of chronic hepatitis C, genotype 1. Telaprevir was approved in May 2011 for this purpose.

Since the drug is primarily metabolized in the liver and excreted in the feces, thus limiting renal toxicity, it was considered a promising treatment option for the 3% of chronic hepatitis C patients with end-stage renal disease on hemodialysis – a population with progressive fibrosis and high mortality, Dr. Basu said.

The findings of this pilot study suggest that truncated triple therapy that includes telaprevir does indeed have an advantage over the standard of care for this special population, he concluded, noting that the telaprevir regimen requires further evaluation in a large prospective trial.

Dr. Basu disclosed financial relationships with Gilead Science, BMS, ROMAX, Genentech, Vertex, Otsuka, Takeda, Three Rivers, GI Pathology, and Salix.

ORLANDO – Triple-drug therapy with the protease inhibitor telaprevir plus ribavirin and peg-interferon alpha 2a provides higher sustained virologic response than traditional dual-drug therapy in chronic hepatitis C patients on hemodialysis, according to findings from the randomized, placebo-controlled Target C Trial.

Sustained virologic response after 24 months was 63% in 12 patients treated with telaprevir for weeks 0-12 plus ribavirin and peg-IFN alpha 2a for weeks 0-24 (group A) and 50% in 12 patients treated with telaprevir for weeks 0-12 plus ribavirin for weeks 13-36 and peg-IFN alpha 2a for weeks 0-36 (group B), compared with 25% in 12 patients treated with placebo plus standard dual therapy with ribavirin and peg-IFN alpha 2a for weeks 0-24 and weeks 37-48 (group C, reference arm), Dr. Patrick Basu reported at the annual Digestive Disease Week.

Telaprevir in groups A and B was given as two 750-mg tablets three times daily for 4 days and three 750-mg tablets given twice daily for 3 days after dialysis. The ribavirin dose in group A was 200 mg for weeks 0-12 and 400 mg for weeks 13-24; for group B it was 400 mg for weeks 13-36 (with placebo given for weeks 0-12). All ribavirin doses in group C were 400 mg, and peg-IFN alpha 2a doses in all three groups were 135 mcg, said Dr. Basu of Columbia University College of Physicians and Surgeons, New York.

Patients in the study included 26 men and 10 women with a mean age of 58 years, a mean body mass index of 26.6 kg/m², and a mean viral load of 869,000 IU/mL who were treated between May 2011 and November 2012. All had end-stage renal disease and were on hemodialysis for a mean of 6 years. The groups were well balanced with respect to BMI, race, viral load, and disease genotype.

Adverse events that occurred more often in the telaprevir groups (A and/or B), compared with group C, included anemia, neutropenia less than 750 ANA, thrombocytopenia, skin rash, anorectal dysfunction, dysgeusia, depression, and constipation. Neuropathy was more common in group C.

Protease inhibitors are now part of the standard of care for treatment of chronic hepatitis C, genotype 1. Telaprevir was approved in May 2011 for this purpose.

Since the drug is primarily metabolized in the liver and excreted in the feces, thus limiting renal toxicity, it was considered a promising treatment option for the 3% of chronic hepatitis C patients with end-stage renal disease on hemodialysis – a population with progressive fibrosis and high mortality, Dr. Basu said.

The findings of this pilot study suggest that truncated triple therapy that includes telaprevir does indeed have an advantage over the standard of care for this special population, he concluded, noting that the telaprevir regimen requires further evaluation in a large prospective trial.

Dr. Basu disclosed financial relationships with Gilead Science, BMS, ROMAX, Genentech, Vertex, Otsuka, Takeda, Three Rivers, GI Pathology, and Salix.

ORLANDO – Triple-drug therapy with the protease inhibitor telaprevir plus ribavirin and peg-interferon alpha 2a provides higher sustained virologic response than traditional dual-drug therapy in chronic hepatitis C patients on hemodialysis, according to findings from the randomized, placebo-controlled Target C Trial.

Sustained virologic response after 24 months was 63% in 12 patients treated with telaprevir for weeks 0-12 plus ribavirin and peg-IFN alpha 2a for weeks 0-24 (group A) and 50% in 12 patients treated with telaprevir for weeks 0-12 plus ribavirin for weeks 13-36 and peg-IFN alpha 2a for weeks 0-36 (group B), compared with 25% in 12 patients treated with placebo plus standard dual therapy with ribavirin and peg-IFN alpha 2a for weeks 0-24 and weeks 37-48 (group C, reference arm), Dr. Patrick Basu reported at the annual Digestive Disease Week.

Telaprevir in groups A and B was given as two 750-mg tablets three times daily for 4 days and three 750-mg tablets given twice daily for 3 days after dialysis. The ribavirin dose in group A was 200 mg for weeks 0-12 and 400 mg for weeks 13-24; for group B it was 400 mg for weeks 13-36 (with placebo given for weeks 0-12). All ribavirin doses in group C were 400 mg, and peg-IFN alpha 2a doses in all three groups were 135 mcg, said Dr. Basu of Columbia University College of Physicians and Surgeons, New York.

Patients in the study included 26 men and 10 women with a mean age of 58 years, a mean body mass index of 26.6 kg/m², and a mean viral load of 869,000 IU/mL who were treated between May 2011 and November 2012. All had end-stage renal disease and were on hemodialysis for a mean of 6 years. The groups were well balanced with respect to BMI, race, viral load, and disease genotype.

Adverse events that occurred more often in the telaprevir groups (A and/or B), compared with group C, included anemia, neutropenia less than 750 ANA, thrombocytopenia, skin rash, anorectal dysfunction, dysgeusia, depression, and constipation. Neuropathy was more common in group C.

Protease inhibitors are now part of the standard of care for treatment of chronic hepatitis C, genotype 1. Telaprevir was approved in May 2011 for this purpose.

Since the drug is primarily metabolized in the liver and excreted in the feces, thus limiting renal toxicity, it was considered a promising treatment option for the 3% of chronic hepatitis C patients with end-stage renal disease on hemodialysis – a population with progressive fibrosis and high mortality, Dr. Basu said.

The findings of this pilot study suggest that truncated triple therapy that includes telaprevir does indeed have an advantage over the standard of care for this special population, he concluded, noting that the telaprevir regimen requires further evaluation in a large prospective trial.

Dr. Basu disclosed financial relationships with Gilead Science, BMS, ROMAX, Genentech, Vertex, Otsuka, Takeda, Three Rivers, GI Pathology, and Salix.

ORLANDO – Mid- and long-term esophageal cancer-free survival rates are similar in patients with early esophageal adenocarcinoma who undergo endoscopic eradication therapy and those who undergo surgical resection, according to findings from a large population-based study.

Of 1,087 patients with early esophageal adenocarcinoma (EAC) who were included in the Surveillance, Epidemiology and End Results (SEER) database, 283 underwent endoscopic eradication therapy (EET), and 804 underwent surgical resection. No significant differences were seen between the groups with respect to 2-year esophageal cancer-free survival (93.5% and 89.6% in the EET and surgery groups, respectively) or 5-year survival (69.3% and 75.8%, respectively), Dr. Sachin Wani reported during a late-breaking abstract session at the annual Digestive Disease Week.

However, the EET group had higher mortality than the surgery group due to non-EAC causes (12.8% vs. 5.7% at 2 years, and 34.8% vs. 12.9% at 5 years), he said. Cardiovascular disease was the most common cause of non-EAC mortality.

Variables significantly associated with mortality were older age (hazard ratio, 1.02), stage T1a disease (compared with T0 disease; HR, 2.71), year of diagnosis (HR, 0.93), and radiation therapy (HR, 5.29), said Dr. Wani of the University of Colorado, Aurora.

Treatment arm was not a predictor of overall survival.

A time-trend analysis showed a significant increase in the proportion of patients with T0 disease undergoing endoscopic eradication therapy. A similar significant increase was noted in patients with stage T1a disease, as well, he said.

Notably, patients undergoing EET were significantly older than those undergoing surgery (70 vs. 63 years), and more likely to be diagnosed with T0 disease (32.5% vs. 23.1% of patients) with well-differentiated histology (33% vs. 24%). They also were less likely to be men, and less likely to receive radiation therapy.

"However, the overall follow-up in the endoscopy arm was shorter than for their surgical counterparts," Dr. Wani noted.

Regional variations were observed in the proportions of patients undergoing EET and surgery, he said.

The differences between the groups, along with the significant differences in non–EAC-related mortality between the treatment groups, highlight selection bias with respect to the therapies offered to patients with EAC, he said.

Patients included in this analysis were adults who had EAC between 1998 and 2009. EAC was defined as carcinoma in situ (T0 disease), or invasive tumor confined to the mucosa, lamina propria, and muscularis mucosae (T1a disease).

The vast majority of patients in the endoscopy arm underwent endoscopic mucosal resection alone; the vast majority in the surgery arm underwent esophagectomy plus partial or total gastrectomy, Dr. Wani said.

Though limited by the use of population-based data that lacked details on recurrences, pathology, staging modalities, and complications and morbidity, this study analyzed one of the largest cohorts of patients with EAC undergoing endoscopic therapy. The findings are important, because EETs for EAC have gained wide acceptance, and have been endorsed by society guidelines despite a paucity of long-term data examining the differences in outcomes between EET and the gold standard of surgical resection, he said.

Indeed, esophagectomy has traditionally been considered the treatment of choice for EAC, but it is also associated with high morbidity and mortality, even in expert centers, he noted.

"The implications of our study? It really provides a greater degree of confidence in what we do on a daily basis and this whole concept of endoscopic eradication therapy for patients with early esophageal cancer. However we need long-term data – i.e., 5-year data, at least – with newer ablative therapies, such as radiofrequency ablation in combination with endoscopy mucosal resection," he said. Future studies should focus on identifying patient and provider determinants of optimal outcomes, he added.

Dr. Wani reported having no disclosures.

ORLANDO – Mid- and long-term esophageal cancer-free survival rates are similar in patients with early esophageal adenocarcinoma who undergo endoscopic eradication therapy and those who undergo surgical resection, according to findings from a large population-based study.

Of 1,087 patients with early esophageal adenocarcinoma (EAC) who were included in the Surveillance, Epidemiology and End Results (SEER) database, 283 underwent endoscopic eradication therapy (EET), and 804 underwent surgical resection. No significant differences were seen between the groups with respect to 2-year esophageal cancer-free survival (93.5% and 89.6% in the EET and surgery groups, respectively) or 5-year survival (69.3% and 75.8%, respectively), Dr. Sachin Wani reported during a late-breaking abstract session at the annual Digestive Disease Week.

However, the EET group had higher mortality than the surgery group due to non-EAC causes (12.8% vs. 5.7% at 2 years, and 34.8% vs. 12.9% at 5 years), he said. Cardiovascular disease was the most common cause of non-EAC mortality.

Variables significantly associated with mortality were older age (hazard ratio, 1.02), stage T1a disease (compared with T0 disease; HR, 2.71), year of diagnosis (HR, 0.93), and radiation therapy (HR, 5.29), said Dr. Wani of the University of Colorado, Aurora.

Treatment arm was not a predictor of overall survival.

A time-trend analysis showed a significant increase in the proportion of patients with T0 disease undergoing endoscopic eradication therapy. A similar significant increase was noted in patients with stage T1a disease, as well, he said.

Notably, patients undergoing EET were significantly older than those undergoing surgery (70 vs. 63 years), and more likely to be diagnosed with T0 disease (32.5% vs. 23.1% of patients) with well-differentiated histology (33% vs. 24%). They also were less likely to be men, and less likely to receive radiation therapy.

"However, the overall follow-up in the endoscopy arm was shorter than for their surgical counterparts," Dr. Wani noted.

Regional variations were observed in the proportions of patients undergoing EET and surgery, he said.

The differences between the groups, along with the significant differences in non–EAC-related mortality between the treatment groups, highlight selection bias with respect to the therapies offered to patients with EAC, he said.

Patients included in this analysis were adults who had EAC between 1998 and 2009. EAC was defined as carcinoma in situ (T0 disease), or invasive tumor confined to the mucosa, lamina propria, and muscularis mucosae (T1a disease).

The vast majority of patients in the endoscopy arm underwent endoscopic mucosal resection alone; the vast majority in the surgery arm underwent esophagectomy plus partial or total gastrectomy, Dr. Wani said.

Though limited by the use of population-based data that lacked details on recurrences, pathology, staging modalities, and complications and morbidity, this study analyzed one of the largest cohorts of patients with EAC undergoing endoscopic therapy. The findings are important, because EETs for EAC have gained wide acceptance, and have been endorsed by society guidelines despite a paucity of long-term data examining the differences in outcomes between EET and the gold standard of surgical resection, he said.

Indeed, esophagectomy has traditionally been considered the treatment of choice for EAC, but it is also associated with high morbidity and mortality, even in expert centers, he noted.

"The implications of our study? It really provides a greater degree of confidence in what we do on a daily basis and this whole concept of endoscopic eradication therapy for patients with early esophageal cancer. However we need long-term data – i.e., 5-year data, at least – with newer ablative therapies, such as radiofrequency ablation in combination with endoscopy mucosal resection," he said. Future studies should focus on identifying patient and provider determinants of optimal outcomes, he added.

Dr. Wani reported having no disclosures.

ORLANDO – Mid- and long-term esophageal cancer-free survival rates are similar in patients with early esophageal adenocarcinoma who undergo endoscopic eradication therapy and those who undergo surgical resection, according to findings from a large population-based study.

Of 1,087 patients with early esophageal adenocarcinoma (EAC) who were included in the Surveillance, Epidemiology and End Results (SEER) database, 283 underwent endoscopic eradication therapy (EET), and 804 underwent surgical resection. No significant differences were seen between the groups with respect to 2-year esophageal cancer-free survival (93.5% and 89.6% in the EET and surgery groups, respectively) or 5-year survival (69.3% and 75.8%, respectively), Dr. Sachin Wani reported during a late-breaking abstract session at the annual Digestive Disease Week.

However, the EET group had higher mortality than the surgery group due to non-EAC causes (12.8% vs. 5.7% at 2 years, and 34.8% vs. 12.9% at 5 years), he said. Cardiovascular disease was the most common cause of non-EAC mortality.

Variables significantly associated with mortality were older age (hazard ratio, 1.02), stage T1a disease (compared with T0 disease; HR, 2.71), year of diagnosis (HR, 0.93), and radiation therapy (HR, 5.29), said Dr. Wani of the University of Colorado, Aurora.

Treatment arm was not a predictor of overall survival.

A time-trend analysis showed a significant increase in the proportion of patients with T0 disease undergoing endoscopic eradication therapy. A similar significant increase was noted in patients with stage T1a disease, as well, he said.

Notably, patients undergoing EET were significantly older than those undergoing surgery (70 vs. 63 years), and more likely to be diagnosed with T0 disease (32.5% vs. 23.1% of patients) with well-differentiated histology (33% vs. 24%). They also were less likely to be men, and less likely to receive radiation therapy.

"However, the overall follow-up in the endoscopy arm was shorter than for their surgical counterparts," Dr. Wani noted.

Regional variations were observed in the proportions of patients undergoing EET and surgery, he said.

The differences between the groups, along with the significant differences in non–EAC-related mortality between the treatment groups, highlight selection bias with respect to the therapies offered to patients with EAC, he said.

Patients included in this analysis were adults who had EAC between 1998 and 2009. EAC was defined as carcinoma in situ (T0 disease), or invasive tumor confined to the mucosa, lamina propria, and muscularis mucosae (T1a disease).

The vast majority of patients in the endoscopy arm underwent endoscopic mucosal resection alone; the vast majority in the surgery arm underwent esophagectomy plus partial or total gastrectomy, Dr. Wani said.

Though limited by the use of population-based data that lacked details on recurrences, pathology, staging modalities, and complications and morbidity, this study analyzed one of the largest cohorts of patients with EAC undergoing endoscopic therapy. The findings are important, because EETs for EAC have gained wide acceptance, and have been endorsed by society guidelines despite a paucity of long-term data examining the differences in outcomes between EET and the gold standard of surgical resection, he said.

Indeed, esophagectomy has traditionally been considered the treatment of choice for EAC, but it is also associated with high morbidity and mortality, even in expert centers, he noted.

"The implications of our study? It really provides a greater degree of confidence in what we do on a daily basis and this whole concept of endoscopic eradication therapy for patients with early esophageal cancer. However we need long-term data – i.e., 5-year data, at least – with newer ablative therapies, such as radiofrequency ablation in combination with endoscopy mucosal resection," he said. Future studies should focus on identifying patient and provider determinants of optimal outcomes, he added.

Dr. Wani reported having no disclosures.

ORLANDO – Nosocomial infections in cirrhotic patients are associated with acute kidney injury and prolonged hospital stay, and thus adversely affect outcomes, findings from a Swedish population-based study suggest.

Of 344 patients diagnosed with cirrhosis between 2000 and 2010, 122 experienced a total of 230 bacterial infections; 29% were community acquired, 51% were health care acquired (HCA), and 20% were nosocomial. Most (70%) occurred in decompensated patients, and most patients (64%) used proton pump inhibitors. In-hospital mortality was 18%, Dr. Konstantina Sargenti reported at the annual Digestive Disease Week.

On logistic regression analysis, nosocomial/HCA infections, compared with community-acquired infections, were independently associated with PPI use (odds ratio, 2.07) and decompensated patient status (OR, 2.12). After researchers adjusted for confounders, nosocomial/HCA infections were not found to be associated with inpatient mortality (OR, 1.78) or systemic inflammatory response syndrome (OR, 1.18), but nosocomial infections alone were independently associated with hospital length of stay (OR, 23.34 per day) and acute kidney injury (OR, 2.82), which was defined by an increase of greater than 50% in serum creatinine, said Dr. Sargenti of Skane University Hospital, University of Lund (Sweden).

Study subjects – residents of an area in Sweden with a population of about 250,000 – all were diagnosed with cirrhosis during the study period. The patients were retrospectively evaluated, with all relevant hospitalization- and infection-related data extracted from medical records. They were then followed until death, transplantation, or the end of 2011, for a median follow-up of 50 months.

The groups of patients with community-acquired, HCA, or nosocomial infections did not differ significantly with respect to patient demographics, etiology of liver cirrhosis, or the presence of comorbidities or hepatocellular carcinoma. Length of stay was longer for those with HCA and nosocomial infections, but the three groups did not differ with respect to need for intensive care unit stay, in-hospital mortality, acute kidney injury, or systemic inflammatory response syndrome occurrence.

Also, PPI use was more frequent in the HCA and nosocomial infection groups, but the groups did not differ in their use of immunosuppressive or steroid use.

The results did not change in an analysis that included only the first bacterial infection for each patient, Dr. Sargenti said.

The most common types of infections were urinary tract infections in 22% of patients, spontaneous bacterial peritonitis in 19%, pneumonia in 14%, spontaneous bacteremia in 14%, and skin infections in 10%.

Nosocomial and HCA infections occur commonly in cirrhosis, but population-based data characterizing their occurrence and potential role in mortality or length of stay have been lacking, Dr. Sargenti said, noting also that while PPIs are known to increase the risk for infections, and acute kidney injury and systemic inflammatory response syndrome during an infectious episode are known to be associated with poor prognosis, it was previously unclear whether these conditions are more common in nosocomial and HCA infections.

The current findings suggest that most infections in a cirrhotic cohort are HCA or nosocomial infections, and that PPI use is an independent predictor of such infections. Nosocomial infections are a particular concern, as they appear to increase the risk of factors associated with poor outcomes, she concluded.

Dr. Sargenti reported having no disclosures.

ginews@gastro.org

ORLANDO – Nosocomial infections in cirrhotic patients are associated with acute kidney injury and prolonged hospital stay, and thus adversely affect outcomes, findings from a Swedish population-based study suggest.

Of 344 patients diagnosed with cirrhosis between 2000 and 2010, 122 experienced a total of 230 bacterial infections; 29% were community acquired, 51% were health care acquired (HCA), and 20% were nosocomial. Most (70%) occurred in decompensated patients, and most patients (64%) used proton pump inhibitors. In-hospital mortality was 18%, Dr. Konstantina Sargenti reported at the annual Digestive Disease Week.

On logistic regression analysis, nosocomial/HCA infections, compared with community-acquired infections, were independently associated with PPI use (odds ratio, 2.07) and decompensated patient status (OR, 2.12). After researchers adjusted for confounders, nosocomial/HCA infections were not found to be associated with inpatient mortality (OR, 1.78) or systemic inflammatory response syndrome (OR, 1.18), but nosocomial infections alone were independently associated with hospital length of stay (OR, 23.34 per day) and acute kidney injury (OR, 2.82), which was defined by an increase of greater than 50% in serum creatinine, said Dr. Sargenti of Skane University Hospital, University of Lund (Sweden).

Study subjects – residents of an area in Sweden with a population of about 250,000 – all were diagnosed with cirrhosis during the study period. The patients were retrospectively evaluated, with all relevant hospitalization- and infection-related data extracted from medical records. They were then followed until death, transplantation, or the end of 2011, for a median follow-up of 50 months.

The groups of patients with community-acquired, HCA, or nosocomial infections did not differ significantly with respect to patient demographics, etiology of liver cirrhosis, or the presence of comorbidities or hepatocellular carcinoma. Length of stay was longer for those with HCA and nosocomial infections, but the three groups did not differ with respect to need for intensive care unit stay, in-hospital mortality, acute kidney injury, or systemic inflammatory response syndrome occurrence.

Also, PPI use was more frequent in the HCA and nosocomial infection groups, but the groups did not differ in their use of immunosuppressive or steroid use.

The results did not change in an analysis that included only the first bacterial infection for each patient, Dr. Sargenti said.

The most common types of infections were urinary tract infections in 22% of patients, spontaneous bacterial peritonitis in 19%, pneumonia in 14%, spontaneous bacteremia in 14%, and skin infections in 10%.

Nosocomial and HCA infections occur commonly in cirrhosis, but population-based data characterizing their occurrence and potential role in mortality or length of stay have been lacking, Dr. Sargenti said, noting also that while PPIs are known to increase the risk for infections, and acute kidney injury and systemic inflammatory response syndrome during an infectious episode are known to be associated with poor prognosis, it was previously unclear whether these conditions are more common in nosocomial and HCA infections.

The current findings suggest that most infections in a cirrhotic cohort are HCA or nosocomial infections, and that PPI use is an independent predictor of such infections. Nosocomial infections are a particular concern, as they appear to increase the risk of factors associated with poor outcomes, she concluded.

Dr. Sargenti reported having no disclosures.

ginews@gastro.org

ORLANDO – Nosocomial infections in cirrhotic patients are associated with acute kidney injury and prolonged hospital stay, and thus adversely affect outcomes, findings from a Swedish population-based study suggest.

Of 344 patients diagnosed with cirrhosis between 2000 and 2010, 122 experienced a total of 230 bacterial infections; 29% were community acquired, 51% were health care acquired (HCA), and 20% were nosocomial. Most (70%) occurred in decompensated patients, and most patients (64%) used proton pump inhibitors. In-hospital mortality was 18%, Dr. Konstantina Sargenti reported at the annual Digestive Disease Week.

On logistic regression analysis, nosocomial/HCA infections, compared with community-acquired infections, were independently associated with PPI use (odds ratio, 2.07) and decompensated patient status (OR, 2.12). After researchers adjusted for confounders, nosocomial/HCA infections were not found to be associated with inpatient mortality (OR, 1.78) or systemic inflammatory response syndrome (OR, 1.18), but nosocomial infections alone were independently associated with hospital length of stay (OR, 23.34 per day) and acute kidney injury (OR, 2.82), which was defined by an increase of greater than 50% in serum creatinine, said Dr. Sargenti of Skane University Hospital, University of Lund (Sweden).

Study subjects – residents of an area in Sweden with a population of about 250,000 – all were diagnosed with cirrhosis during the study period. The patients were retrospectively evaluated, with all relevant hospitalization- and infection-related data extracted from medical records. They were then followed until death, transplantation, or the end of 2011, for a median follow-up of 50 months.

The groups of patients with community-acquired, HCA, or nosocomial infections did not differ significantly with respect to patient demographics, etiology of liver cirrhosis, or the presence of comorbidities or hepatocellular carcinoma. Length of stay was longer for those with HCA and nosocomial infections, but the three groups did not differ with respect to need for intensive care unit stay, in-hospital mortality, acute kidney injury, or systemic inflammatory response syndrome occurrence.

Also, PPI use was more frequent in the HCA and nosocomial infection groups, but the groups did not differ in their use of immunosuppressive or steroid use.

The results did not change in an analysis that included only the first bacterial infection for each patient, Dr. Sargenti said.

The most common types of infections were urinary tract infections in 22% of patients, spontaneous bacterial peritonitis in 19%, pneumonia in 14%, spontaneous bacteremia in 14%, and skin infections in 10%.

Nosocomial and HCA infections occur commonly in cirrhosis, but population-based data characterizing their occurrence and potential role in mortality or length of stay have been lacking, Dr. Sargenti said, noting also that while PPIs are known to increase the risk for infections, and acute kidney injury and systemic inflammatory response syndrome during an infectious episode are known to be associated with poor prognosis, it was previously unclear whether these conditions are more common in nosocomial and HCA infections.

The current findings suggest that most infections in a cirrhotic cohort are HCA or nosocomial infections, and that PPI use is an independent predictor of such infections. Nosocomial infections are a particular concern, as they appear to increase the risk of factors associated with poor outcomes, she concluded.

Dr. Sargenti reported having no disclosures.

ginews@gastro.org

ORLANDO – Colonoscopy with or without fecal occult blood testing is associated with lower overall mortality risk in individuals with increased baseline colorectal cancer risk, findings from a large prospective cohort study suggest.

Overall mortality was 33.2% in 2,123 Veterans Administration patients aged 21-89 years who were followed for up to 16 years as part of the study. Deceased patients, compared with those still living at the end of the study period, had significantly lower odds of having undergone colonoscopy alone (18.5% vs. 23%) or colonoscopy plus fecal occult blood testing (17.4% vs. 23.9%), and significantly greater odds of having undergone neither screening modality (41.4% vs. 28%), Dr. Martin Tobi reported at the annual Digestive Disease Week.

The use of fecal occult blood testing (FOBT) alone was not associated with overall mortality; 25% and 22% of the deceased and living patients, respectively, underwent FOBT alone, said Dr. Tobi of the University of Pennsylvania, Philadelphia.

Study participants were adults seen at the outpatient primary care clinics of a VA hospital between 1995 and 2012. Some had symptoms and some did not – this was not a screening population, Dr. Tobi noted.

The subjects were followed for a mean of 8 years. Risk for colorectal cancer at baseline was assessed using a risk questionnaire and based on past neoplasia, chronic inflammatory bowel disease, symptomatology, and family history. Mortality and use of FOBT and colonoscopy were determined by a manual medical records review.

The impact of colonoscopy and FOBT on overall mortality associated with colorectal cancer has been unclear, and although large-scale randomized trials to evaluate the relationships are ongoing, definitive results are more than a decade away, Dr. Tobi said.

Though limited by missing data in a substantial number of cases, the current findings from a large VA population suggest there is indeed a relationship between colonoscopy with or without FOBT and overall mortality.

"Further analyses are needed to determine whether a true protective effect of colonoscopy is attributable to a causal relationship or due to a confounding one – mainly a healthy user effect," he concluded.

The Veterans Health Administration provided funding for this study. Dr. Tobi reported having no disclosures.

ORLANDO – Colonoscopy with or without fecal occult blood testing is associated with lower overall mortality risk in individuals with increased baseline colorectal cancer risk, findings from a large prospective cohort study suggest.

Overall mortality was 33.2% in 2,123 Veterans Administration patients aged 21-89 years who were followed for up to 16 years as part of the study. Deceased patients, compared with those still living at the end of the study period, had significantly lower odds of having undergone colonoscopy alone (18.5% vs. 23%) or colonoscopy plus fecal occult blood testing (17.4% vs. 23.9%), and significantly greater odds of having undergone neither screening modality (41.4% vs. 28%), Dr. Martin Tobi reported at the annual Digestive Disease Week.

The use of fecal occult blood testing (FOBT) alone was not associated with overall mortality; 25% and 22% of the deceased and living patients, respectively, underwent FOBT alone, said Dr. Tobi of the University of Pennsylvania, Philadelphia.

Study participants were adults seen at the outpatient primary care clinics of a VA hospital between 1995 and 2012. Some had symptoms and some did not – this was not a screening population, Dr. Tobi noted.

The subjects were followed for a mean of 8 years. Risk for colorectal cancer at baseline was assessed using a risk questionnaire and based on past neoplasia, chronic inflammatory bowel disease, symptomatology, and family history. Mortality and use of FOBT and colonoscopy were determined by a manual medical records review.

The impact of colonoscopy and FOBT on overall mortality associated with colorectal cancer has been unclear, and although large-scale randomized trials to evaluate the relationships are ongoing, definitive results are more than a decade away, Dr. Tobi said.

Though limited by missing data in a substantial number of cases, the current findings from a large VA population suggest there is indeed a relationship between colonoscopy with or without FOBT and overall mortality.

"Further analyses are needed to determine whether a true protective effect of colonoscopy is attributable to a causal relationship or due to a confounding one – mainly a healthy user effect," he concluded.

The Veterans Health Administration provided funding for this study. Dr. Tobi reported having no disclosures.

ORLANDO – Colonoscopy with or without fecal occult blood testing is associated with lower overall mortality risk in individuals with increased baseline colorectal cancer risk, findings from a large prospective cohort study suggest.

Overall mortality was 33.2% in 2,123 Veterans Administration patients aged 21-89 years who were followed for up to 16 years as part of the study. Deceased patients, compared with those still living at the end of the study period, had significantly lower odds of having undergone colonoscopy alone (18.5% vs. 23%) or colonoscopy plus fecal occult blood testing (17.4% vs. 23.9%), and significantly greater odds of having undergone neither screening modality (41.4% vs. 28%), Dr. Martin Tobi reported at the annual Digestive Disease Week.

The use of fecal occult blood testing (FOBT) alone was not associated with overall mortality; 25% and 22% of the deceased and living patients, respectively, underwent FOBT alone, said Dr. Tobi of the University of Pennsylvania, Philadelphia.

Study participants were adults seen at the outpatient primary care clinics of a VA hospital between 1995 and 2012. Some had symptoms and some did not – this was not a screening population, Dr. Tobi noted.

The subjects were followed for a mean of 8 years. Risk for colorectal cancer at baseline was assessed using a risk questionnaire and based on past neoplasia, chronic inflammatory bowel disease, symptomatology, and family history. Mortality and use of FOBT and colonoscopy were determined by a manual medical records review.

The impact of colonoscopy and FOBT on overall mortality associated with colorectal cancer has been unclear, and although large-scale randomized trials to evaluate the relationships are ongoing, definitive results are more than a decade away, Dr. Tobi said.

Though limited by missing data in a substantial number of cases, the current findings from a large VA population suggest there is indeed a relationship between colonoscopy with or without FOBT and overall mortality.

"Further analyses are needed to determine whether a true protective effect of colonoscopy is attributable to a causal relationship or due to a confounding one – mainly a healthy user effect," he concluded.

The Veterans Health Administration provided funding for this study. Dr. Tobi reported having no disclosures.

ORLANDO – A novel urinary test differentiates pancreatic cancer from chronic pancreatitis and could ultimately provide a tool for the early detection of pancreatic cancer, according to findings from a prospective multicenter study in Germany.

In an independent validation cohort of 47 patients with pancreatic cancer and 60 patients with chronic pancreatitis, the test – which measures the distribution of 55 peptides shown in a screening cohort to be distinct in malignant vs. benign disease – had an area under the curve (AUC) of 0.89. At the optimum cutoff, sensitivity and specificity of the test were 85% and 91%, respectively, Dr. Bastian Schönemeier reported at the annual Digestive Disease Week.

In 94 healthy controls, specificity was 80%, he said, explaining that the test was designed to compare malignant and benign disease, rather than malignant disease and no disease.

The use of proteomic analysis to identify patterns of multiple peptide markers that may have diagnostic value is an emerging technology that has shown promise in other conditions, as well. For example, Dr. Schönemeier and his colleagues demonstrated in a prior study that a proteomic analysis of urine distinguishes cholangiocarcinoma from other benign biliary disorders.

Given their success, the investigators began to investigate whether certain peptide markers in urine are differentially regulated in pancreatic cancer and chronic pancreatitis. The goal was include the most discriminative peptides in a multimarker model for accurate differentiation of the two conditions.

Peptides with altered excretion levels in a sample of 18 patients with histologically proven, but untreated pancreatic cancer, and 22 patients with chronic pancreatitis were identified using capillary electrophoresis coupled online to mass spectrometry. Those that differed significantly between the groups were included in the model, which was then applied prospectively to the independent cohort and healthy controls.

On amino acid sequencing, fragments of fetuin-a and alpha-1-antitrypsin were among 13 prominent markers for pancreatic cancer. This was verified by enzyme immunoassay and immunohistochemistry.

The findings are intriguing, because the diagnosis of pancreatic cancer – the fifth-most-deadly cancer worldwide, has doubled in incidence during the last 40 years, from 5 to 10 cases per 100,000 persons per year, Dr. Schönemeier said, adding that 5-year survival is less than 5%, because a lack of markers and specific symptoms impedes early diagnosis.

While the urinary test evaluated in this study is promising and clearly is capable of differentiating chronic pancreatitis and pancreatic cancer, further study is needed, he said.

"I’m not saying at all that we can now detect (pancreatic) cancer early, but ... it may be useful for proving pancreatic cancer in unclear cases, and it may be useful for surveillance of patients with chronic pancreatitis, he said.

Longitudinal and larger studies are needed to verify the findings, he noted.

Dr. Schönemeier reported having no disclosures.

ORLANDO – A novel urinary test differentiates pancreatic cancer from chronic pancreatitis and could ultimately provide a tool for the early detection of pancreatic cancer, according to findings from a prospective multicenter study in Germany.

In an independent validation cohort of 47 patients with pancreatic cancer and 60 patients with chronic pancreatitis, the test – which measures the distribution of 55 peptides shown in a screening cohort to be distinct in malignant vs. benign disease – had an area under the curve (AUC) of 0.89. At the optimum cutoff, sensitivity and specificity of the test were 85% and 91%, respectively, Dr. Bastian Schönemeier reported at the annual Digestive Disease Week.

In 94 healthy controls, specificity was 80%, he said, explaining that the test was designed to compare malignant and benign disease, rather than malignant disease and no disease.

The use of proteomic analysis to identify patterns of multiple peptide markers that may have diagnostic value is an emerging technology that has shown promise in other conditions, as well. For example, Dr. Schönemeier and his colleagues demonstrated in a prior study that a proteomic analysis of urine distinguishes cholangiocarcinoma from other benign biliary disorders.

Given their success, the investigators began to investigate whether certain peptide markers in urine are differentially regulated in pancreatic cancer and chronic pancreatitis. The goal was include the most discriminative peptides in a multimarker model for accurate differentiation of the two conditions.

Peptides with altered excretion levels in a sample of 18 patients with histologically proven, but untreated pancreatic cancer, and 22 patients with chronic pancreatitis were identified using capillary electrophoresis coupled online to mass spectrometry. Those that differed significantly between the groups were included in the model, which was then applied prospectively to the independent cohort and healthy controls.

On amino acid sequencing, fragments of fetuin-a and alpha-1-antitrypsin were among 13 prominent markers for pancreatic cancer. This was verified by enzyme immunoassay and immunohistochemistry.

The findings are intriguing, because the diagnosis of pancreatic cancer – the fifth-most-deadly cancer worldwide, has doubled in incidence during the last 40 years, from 5 to 10 cases per 100,000 persons per year, Dr. Schönemeier said, adding that 5-year survival is less than 5%, because a lack of markers and specific symptoms impedes early diagnosis.

While the urinary test evaluated in this study is promising and clearly is capable of differentiating chronic pancreatitis and pancreatic cancer, further study is needed, he said.

"I’m not saying at all that we can now detect (pancreatic) cancer early, but ... it may be useful for proving pancreatic cancer in unclear cases, and it may be useful for surveillance of patients with chronic pancreatitis, he said.

Longitudinal and larger studies are needed to verify the findings, he noted.

Dr. Schönemeier reported having no disclosures.

ORLANDO – A novel urinary test differentiates pancreatic cancer from chronic pancreatitis and could ultimately provide a tool for the early detection of pancreatic cancer, according to findings from a prospective multicenter study in Germany.

In an independent validation cohort of 47 patients with pancreatic cancer and 60 patients with chronic pancreatitis, the test – which measures the distribution of 55 peptides shown in a screening cohort to be distinct in malignant vs. benign disease – had an area under the curve (AUC) of 0.89. At the optimum cutoff, sensitivity and specificity of the test were 85% and 91%, respectively, Dr. Bastian Schönemeier reported at the annual Digestive Disease Week.

In 94 healthy controls, specificity was 80%, he said, explaining that the test was designed to compare malignant and benign disease, rather than malignant disease and no disease.

The use of proteomic analysis to identify patterns of multiple peptide markers that may have diagnostic value is an emerging technology that has shown promise in other conditions, as well. For example, Dr. Schönemeier and his colleagues demonstrated in a prior study that a proteomic analysis of urine distinguishes cholangiocarcinoma from other benign biliary disorders.

Given their success, the investigators began to investigate whether certain peptide markers in urine are differentially regulated in pancreatic cancer and chronic pancreatitis. The goal was include the most discriminative peptides in a multimarker model for accurate differentiation of the two conditions.

Peptides with altered excretion levels in a sample of 18 patients with histologically proven, but untreated pancreatic cancer, and 22 patients with chronic pancreatitis were identified using capillary electrophoresis coupled online to mass spectrometry. Those that differed significantly between the groups were included in the model, which was then applied prospectively to the independent cohort and healthy controls.

On amino acid sequencing, fragments of fetuin-a and alpha-1-antitrypsin were among 13 prominent markers for pancreatic cancer. This was verified by enzyme immunoassay and immunohistochemistry.

The findings are intriguing, because the diagnosis of pancreatic cancer – the fifth-most-deadly cancer worldwide, has doubled in incidence during the last 40 years, from 5 to 10 cases per 100,000 persons per year, Dr. Schönemeier said, adding that 5-year survival is less than 5%, because a lack of markers and specific symptoms impedes early diagnosis.

While the urinary test evaluated in this study is promising and clearly is capable of differentiating chronic pancreatitis and pancreatic cancer, further study is needed, he said.

"I’m not saying at all that we can now detect (pancreatic) cancer early, but ... it may be useful for proving pancreatic cancer in unclear cases, and it may be useful for surveillance of patients with chronic pancreatitis, he said.

Longitudinal and larger studies are needed to verify the findings, he noted.

Dr. Schönemeier reported having no disclosures.

MIAMI BEACH – More men are seeking cosmetic dermatologic procedures and products, and successfully engaging and treating this segment of the population require recognition of a number of gender-specific differences with respect to skin biology, skin aging, behaviors, and rejuvenation goals, according to Dr. Ivan Camacho.

"We need to be able to understand all of these the differences in order to be able to provide tailored treatments for our patients, so they can get the best results possible," Dr. Camacho said during a focus session on men’s aesthetics at the annual meeting of the American Academy of Dermatology.

Skin biology

When it comes to skin biology, men and women share a number of characteristics, but there are important differences driven by genetic or hormonal specificity that can affect treatment outcomes, Dr. Camacho said. For example, although the number of cell layers and thickness of the stratum corneum is similar in men and women, the dermis is about 20% thicker in men than in women, across the age spectrum and in all anatomic locations, he noted.

Men also have higher collagen density early in life, but they experience skin thinning at a younger age than women. For women, skin thickness generally remains constant until menopause, and then the skin begins to thin rapidly. This difference is most likely because of the role of testosterone in maintaining collagen content, said Dr. Camacho of the University of Miami.

Men also have less subcutaneous fat, greater distribution of body fat in the abdomen and trunk, and higher facial bone density mass than women, Dr. Camacho explained. In addition, men tend to have higher transepidermal water loss because of the lack of estrogen, which has positive effects in the stratum corneum, he said.

Dr. Camacho described other functional differences in men’s skin compared with women’s skin, including:

• A fourfold increase in sebum generation.

• A 30% overall increase in sweating.

• Different hair distribution as determined by androgens, but also by genetics.

• Stronger skin tone.

• Greater sensitivity to ultraviolet radiation, and thus a lower minimal erythema dose threshold and increased rate of skin cancers.

• Greater susceptibility to bacterial and viral infections and slower healing rates as a result of the inhibitory effects of testosterone and hydrotestosterone with respect to wound healing.

• Greater susceptibility to stress-induced immunosuppression, which may explain the higher skin cancer rates and delayed wound healing.

Skin aging

As for the aging process, men age differently from women in that their higher collagen density leads to better maintenance of elasticity, and their higher facial bone density provides better overall support, said Dr. Camacho.

However, thicker skin and stronger muscles make men more prone to develop deeper expression lines, as opposed to the "superficial wrinkles that women complain about," Dr. Camacho noted.

Also, the reduced level of subcutaneous fat in men can lead to more dramatic volume loss.

"Men are ‘sinkers.’ We sink more than wrinklers or saggers, because we have good elasticity, but we actually tend to lose quite a bit of subcutaneous fat," Dr. Camacho explained.

As a result of other differences related to skin aging, he said, men’s skin may be:

• More prone to acne and enlarged pores due to the higher sebaceous gland count.

• More prone to darker and/or redder complexions because of the increased tone and vascularity.

• More likely to have dull areas due to the epidermal water loss.

• Less prone to perioral lines and wrinkles due to facial hair distribution, which acts as a structural support.

• More likely to have unwanted fat in the abdominal and trunk region.

• More likely to develop both melanoma and nonmelanoma skin cancers and to experience photoaging because of greater sensitivity to ultraviolet radiation.

Behavior

In Dr. Camacho’s experience, men tend to be very goal oriented, and that carries over to cosmetic procedures.

"Men are very results-oriented, so we want to have a very clear purpose of what we want to achieve with a given treatment or product," he added, noting that male patients often prefer a lot of detail about procedures and processes.

Providing the extra details requires a greater educational effort on the part of the physician, he said, but "that’s a great thing, because they are going to be well informed about the pros and cons of a given treatment."

Male patients also want fast results. For these reasons, injectables and laser therapies are probably a good fit, he noted.

Men also tend to prefer simplicity, minimal discomfort, and minimal downtime, making noninvasive procedures and multifunctional skin care products ideal, he added.

Rejuvenation goals

Men often have rejuvenation goals that are different from those of women, Dr. Camacho said.

The most common reason that men seek cosmetic treatment is for a "tired, sinking face"; they want to look refreshed and confident, but they want subtle, natural-looking results, he said.

And, of course, there’s hair.

"Hair, hair, hair. Hair is a huge concern for men," Dr. Camacho said.

Sometimes men think they have too much hair, sometimes they have too little. Men drive the market for hair loss treatments, and also are increasingly seeking hair removal treatments, Dr. Camacho noted. Since traditional methods for hair removal, such as waxing, shaving, and epilation, are temporary and can cause irritation, laser hair removal is increasing in popularity among men. In fact, according to the American Society of Aesthetic Plastic Surgery, it was the second most common nonsurgical cosmetic intervention for men in 2011, Dr. Camacho said.

Other useful cosmetic procedures

One of the most popular noninvasive cosmetic interventions for both men and women is neuromodulation injections, for softening of expression lines and treating areas including the glabella, forehead, and periocular area, that can contribute to an angry-, tired-, or sad-looking face, Dr. Camacho said.

In 2011, men accounted for 9.1% of botulinum toxin treatment patients, and this represented a 258% increase from the year 2000, he noted.

Skin resurfacing treatments are increasing in popularity among men as well. In 2011, men accounted for 7.3% of skin resurfacing treatments, making skin resurfacing the fourth most common nonsurgical cosmetic intervention in men, Dr. Camacho said.

Other treatments for skin issues of concern to men include laser and light therapies to improve the complexion, and skin-tightening procedures, such as radiofrequency and ultrasound, to help improve skin laxity

In addition, data from 2011 showed that men accounted for about 20% of patients undergoing CoolSculpting, which is both effective and appealing to men seeking treatment for abdominal and trunk fat deposits, Dr. Camacho said.

Treatment pearls

When providing facial treatments for men, preservation of a masculine appearance is essential, Dr. Camacho said.

"The last thing we want to do is have a man’s face looking like a woman’s face; we need to be able to preserve the masculine appearance," Dr. Camacho said, noting that in his experience, a combination of neurotoxins and dermal fillers is excellent for achieving desired results.

For neurotoxins, remember that men require doses at about 1.5 to 2 times as much as women, he said

"But also remember that men want to preserve some animation, so it’s always important to keep a balance between being effective with our treatment, but also keeping the patient happy with what they want," he said.

In Dr. Camacho’s experience, most men are less concerned with periocular lines, but some are, so be sure to ask them exactly what they want at a treatment session.

"You can’t assume they want three areas treated at a time as we usually do with women," he said.

Be sure to preserve the masculine position of the brow, which in men is very subtle, located right at the supraorbital rim, and has no major arching, said Dr. Camacho.

By avoiding injecting at the superior portion of the orbicularis ocular muscle, the subtle arch at the supraorbital rim can be maintained, and feminization of the brow avoided, he said.

"Also, when treating the frontalis major make sure to go all the way lateral, because you don’t want a little bit of frontalis pulling and giving some arching to the eyebrows," he added.

As for fillers, keep in mind that men probably will require higher volumes, which is an important consideration when discussing finances during the initial consultation.

Fillers are particularly useful in the tear trough area for men seeking treatment of tired-looking sunken eyes.

"Very easily, we can create a smooth transition between the lower eyelid and cheek. We can also use (fillers) for prominent nasolabial folds," Dr. Camacho explained.

Before filling the lines, however, consider restoring the cheek to correct for the midfacial fat loss common in men, he noted.

Also, if treatment involves the lip area, avoid overfilling the vermilion border – this will feminize the lips, he said.

Breaking into the men’s market

Consider developing a marketing strategy that shows your practice’s appeal to both genders – by launching a website and developing marketing materials that feature both male and female models and patients, and by offering cosmeceutical product lines developed for men, Dr. Camacho suggested.

"The modern man is here, and the modern man is actively looking for advice on cosmetic procedures and recommendations for skin care. Dermatologists will have a very important role in male aesthetics," he said, noting that a dermatologist’s role can include enhancing awareness and cultural acceptance of cosmetic interventions for men.

"We have every day in our practices, an opportunity to educate our male patients on the multiple treatment options available for them. We also have a responsibility for being knowledgeable about the specificities of male skin ... to be able to formulate tailored treatments, and to be able to, therefore, obtain the best results for our male patients," he said.

Dr. Camacho reported having no disclosures.

MIAMI BEACH – More men are seeking cosmetic dermatologic procedures and products, and successfully engaging and treating this segment of the population require recognition of a number of gender-specific differences with respect to skin biology, skin aging, behaviors, and rejuvenation goals, according to Dr. Ivan Camacho.

"We need to be able to understand all of these the differences in order to be able to provide tailored treatments for our patients, so they can get the best results possible," Dr. Camacho said during a focus session on men’s aesthetics at the annual meeting of the American Academy of Dermatology.

Skin biology

When it comes to skin biology, men and women share a number of characteristics, but there are important differences driven by genetic or hormonal specificity that can affect treatment outcomes, Dr. Camacho said. For example, although the number of cell layers and thickness of the stratum corneum is similar in men and women, the dermis is about 20% thicker in men than in women, across the age spectrum and in all anatomic locations, he noted.

Men also have higher collagen density early in life, but they experience skin thinning at a younger age than women. For women, skin thickness generally remains constant until menopause, and then the skin begins to thin rapidly. This difference is most likely because of the role of testosterone in maintaining collagen content, said Dr. Camacho of the University of Miami.

Men also have less subcutaneous fat, greater distribution of body fat in the abdomen and trunk, and higher facial bone density mass than women, Dr. Camacho explained. In addition, men tend to have higher transepidermal water loss because of the lack of estrogen, which has positive effects in the stratum corneum, he said.

Dr. Camacho described other functional differences in men’s skin compared with women’s skin, including:

• A fourfold increase in sebum generation.

• A 30% overall increase in sweating.

• Different hair distribution as determined by androgens, but also by genetics.

• Stronger skin tone.

• Greater sensitivity to ultraviolet radiation, and thus a lower minimal erythema dose threshold and increased rate of skin cancers.

• Greater susceptibility to bacterial and viral infections and slower healing rates as a result of the inhibitory effects of testosterone and hydrotestosterone with respect to wound healing.

• Greater susceptibility to stress-induced immunosuppression, which may explain the higher skin cancer rates and delayed wound healing.

Skin aging

As for the aging process, men age differently from women in that their higher collagen density leads to better maintenance of elasticity, and their higher facial bone density provides better overall support, said Dr. Camacho.

However, thicker skin and stronger muscles make men more prone to develop deeper expression lines, as opposed to the "superficial wrinkles that women complain about," Dr. Camacho noted.

Also, the reduced level of subcutaneous fat in men can lead to more dramatic volume loss.

"Men are ‘sinkers.’ We sink more than wrinklers or saggers, because we have good elasticity, but we actually tend to lose quite a bit of subcutaneous fat," Dr. Camacho explained.

As a result of other differences related to skin aging, he said, men’s skin may be:

• More prone to acne and enlarged pores due to the higher sebaceous gland count.

• More prone to darker and/or redder complexions because of the increased tone and vascularity.

• More likely to have dull areas due to the epidermal water loss.

• Less prone to perioral lines and wrinkles due to facial hair distribution, which acts as a structural support.

• More likely to have unwanted fat in the abdominal and trunk region.

• More likely to develop both melanoma and nonmelanoma skin cancers and to experience photoaging because of greater sensitivity to ultraviolet radiation.

Behavior

In Dr. Camacho’s experience, men tend to be very goal oriented, and that carries over to cosmetic procedures.

"Men are very results-oriented, so we want to have a very clear purpose of what we want to achieve with a given treatment or product," he added, noting that male patients often prefer a lot of detail about procedures and processes.

Providing the extra details requires a greater educational effort on the part of the physician, he said, but "that’s a great thing, because they are going to be well informed about the pros and cons of a given treatment."

Male patients also want fast results. For these reasons, injectables and laser therapies are probably a good fit, he noted.

Men also tend to prefer simplicity, minimal discomfort, and minimal downtime, making noninvasive procedures and multifunctional skin care products ideal, he added.

Rejuvenation goals

Men often have rejuvenation goals that are different from those of women, Dr. Camacho said.

The most common reason that men seek cosmetic treatment is for a "tired, sinking face"; they want to look refreshed and confident, but they want subtle, natural-looking results, he said.

And, of course, there’s hair.

"Hair, hair, hair. Hair is a huge concern for men," Dr. Camacho said.

Sometimes men think they have too much hair, sometimes they have too little. Men drive the market for hair loss treatments, and also are increasingly seeking hair removal treatments, Dr. Camacho noted. Since traditional methods for hair removal, such as waxing, shaving, and epilation, are temporary and can cause irritation, laser hair removal is increasing in popularity among men. In fact, according to the American Society of Aesthetic Plastic Surgery, it was the second most common nonsurgical cosmetic intervention for men in 2011, Dr. Camacho said.

Other useful cosmetic procedures

One of the most popular noninvasive cosmetic interventions for both men and women is neuromodulation injections, for softening of expression lines and treating areas including the glabella, forehead, and periocular area, that can contribute to an angry-, tired-, or sad-looking face, Dr. Camacho said.

In 2011, men accounted for 9.1% of botulinum toxin treatment patients, and this represented a 258% increase from the year 2000, he noted.

Skin resurfacing treatments are increasing in popularity among men as well. In 2011, men accounted for 7.3% of skin resurfacing treatments, making skin resurfacing the fourth most common nonsurgical cosmetic intervention in men, Dr. Camacho said.

Other treatments for skin issues of concern to men include laser and light therapies to improve the complexion, and skin-tightening procedures, such as radiofrequency and ultrasound, to help improve skin laxity

In addition, data from 2011 showed that men accounted for about 20% of patients undergoing CoolSculpting, which is both effective and appealing to men seeking treatment for abdominal and trunk fat deposits, Dr. Camacho said.

Treatment pearls

When providing facial treatments for men, preservation of a masculine appearance is essential, Dr. Camacho said.

"The last thing we want to do is have a man’s face looking like a woman’s face; we need to be able to preserve the masculine appearance," Dr. Camacho said, noting that in his experience, a combination of neurotoxins and dermal fillers is excellent for achieving desired results.

For neurotoxins, remember that men require doses at about 1.5 to 2 times as much as women, he said

"But also remember that men want to preserve some animation, so it’s always important to keep a balance between being effective with our treatment, but also keeping the patient happy with what they want," he said.

In Dr. Camacho’s experience, most men are less concerned with periocular lines, but some are, so be sure to ask them exactly what they want at a treatment session.

"You can’t assume they want three areas treated at a time as we usually do with women," he said.

Be sure to preserve the masculine position of the brow, which in men is very subtle, located right at the supraorbital rim, and has no major arching, said Dr. Camacho.

By avoiding injecting at the superior portion of the orbicularis ocular muscle, the subtle arch at the supraorbital rim can be maintained, and feminization of the brow avoided, he said.

"Also, when treating the frontalis major make sure to go all the way lateral, because you don’t want a little bit of frontalis pulling and giving some arching to the eyebrows," he added.

As for fillers, keep in mind that men probably will require higher volumes, which is an important consideration when discussing finances during the initial consultation.

Fillers are particularly useful in the tear trough area for men seeking treatment of tired-looking sunken eyes.

"Very easily, we can create a smooth transition between the lower eyelid and cheek. We can also use (fillers) for prominent nasolabial folds," Dr. Camacho explained.

Before filling the lines, however, consider restoring the cheek to correct for the midfacial fat loss common in men, he noted.

Also, if treatment involves the lip area, avoid overfilling the vermilion border – this will feminize the lips, he said.

Breaking into the men’s market

Consider developing a marketing strategy that shows your practice’s appeal to both genders – by launching a website and developing marketing materials that feature both male and female models and patients, and by offering cosmeceutical product lines developed for men, Dr. Camacho suggested.

"The modern man is here, and the modern man is actively looking for advice on cosmetic procedures and recommendations for skin care. Dermatologists will have a very important role in male aesthetics," he said, noting that a dermatologist’s role can include enhancing awareness and cultural acceptance of cosmetic interventions for men.

"We have every day in our practices, an opportunity to educate our male patients on the multiple treatment options available for them. We also have a responsibility for being knowledgeable about the specificities of male skin ... to be able to formulate tailored treatments, and to be able to, therefore, obtain the best results for our male patients," he said.

Dr. Camacho reported having no disclosures.

MIAMI BEACH – More men are seeking cosmetic dermatologic procedures and products, and successfully engaging and treating this segment of the population require recognition of a number of gender-specific differences with respect to skin biology, skin aging, behaviors, and rejuvenation goals, according to Dr. Ivan Camacho.

"We need to be able to understand all of these the differences in order to be able to provide tailored treatments for our patients, so they can get the best results possible," Dr. Camacho said during a focus session on men’s aesthetics at the annual meeting of the American Academy of Dermatology.

Skin biology

When it comes to skin biology, men and women share a number of characteristics, but there are important differences driven by genetic or hormonal specificity that can affect treatment outcomes, Dr. Camacho said. For example, although the number of cell layers and thickness of the stratum corneum is similar in men and women, the dermis is about 20% thicker in men than in women, across the age spectrum and in all anatomic locations, he noted.

Men also have higher collagen density early in life, but they experience skin thinning at a younger age than women. For women, skin thickness generally remains constant until menopause, and then the skin begins to thin rapidly. This difference is most likely because of the role of testosterone in maintaining collagen content, said Dr. Camacho of the University of Miami.

Men also have less subcutaneous fat, greater distribution of body fat in the abdomen and trunk, and higher facial bone density mass than women, Dr. Camacho explained. In addition, men tend to have higher transepidermal water loss because of the lack of estrogen, which has positive effects in the stratum corneum, he said.

Dr. Camacho described other functional differences in men’s skin compared with women’s skin, including:

• A fourfold increase in sebum generation.

• A 30% overall increase in sweating.

• Different hair distribution as determined by androgens, but also by genetics.

• Stronger skin tone.

• Greater sensitivity to ultraviolet radiation, and thus a lower minimal erythema dose threshold and increased rate of skin cancers.

• Greater susceptibility to bacterial and viral infections and slower healing rates as a result of the inhibitory effects of testosterone and hydrotestosterone with respect to wound healing.

• Greater susceptibility to stress-induced immunosuppression, which may explain the higher skin cancer rates and delayed wound healing.

Skin aging

As for the aging process, men age differently from women in that their higher collagen density leads to better maintenance of elasticity, and their higher facial bone density provides better overall support, said Dr. Camacho.

However, thicker skin and stronger muscles make men more prone to develop deeper expression lines, as opposed to the "superficial wrinkles that women complain about," Dr. Camacho noted.

Also, the reduced level of subcutaneous fat in men can lead to more dramatic volume loss.

"Men are ‘sinkers.’ We sink more than wrinklers or saggers, because we have good elasticity, but we actually tend to lose quite a bit of subcutaneous fat," Dr. Camacho explained.

As a result of other differences related to skin aging, he said, men’s skin may be:

• More prone to acne and enlarged pores due to the higher sebaceous gland count.

• More prone to darker and/or redder complexions because of the increased tone and vascularity.

• More likely to have dull areas due to the epidermal water loss.

• Less prone to perioral lines and wrinkles due to facial hair distribution, which acts as a structural support.

• More likely to have unwanted fat in the abdominal and trunk region.

• More likely to develop both melanoma and nonmelanoma skin cancers and to experience photoaging because of greater sensitivity to ultraviolet radiation.

Behavior

In Dr. Camacho’s experience, men tend to be very goal oriented, and that carries over to cosmetic procedures.

"Men are very results-oriented, so we want to have a very clear purpose of what we want to achieve with a given treatment or product," he added, noting that male patients often prefer a lot of detail about procedures and processes.

Providing the extra details requires a greater educational effort on the part of the physician, he said, but "that’s a great thing, because they are going to be well informed about the pros and cons of a given treatment."

Male patients also want fast results. For these reasons, injectables and laser therapies are probably a good fit, he noted.

Men also tend to prefer simplicity, minimal discomfort, and minimal downtime, making noninvasive procedures and multifunctional skin care products ideal, he added.

Rejuvenation goals

Men often have rejuvenation goals that are different from those of women, Dr. Camacho said.

The most common reason that men seek cosmetic treatment is for a "tired, sinking face"; they want to look refreshed and confident, but they want subtle, natural-looking results, he said.

And, of course, there’s hair.

"Hair, hair, hair. Hair is a huge concern for men," Dr. Camacho said.

Sometimes men think they have too much hair, sometimes they have too little. Men drive the market for hair loss treatments, and also are increasingly seeking hair removal treatments, Dr. Camacho noted. Since traditional methods for hair removal, such as waxing, shaving, and epilation, are temporary and can cause irritation, laser hair removal is increasing in popularity among men. In fact, according to the American Society of Aesthetic Plastic Surgery, it was the second most common nonsurgical cosmetic intervention for men in 2011, Dr. Camacho said.

Other useful cosmetic procedures

One of the most popular noninvasive cosmetic interventions for both men and women is neuromodulation injections, for softening of expression lines and treating areas including the glabella, forehead, and periocular area, that can contribute to an angry-, tired-, or sad-looking face, Dr. Camacho said.

In 2011, men accounted for 9.1% of botulinum toxin treatment patients, and this represented a 258% increase from the year 2000, he noted.

Skin resurfacing treatments are increasing in popularity among men as well. In 2011, men accounted for 7.3% of skin resurfacing treatments, making skin resurfacing the fourth most common nonsurgical cosmetic intervention in men, Dr. Camacho said.

Other treatments for skin issues of concern to men include laser and light therapies to improve the complexion, and skin-tightening procedures, such as radiofrequency and ultrasound, to help improve skin laxity

In addition, data from 2011 showed that men accounted for about 20% of patients undergoing CoolSculpting, which is both effective and appealing to men seeking treatment for abdominal and trunk fat deposits, Dr. Camacho said.

Treatment pearls

When providing facial treatments for men, preservation of a masculine appearance is essential, Dr. Camacho said.

"The last thing we want to do is have a man’s face looking like a woman’s face; we need to be able to preserve the masculine appearance," Dr. Camacho said, noting that in his experience, a combination of neurotoxins and dermal fillers is excellent for achieving desired results.

For neurotoxins, remember that men require doses at about 1.5 to 2 times as much as women, he said

"But also remember that men want to preserve some animation, so it’s always important to keep a balance between being effective with our treatment, but also keeping the patient happy with what they want," he said.

In Dr. Camacho’s experience, most men are less concerned with periocular lines, but some are, so be sure to ask them exactly what they want at a treatment session.

"You can’t assume they want three areas treated at a time as we usually do with women," he said.

Be sure to preserve the masculine position of the brow, which in men is very subtle, located right at the supraorbital rim, and has no major arching, said Dr. Camacho.

By avoiding injecting at the superior portion of the orbicularis ocular muscle, the subtle arch at the supraorbital rim can be maintained, and feminization of the brow avoided, he said.

"Also, when treating the frontalis major make sure to go all the way lateral, because you don’t want a little bit of frontalis pulling and giving some arching to the eyebrows," he added.

As for fillers, keep in mind that men probably will require higher volumes, which is an important consideration when discussing finances during the initial consultation.

Fillers are particularly useful in the tear trough area for men seeking treatment of tired-looking sunken eyes.

"Very easily, we can create a smooth transition between the lower eyelid and cheek. We can also use (fillers) for prominent nasolabial folds," Dr. Camacho explained.

Before filling the lines, however, consider restoring the cheek to correct for the midfacial fat loss common in men, he noted.

Also, if treatment involves the lip area, avoid overfilling the vermilion border – this will feminize the lips, he said.

Breaking into the men’s market

Consider developing a marketing strategy that shows your practice’s appeal to both genders – by launching a website and developing marketing materials that feature both male and female models and patients, and by offering cosmeceutical product lines developed for men, Dr. Camacho suggested.

"The modern man is here, and the modern man is actively looking for advice on cosmetic procedures and recommendations for skin care. Dermatologists will have a very important role in male aesthetics," he said, noting that a dermatologist’s role can include enhancing awareness and cultural acceptance of cosmetic interventions for men.

"We have every day in our practices, an opportunity to educate our male patients on the multiple treatment options available for them. We also have a responsibility for being knowledgeable about the specificities of male skin ... to be able to formulate tailored treatments, and to be able to, therefore, obtain the best results for our male patients," he said.

Dr. Camacho reported having no disclosures.

ORLANDO – Risk-based drug treatment with colonoscopy at 6 months – and treatment step-up for recurrence – was significantly more effective in preventing postoperative recurrence of Crohn’s disease, compared with standard drug therapy alone, based on data from the POCER (Post-Operative Crohn’s Endoscopic Recurrence) study.

At an 18-month follow-up colonoscopy, 49% of patients randomized to a risk-based intervention had endoscopic recurrence, compared with 67% of those in a standard drug therapy arm, Dr. Peter De Cruz reported during a late-breaking abstract session at the annual Digestive Disease Week.

Researchers compared the two recurrence-prevention strategies in 174 subjects who were stratified as high risk or low risk based on smoking status, presence of perforating disease, and previous surgeries. The participants were randomized 2:1 to either active care or standard drug therapy. Approximately one-third of patients in the active care arm showed signs of early recurrence at a 6-month colonoscopy and thus received step-up treatment.

Complete mucosal normality was observed in 22% of those in the risk-based treatment arm, compared with 8% in the standard therapy arm; no significant differences were noted with respect to severe endoscopic recurrence or clinical recurrence, said Dr. De Cruz of St. Vincent’s Hospital, Melbourne, Australia.

Patients in the multicenter POCER study were adults undergoing intestinal resection of all macroscopic disease. The treatment arms were similar in terms of demographics, disease characteristics, and prior drug therapy. Of 122 patients in the risk-based treatment arm, 101 were high-risk, and 21 were low-risk. Of 52 patients in the standard drug therapy arm, 44 were high-risk, and 8 were low-risk.

All patients were treated beginning postoperatively with 3 months of 400 mg metronidazole twice daily. High-risk patients also received 2 mg/kg of azathioprine daily, or 1.5 mg/kg of 6 mercaptopurine. Those intolerant of thiopurine were treated with adalimumab induction, followed by 40 mg every 2 weeks. Low-risk patients received no additional treatment following the 3 months of metronidazole.

For recurrence at 6 months, low-risk patients were stepped up to thiopurine; high-risk patients on thiopurine were stepped up to 40 mg adalimumab every 2 weeks, and high-risk patients on adalimumab every 2 weeks stepped up to weekly adalimumab.

The endoscopic remission rate at 18 months was 25% for the low-risk patients who stepped up to thiopurine 41% for high-risk patients who stepped up to thiopurine, and 50% for those who stepped up to weekly adalimumab.

Overall, 39% of patients who stepped up at 6 months were in remission at 1 year. Notably, 31% of the low-risk patients with endoscopic remission at the 6-month colonoscopy, 46% of the high-risk patients on thiopurine, and 41% of the high-risk patients on adalimumab with endoscopic remission at 6 months had endoscopic recurrence 1 year later.

"We can’t afford to relax," Dr. De Cruz said regarding those patients with remission 6 months postoperatively.

This study also allowed for comparison of the efficacy of adalimumab and thiopurine given immediately postoperatively in the high-risk patients. At 6 months, adalimumab was associated with a nearly 80% endoscopic remission rate, compared with 55% for thiopurine, Dr. De Cruz noted.

At 18 months, there was no significant difference in the recurrence rates between patients treated with adalimumab immediately postoperatively and those stepped up to adalimumab in combination with thiopurine. There was, however, a trend toward reduced recurrence rates among those on immediate postoperative adalimumab.

A multivariate analysis showed that active smoking was significantly associated with an increased endoscopic recurrence rate at 18 months, whereas the intervention of endoscopy at 6 months was significantly associated with a reduced recurrence risk at 18 months.

Most prior studies of postoperative recurrence prevention in Crohn’s surgery patients have focused on drug therapy compared with placebo; few have focused on risk-based strategies, Dr. De Cruz noted.

The findings indicate that step-up therapy based on endoscopy is a viable postoperative strategy in patients at high risk of recurrence, he said. No unexpected serious adverse events occurred in this study.

Dr. De Cruz warned, however, that remission at 6 months is no guarantee of remission 1 year later.

"Intensifying treatment at 6 months brings about 40% of patients with recurrence into remission, and we found that a small group of patients had recurrent disease despite endoscopic monitoring and intense treatment," he said.

Dr. De Cruz reported having no disclosures. Several study coauthors disclosed relationships with multiple pharmaceutical companies.

ORLANDO – Risk-based drug treatment with colonoscopy at 6 months – and treatment step-up for recurrence – was significantly more effective in preventing postoperative recurrence of Crohn’s disease, compared with standard drug therapy alone, based on data from the POCER (Post-Operative Crohn’s Endoscopic Recurrence) study.

At an 18-month follow-up colonoscopy, 49% of patients randomized to a risk-based intervention had endoscopic recurrence, compared with 67% of those in a standard drug therapy arm, Dr. Peter De Cruz reported during a late-breaking abstract session at the annual Digestive Disease Week.

Researchers compared the two recurrence-prevention strategies in 174 subjects who were stratified as high risk or low risk based on smoking status, presence of perforating disease, and previous surgeries. The participants were randomized 2:1 to either active care or standard drug therapy. Approximately one-third of patients in the active care arm showed signs of early recurrence at a 6-month colonoscopy and thus received step-up treatment.

Complete mucosal normality was observed in 22% of those in the risk-based treatment arm, compared with 8% in the standard therapy arm; no significant differences were noted with respect to severe endoscopic recurrence or clinical recurrence, said Dr. De Cruz of St. Vincent’s Hospital, Melbourne, Australia.

Patients in the multicenter POCER study were adults undergoing intestinal resection of all macroscopic disease. The treatment arms were similar in terms of demographics, disease characteristics, and prior drug therapy. Of 122 patients in the risk-based treatment arm, 101 were high-risk, and 21 were low-risk. Of 52 patients in the standard drug therapy arm, 44 were high-risk, and 8 were low-risk.

All patients were treated beginning postoperatively with 3 months of 400 mg metronidazole twice daily. High-risk patients also received 2 mg/kg of azathioprine daily, or 1.5 mg/kg of 6 mercaptopurine. Those intolerant of thiopurine were treated with adalimumab induction, followed by 40 mg every 2 weeks. Low-risk patients received no additional treatment following the 3 months of metronidazole.

For recurrence at 6 months, low-risk patients were stepped up to thiopurine; high-risk patients on thiopurine were stepped up to 40 mg adalimumab every 2 weeks, and high-risk patients on adalimumab every 2 weeks stepped up to weekly adalimumab.

The endoscopic remission rate at 18 months was 25% for the low-risk patients who stepped up to thiopurine 41% for high-risk patients who stepped up to thiopurine, and 50% for those who stepped up to weekly adalimumab.

Overall, 39% of patients who stepped up at 6 months were in remission at 1 year. Notably, 31% of the low-risk patients with endoscopic remission at the 6-month colonoscopy, 46% of the high-risk patients on thiopurine, and 41% of the high-risk patients on adalimumab with endoscopic remission at 6 months had endoscopic recurrence 1 year later.

"We can’t afford to relax," Dr. De Cruz said regarding those patients with remission 6 months postoperatively.

This study also allowed for comparison of the efficacy of adalimumab and thiopurine given immediately postoperatively in the high-risk patients. At 6 months, adalimumab was associated with a nearly 80% endoscopic remission rate, compared with 55% for thiopurine, Dr. De Cruz noted.

At 18 months, there was no significant difference in the recurrence rates between patients treated with adalimumab immediately postoperatively and those stepped up to adalimumab in combination with thiopurine. There was, however, a trend toward reduced recurrence rates among those on immediate postoperative adalimumab.

A multivariate analysis showed that active smoking was significantly associated with an increased endoscopic recurrence rate at 18 months, whereas the intervention of endoscopy at 6 months was significantly associated with a reduced recurrence risk at 18 months.

Most prior studies of postoperative recurrence prevention in Crohn’s surgery patients have focused on drug therapy compared with placebo; few have focused on risk-based strategies, Dr. De Cruz noted.

The findings indicate that step-up therapy based on endoscopy is a viable postoperative strategy in patients at high risk of recurrence, he said. No unexpected serious adverse events occurred in this study.

Dr. De Cruz warned, however, that remission at 6 months is no guarantee of remission 1 year later.

"Intensifying treatment at 6 months brings about 40% of patients with recurrence into remission, and we found that a small group of patients had recurrent disease despite endoscopic monitoring and intense treatment," he said.

Dr. De Cruz reported having no disclosures. Several study coauthors disclosed relationships with multiple pharmaceutical companies.

ORLANDO – Risk-based drug treatment with colonoscopy at 6 months – and treatment step-up for recurrence – was significantly more effective in preventing postoperative recurrence of Crohn’s disease, compared with standard drug therapy alone, based on data from the POCER (Post-Operative Crohn’s Endoscopic Recurrence) study.

At an 18-month follow-up colonoscopy, 49% of patients randomized to a risk-based intervention had endoscopic recurrence, compared with 67% of those in a standard drug therapy arm, Dr. Peter De Cruz reported during a late-breaking abstract session at the annual Digestive Disease Week.

Researchers compared the two recurrence-prevention strategies in 174 subjects who were stratified as high risk or low risk based on smoking status, presence of perforating disease, and previous surgeries. The participants were randomized 2:1 to either active care or standard drug therapy. Approximately one-third of patients in the active care arm showed signs of early recurrence at a 6-month colonoscopy and thus received step-up treatment.

Complete mucosal normality was observed in 22% of those in the risk-based treatment arm, compared with 8% in the standard therapy arm; no significant differences were noted with respect to severe endoscopic recurrence or clinical recurrence, said Dr. De Cruz of St. Vincent’s Hospital, Melbourne, Australia.

Patients in the multicenter POCER study were adults undergoing intestinal resection of all macroscopic disease. The treatment arms were similar in terms of demographics, disease characteristics, and prior drug therapy. Of 122 patients in the risk-based treatment arm, 101 were high-risk, and 21 were low-risk. Of 52 patients in the standard drug therapy arm, 44 were high-risk, and 8 were low-risk.

All patients were treated beginning postoperatively with 3 months of 400 mg metronidazole twice daily. High-risk patients also received 2 mg/kg of azathioprine daily, or 1.5 mg/kg of 6 mercaptopurine. Those intolerant of thiopurine were treated with adalimumab induction, followed by 40 mg every 2 weeks. Low-risk patients received no additional treatment following the 3 months of metronidazole.

For recurrence at 6 months, low-risk patients were stepped up to thiopurine; high-risk patients on thiopurine were stepped up to 40 mg adalimumab every 2 weeks, and high-risk patients on adalimumab every 2 weeks stepped up to weekly adalimumab.

The endoscopic remission rate at 18 months was 25% for the low-risk patients who stepped up to thiopurine 41% for high-risk patients who stepped up to thiopurine, and 50% for those who stepped up to weekly adalimumab.

Overall, 39% of patients who stepped up at 6 months were in remission at 1 year. Notably, 31% of the low-risk patients with endoscopic remission at the 6-month colonoscopy, 46% of the high-risk patients on thiopurine, and 41% of the high-risk patients on adalimumab with endoscopic remission at 6 months had endoscopic recurrence 1 year later.

"We can’t afford to relax," Dr. De Cruz said regarding those patients with remission 6 months postoperatively.

This study also allowed for comparison of the efficacy of adalimumab and thiopurine given immediately postoperatively in the high-risk patients. At 6 months, adalimumab was associated with a nearly 80% endoscopic remission rate, compared with 55% for thiopurine, Dr. De Cruz noted.

At 18 months, there was no significant difference in the recurrence rates between patients treated with adalimumab immediately postoperatively and those stepped up to adalimumab in combination with thiopurine. There was, however, a trend toward reduced recurrence rates among those on immediate postoperative adalimumab.

A multivariate analysis showed that active smoking was significantly associated with an increased endoscopic recurrence rate at 18 months, whereas the intervention of endoscopy at 6 months was significantly associated with a reduced recurrence risk at 18 months.

Most prior studies of postoperative recurrence prevention in Crohn’s surgery patients have focused on drug therapy compared with placebo; few have focused on risk-based strategies, Dr. De Cruz noted.

The findings indicate that step-up therapy based on endoscopy is a viable postoperative strategy in patients at high risk of recurrence, he said. No unexpected serious adverse events occurred in this study.

Dr. De Cruz warned, however, that remission at 6 months is no guarantee of remission 1 year later.

"Intensifying treatment at 6 months brings about 40% of patients with recurrence into remission, and we found that a small group of patients had recurrent disease despite endoscopic monitoring and intense treatment," he said.

Dr. De Cruz reported having no disclosures. Several study coauthors disclosed relationships with multiple pharmaceutical companies.

MIAMI BEACH – American men are showing an increased interest in skin care products, according to Dr. Ivan Camacho.

Men are becoming more aware of the importance of skin care, and they are actively seeking information and products. In fact, the men’s skin care market increased 9% from 2009 to 2010, and is expected to grow 16% by 2014, Dr. Camacho said at the annual meeting of the American Academy of Dermatology.

One point for dermatologists to keep in mind when it comes to introducing men to a skin care routine is that simple is best. Using multipurpose products, keeping regimens to one or two steps – three at most – and incorporating new products into an established routine, such as shaving, will likely improve compliance and results, said Dr. Camacho of the University of Miami.

Dr. Camacho’s additional tips for better skin care for men include:

• Recommend multifunctional products, such as those that combine antioxidants and botanicals, as well as other cosmeceuticals that can enhance anti-aging, provide anti-inflammatory effects, and hydrate the skin.

• Suggest fragrance-free or subtly scented products.

• Incorporate a broad-spectrum sunscreen (also unscented or subtly scented) with a sun protection factor (SPF) of at least 30. A product with botanical and other cosmeceutical ingredients or with anti-inflammatory properties may be a good choice, especially in patients with inflammatory conditions like acne or rosacea.

• Incorporate a moisturizer, which is very important for restoring facial hydration and improving the skin barrier. A moisturizer can be included in the sunscreen or other products.

"Tell patients to moisturize, moisturize, moisturize," Dr. Camacho said, noting: "If you tell them they need to do it three times a day, they will probably do it once a day, because this is a practice very neglected by many men. As we know, moisturizers will benefit all skin types."

For men with oily skin, recommend an oil-absorbing or mattifying formulation; for those with drier skin, recommend a lipid-based formulation. Given that more men are seeking information about skin care, dermatologists would do well to become knowledgeable about the various products available that may be most appealing to and effective for men, said Dr. Camacho.

Products currently attracting attention include moisturizers with topical caffeine, which has been shown to reduce the transepidermal water loss that is greater in men than in women, he noted.

Also, glycerin-based and niacinamide-based moisturizers have been shown in several studies to reduce transepidermal water loss, which may increase after shaving, he said.

In addition, many men can benefit from cleansers and toners developed for their particular skin types, shaving products that prevent or relieve irritation, oil-absorbing primers to provide temporary relief for skin oiliness, and exfoliating products and retinoids to improve an uneven complexion, said Dr. Camacho.

In addition, antiaging formulations containing alpha-hydroxy acids, retinoids, growth factors, antioxidants, peptides, and/or botanicals can be used to help reverse ultraviolet-related damage and help improve the appearance of fine lines, he said.

Dr. Camacho reported having no disclosures.

MIAMI BEACH – American men are showing an increased interest in skin care products, according to Dr. Ivan Camacho.

Men are becoming more aware of the importance of skin care, and they are actively seeking information and products. In fact, the men’s skin care market increased 9% from 2009 to 2010, and is expected to grow 16% by 2014, Dr. Camacho said at the annual meeting of the American Academy of Dermatology.

One point for dermatologists to keep in mind when it comes to introducing men to a skin care routine is that simple is best. Using multipurpose products, keeping regimens to one or two steps – three at most – and incorporating new products into an established routine, such as shaving, will likely improve compliance and results, said Dr. Camacho of the University of Miami.

Dr. Camacho’s additional tips for better skin care for men include:

• Recommend multifunctional products, such as those that combine antioxidants and botanicals, as well as other cosmeceuticals that can enhance anti-aging, provide anti-inflammatory effects, and hydrate the skin.

• Suggest fragrance-free or subtly scented products.

• Incorporate a broad-spectrum sunscreen (also unscented or subtly scented) with a sun protection factor (SPF) of at least 30. A product with botanical and other cosmeceutical ingredients or with anti-inflammatory properties may be a good choice, especially in patients with inflammatory conditions like acne or rosacea.

• Incorporate a moisturizer, which is very important for restoring facial hydration and improving the skin barrier. A moisturizer can be included in the sunscreen or other products.

"Tell patients to moisturize, moisturize, moisturize," Dr. Camacho said, noting: "If you tell them they need to do it three times a day, they will probably do it once a day, because this is a practice very neglected by many men. As we know, moisturizers will benefit all skin types."

For men with oily skin, recommend an oil-absorbing or mattifying formulation; for those with drier skin, recommend a lipid-based formulation. Given that more men are seeking information about skin care, dermatologists would do well to become knowledgeable about the various products available that may be most appealing to and effective for men, said Dr. Camacho.

Products currently attracting attention include moisturizers with topical caffeine, which has been shown to reduce the transepidermal water loss that is greater in men than in women, he noted.

Also, glycerin-based and niacinamide-based moisturizers have been shown in several studies to reduce transepidermal water loss, which may increase after shaving, he said.

In addition, many men can benefit from cleansers and toners developed for their particular skin types, shaving products that prevent or relieve irritation, oil-absorbing primers to provide temporary relief for skin oiliness, and exfoliating products and retinoids to improve an uneven complexion, said Dr. Camacho.

In addition, antiaging formulations containing alpha-hydroxy acids, retinoids, growth factors, antioxidants, peptides, and/or botanicals can be used to help reverse ultraviolet-related damage and help improve the appearance of fine lines, he said.

Dr. Camacho reported having no disclosures.

MIAMI BEACH – American men are showing an increased interest in skin care products, according to Dr. Ivan Camacho.

Men are becoming more aware of the importance of skin care, and they are actively seeking information and products. In fact, the men’s skin care market increased 9% from 2009 to 2010, and is expected to grow 16% by 2014, Dr. Camacho said at the annual meeting of the American Academy of Dermatology.

One point for dermatologists to keep in mind when it comes to introducing men to a skin care routine is that simple is best. Using multipurpose products, keeping regimens to one or two steps – three at most – and incorporating new products into an established routine, such as shaving, will likely improve compliance and results, said Dr. Camacho of the University of Miami.

Dr. Camacho’s additional tips for better skin care for men include:

• Recommend multifunctional products, such as those that combine antioxidants and botanicals, as well as other cosmeceuticals that can enhance anti-aging, provide anti-inflammatory effects, and hydrate the skin.

• Suggest fragrance-free or subtly scented products.

• Incorporate a broad-spectrum sunscreen (also unscented or subtly scented) with a sun protection factor (SPF) of at least 30. A product with botanical and other cosmeceutical ingredients or with anti-inflammatory properties may be a good choice, especially in patients with inflammatory conditions like acne or rosacea.

• Incorporate a moisturizer, which is very important for restoring facial hydration and improving the skin barrier. A moisturizer can be included in the sunscreen or other products.

"Tell patients to moisturize, moisturize, moisturize," Dr. Camacho said, noting: "If you tell them they need to do it three times a day, they will probably do it once a day, because this is a practice very neglected by many men. As we know, moisturizers will benefit all skin types."

For men with oily skin, recommend an oil-absorbing or mattifying formulation; for those with drier skin, recommend a lipid-based formulation. Given that more men are seeking information about skin care, dermatologists would do well to become knowledgeable about the various products available that may be most appealing to and effective for men, said Dr. Camacho.

Products currently attracting attention include moisturizers with topical caffeine, which has been shown to reduce the transepidermal water loss that is greater in men than in women, he noted.

Also, glycerin-based and niacinamide-based moisturizers have been shown in several studies to reduce transepidermal water loss, which may increase after shaving, he said.

In addition, many men can benefit from cleansers and toners developed for their particular skin types, shaving products that prevent or relieve irritation, oil-absorbing primers to provide temporary relief for skin oiliness, and exfoliating products and retinoids to improve an uneven complexion, said Dr. Camacho.

In addition, antiaging formulations containing alpha-hydroxy acids, retinoids, growth factors, antioxidants, peptides, and/or botanicals can be used to help reverse ultraviolet-related damage and help improve the appearance of fine lines, he said.

Dr. Camacho reported having no disclosures.

ORLANDO – Cold snare polypectomy is clearly superior to double biopsy cold forceps polypectomy for the complete removal of small colorectal polyps, according to findings from a single-center, prospective, randomized controlled study involving 54 patients.

The rates of both visual polyp eradication and complete histologic eradication were significantly higher in patients randomized to the cold snare polypectomy (CSP) group than in those randomized to the cold forceps polypectomy (CFP) group (91.5% vs. 78.3%, and 93.2% vs. 75.9%, respectively), Dr. Chang Kyun Lee reported at the annual Digestive Disease Week.

Additional analysis in the CFP group showed a histologic eradication rate of 92% for 1- to 3-mm polyps, and 50% for 4- to 5-mm polyps.

On logistic regression analysis, CFP and polyp size of 4 mm or larger were associated with incomplete polyp eradication (odds ratios 4.75 and 4.38, respectively), whereas lesion location and histologic diagnosis were not, said Dr. Lee of Kyung Hee University, Seoul, Republic of Korea.

The 54 study subjects were adults (mean age, 53.7 years) and a total of 115 1- to 5-mm polyps. Most polyps (88%) were 0-IIa type, and most (70.1%) were tubular adenomas. The mean polyp size was 3.66 mm.

The treatment groups did not differ significantly with respect to sex, age, indication for colonoscopy, or procedure time, and no differences were noted in the size, location, and diagnosis of polyps.

Only one polyp with advanced histologic features was identified. The 5-mm lesion – a tubular adenoma – was located in the proximal colon and was removed completely via CFP.

CSP was performed using a minisnare, and CFP was performed using standard large-capacity forceps and a double biopsy technique (two "bites" per forceps pass). Polyp removal time was significantly shorter with CSP than with CFP (14.29 vs. 22.03 seconds), though this difference was not clinically meaningful. The rate of successful retrieval of polypectomy samples was lower in the CSP group (93.2% vs. 100% for CFP), Dr. Lee noted.

While cold techniques are widely used in clinical practice, few studies have directly compared outcomes with different techniques. These findings indicate that choice of technique is clinically important to the endoscopic removal of diminutive polyps, he said.

"Based on the findings, we recommend that cold snaring be considered as the primary method for endoscopic treatment of polyps in the 4- to 5-mm size range. However, given the incomplete polypectomy rate in this study – about 15% – further technical refinements and instrumental innovations are required for future studies," Dr. Lee concluded.

Dr. Lee reported having no disclosures.

ORLANDO – Cold snare polypectomy is clearly superior to double biopsy cold forceps polypectomy for the complete removal of small colorectal polyps, according to findings from a single-center, prospective, randomized controlled study involving 54 patients.

The rates of both visual polyp eradication and complete histologic eradication were significantly higher in patients randomized to the cold snare polypectomy (CSP) group than in those randomized to the cold forceps polypectomy (CFP) group (91.5% vs. 78.3%, and 93.2% vs. 75.9%, respectively), Dr. Chang Kyun Lee reported at the annual Digestive Disease Week.

Additional analysis in the CFP group showed a histologic eradication rate of 92% for 1- to 3-mm polyps, and 50% for 4- to 5-mm polyps.

On logistic regression analysis, CFP and polyp size of 4 mm or larger were associated with incomplete polyp eradication (odds ratios 4.75 and 4.38, respectively), whereas lesion location and histologic diagnosis were not, said Dr. Lee of Kyung Hee University, Seoul, Republic of Korea.

The 54 study subjects were adults (mean age, 53.7 years) and a total of 115 1- to 5-mm polyps. Most polyps (88%) were 0-IIa type, and most (70.1%) were tubular adenomas. The mean polyp size was 3.66 mm.

The treatment groups did not differ significantly with respect to sex, age, indication for colonoscopy, or procedure time, and no differences were noted in the size, location, and diagnosis of polyps.

Only one polyp with advanced histologic features was identified. The 5-mm lesion – a tubular adenoma – was located in the proximal colon and was removed completely via CFP.

CSP was performed using a minisnare, and CFP was performed using standard large-capacity forceps and a double biopsy technique (two "bites" per forceps pass). Polyp removal time was significantly shorter with CSP than with CFP (14.29 vs. 22.03 seconds), though this difference was not clinically meaningful. The rate of successful retrieval of polypectomy samples was lower in the CSP group (93.2% vs. 100% for CFP), Dr. Lee noted.

While cold techniques are widely used in clinical practice, few studies have directly compared outcomes with different techniques. These findings indicate that choice of technique is clinically important to the endoscopic removal of diminutive polyps, he said.

"Based on the findings, we recommend that cold snaring be considered as the primary method for endoscopic treatment of polyps in the 4- to 5-mm size range. However, given the incomplete polypectomy rate in this study – about 15% – further technical refinements and instrumental innovations are required for future studies," Dr. Lee concluded.

Dr. Lee reported having no disclosures.

ORLANDO – Cold snare polypectomy is clearly superior to double biopsy cold forceps polypectomy for the complete removal of small colorectal polyps, according to findings from a single-center, prospective, randomized controlled study involving 54 patients.

The rates of both visual polyp eradication and complete histologic eradication were significantly higher in patients randomized to the cold snare polypectomy (CSP) group than in those randomized to the cold forceps polypectomy (CFP) group (91.5% vs. 78.3%, and 93.2% vs. 75.9%, respectively), Dr. Chang Kyun Lee reported at the annual Digestive Disease Week.

Additional analysis in the CFP group showed a histologic eradication rate of 92% for 1- to 3-mm polyps, and 50% for 4- to 5-mm polyps.

On logistic regression analysis, CFP and polyp size of 4 mm or larger were associated with incomplete polyp eradication (odds ratios 4.75 and 4.38, respectively), whereas lesion location and histologic diagnosis were not, said Dr. Lee of Kyung Hee University, Seoul, Republic of Korea.

The 54 study subjects were adults (mean age, 53.7 years) and a total of 115 1- to 5-mm polyps. Most polyps (88%) were 0-IIa type, and most (70.1%) were tubular adenomas. The mean polyp size was 3.66 mm.

The treatment groups did not differ significantly with respect to sex, age, indication for colonoscopy, or procedure time, and no differences were noted in the size, location, and diagnosis of polyps.

Only one polyp with advanced histologic features was identified. The 5-mm lesion – a tubular adenoma – was located in the proximal colon and was removed completely via CFP.

CSP was performed using a minisnare, and CFP was performed using standard large-capacity forceps and a double biopsy technique (two "bites" per forceps pass). Polyp removal time was significantly shorter with CSP than with CFP (14.29 vs. 22.03 seconds), though this difference was not clinically meaningful. The rate of successful retrieval of polypectomy samples was lower in the CSP group (93.2% vs. 100% for CFP), Dr. Lee noted.

While cold techniques are widely used in clinical practice, few studies have directly compared outcomes with different techniques. These findings indicate that choice of technique is clinically important to the endoscopic removal of diminutive polyps, he said.

"Based on the findings, we recommend that cold snaring be considered as the primary method for endoscopic treatment of polyps in the 4- to 5-mm size range. However, given the incomplete polypectomy rate in this study – about 15% – further technical refinements and instrumental innovations are required for future studies," Dr. Lee concluded.

Dr. Lee reported having no disclosures.