Oklahoma University Health Sciences Center Oklahoma City, OK, United States
Kosirog Justin, MD1, Mahum Nadeem, MD1, Alyssa Grossen, MD2, Bryce Yohannan, MD2, Nimrah Bader, MD3, Ijlal Akbar Ali, MD4, Mohammad Madhoun, MD, MS4 1Oklahoma University Health Sciences Center, Oklahoma City, OK; 2University of Oklahoma Health Sciences Center, Oklahoma City, OK; 3Oklahoma University Health Sciences Center, Oklahoma city, OK; 4Oklahoma City VA Medical Center, Oklahoma City, OK
Introduction: One in five adults in the world smoke tobacco. The association of smoking and adenoma detection rate has been well established in the literature. Early detection of adenoma can lead to early diagnosis of colorectal carcinoma (CRC) and can affect cancer-related death rate. There are few tools that one can use on physical exam to risk stratify patients at high risk for colorectal cancer. Through this study we aim to identify a physical exam finding that can guide clinicians to risk stratify their patients.
Methods: A prospective study of 975 patients undergoing colonoscopy at the Veterans Affairs Medical Center (VAMC) in Oklahoma City, Oklahoma from 2019-2020. Patient demographics, comorbidities, medications, bowel preparation score, and results of colonoscopy were extracted from the medical record. Patients completed a pre-endoscopy questionnaire asking about smoking history and tobacco usage and endoscopists completed a post-procedure questionnaire that identified any nicotine staining involving their mouth, hands, or teeth. Chi square test was used to compare variables among the three groups. A P-value < 0.05 was considered statistically significant.
Results: Patients with nicotine staining were older (63.3±8.8, P= 0.03), Caucasian (84.9%, p= 0.01) had lower BMI (27.7 + 5.0, P < 0.0001) and increased incidence of cirrhosis (7.5 %, P=0.001), COPD (32.3%, P < 0.0001), and alcohol abuse (30.1%, P < 0.001) when compared to nonsmokers and smokers without nicotine staining. Analysis showed that patients with nicotine staining had a higher adenoma detection rate (ADR) (70.9%, P= 0.04) and advanced ADR (16.1%, P=0.008) and more likely to have ≥3 adenomas (43.1%, P=0.0007) and ≥5 adenomas (24.7%, P=0.002) (TABLE 1). Patient with nicotine staining showed a trend towards increased risk of colon carcinoma (4.4%) as compared to smokers that did not have stains (1%) and nonsmokers (1.8%), however this was no statistically significant (P=0.14).
Discussion: Our study shows higher risks of multiple adenomas and advanced adenoma among patients with nicotine staining on physical examination. We propose that this physical exam finding can be used as a guide for physicians to risk stratify their patients to pursue screening colonoscopies as opposed to non-invasive CRC screening methods.
No reported history of smoking (n=687)
Reported history of smoking but no nicotine staining (n=195)
Presence of nicotine staining (n=93)
P value
Age, mean ± SD
60.8±12.5
59.2 ± 10.7
63.2± 8.8
0.03
Female Sex, n (%)
82/687 (11.9)
23/195 (11.8)
8/93 (8.6)
0.64
White race, n (%)
500/687 (72.8)
126/195 (64.6)
79/93 (84.9)
0.01
BMI, mean ± SD
31.8±6.2
29.3 ±6.4
27.7 ± 5.0
< 0.0001
Cirrhosis, n (%)
12/687(1.7)
10/195 (5.1)
7/93 (7.5)
0.001
Constipation, n (%)
85/687 (12.4)
24/195 (12.3)
8/92 (8.7)
0.59
Hypothyroidism, n (%)
80/687 (11.6)
22/195 (11.3)
10/93 (10.8)
0.96
COPD, n (%)
73/687 (10.6)
33/195 (16.9)
30/93 (32.3)
< 0.0001
HTN, n (%)
451/687 (65.7)
117/195 (60)
63/93 (67.7)
0.27
CAD, n (%)
100/687 (14.6)
25/195 (12.8)
11/93 (11.8)
0.68
Alcohol abuse, n (%)
74/687 (10.8)
44/195 (22.6)
28/93 (30.1)
< 0.0001
Narcotics, n (%)
56/687 (8.2)
16/195 (8.2)
6/93 (6.5)
0.71
ADR, n (%)
395/687 (57.5)
117/195 (60)
66/93 (70.9)
0.04
≥3 adenomas, n (%)
187/687 (27.2)
73/195 (37.4)
40/93 (43.1)
0.0007
≥5 adenomas, n (%)
88/687 (12.8)
38/195 (19.5)
23/93 (24.7)
0.002
≥10 adenomas, n (%)
24/687 (2.5)
13/196 (6.7)
7/93 (7.5)
0.06
Advanced ADR, n (%)
49/687 (7.1)
21/195 (10.8)
15/93 (16.1)
0.008
SSP detection rate, n (%)
67/687 (9.8)
25/195 (12.8)
11/93 (11.8)
0.43
Hyperplastic detection rate, n (%)
174/687 (25.3)
79/195 (40.5)
30/93 (32.3)
0.0002
Colon cancer, n (%)
12/686 (1.8)
2/193 (1.0)
4/91 (4.4)
0.14
Adenoma, mean ± SD
2.0±3.4
2.7±4.0
3.4±4.7
< 0.0006
Table: Table 1
Disclosures:
Kosirog Justin indicated no relevant financial relationships.
Mahum Nadeem indicated no relevant financial relationships.
Alyssa Grossen indicated no relevant financial relationships.
Bryce Yohannan indicated no relevant financial relationships.
Nimrah Bader indicated no relevant financial relationships.
Ijlal Akbar Ali indicated no relevant financial relationships.
Mohammad Madhoun indicated no relevant financial relationships.
Kosirog Justin, MD1, Mahum Nadeem, MD1, Alyssa Grossen, MD2, Bryce Yohannan, MD2, Nimrah Bader, MD3, Ijlal Akbar Ali, MD4, Mohammad Madhoun, MD, MS4. P2350 - Screen for Nicotine, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
