Michele G. Sullivan

NEW ORLEANS — A combination of ultrasound and alpha-fetoprotein testing identified almost all hepatocellular carcinomas in patients with cirrhosis associated primarily with chronic hepatitis C, according to the findings of a retrospective study.

At an alpha-fetoprotein cutoff level of greater than 20 ng/mL, the combination has 100% specificity and 87% sensitivity, making it an accurate and cost-effective screening method for these patients, Dr. Roger Soloway said at the annual Digestive Disease Week.

Because patients with cirrhosis are at significantly increased risk of developing hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases recommends that they have liver cancer screening every 6–12 months.

Although Dr. Soloway noted that CT and MRI are the “gold standard” in identifying HCC, they are too expensive to employ as a first-line method on a frequent basis.

He and his colleagues examined the medical records of 140 patients with cirrhosis who were screened for HCC with an initial ultrasound liver scan and alpha-fetoprotein (AFP) test, and then had a follow-up CT or MRI within 6 months.

There were 35 cases of HCC in the group. Ultrasound alone detected HCC in 26, for a sensitivity of 77% and a specificity of 99%. There were eight false negatives and one false positive.

In the eight false-negative cases, a subsequent CT scan identified HCC. The mean AFP level in this group of patients was 32,325 ng/mL; only two patients had a level lower than 20 ng/mL.

In the 75 patients with a true negative ultrasound, the mean AFP level was 17 ng/mL.

In all, 9% of the patients in this group had an AFP greater than 20 ng/mL, and one patient had a level of more than 400 ng/mL.

“In this series alone, 74 CT or MRI studies could have been avoided with the combined use of ultrasound and AFP for screening,” said Dr. Soloway, the Marie B. Gale Centennial Professor of Medicine at the University of Texas Medical Branch, Galveston. “Ultrasound can eliminate more expensive imaging studies until confirmation is necessary, thus reducing the overall cost of medical monitoring for patients in HCC screening populations.”

Dr. Jason B. Welch, also of the University of Texas Medical Branch at Galveston, was a coinvestigator on the study.

Disclosures: None of the researchers reported having relevant financial disclosures.

NEW ORLEANS — A combination of ultrasound and alpha-fetoprotein testing identified almost all hepatocellular carcinomas in patients with cirrhosis associated primarily with chronic hepatitis C, according to the findings of a retrospective study.

At an alpha-fetoprotein cutoff level of greater than 20 ng/mL, the combination has 100% specificity and 87% sensitivity, making it an accurate and cost-effective screening method for these patients, Dr. Roger Soloway said at the annual Digestive Disease Week.

Because patients with cirrhosis are at significantly increased risk of developing hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases recommends that they have liver cancer screening every 6–12 months.

Although Dr. Soloway noted that CT and MRI are the “gold standard” in identifying HCC, they are too expensive to employ as a first-line method on a frequent basis.

He and his colleagues examined the medical records of 140 patients with cirrhosis who were screened for HCC with an initial ultrasound liver scan and alpha-fetoprotein (AFP) test, and then had a follow-up CT or MRI within 6 months.

There were 35 cases of HCC in the group. Ultrasound alone detected HCC in 26, for a sensitivity of 77% and a specificity of 99%. There were eight false negatives and one false positive.

In the eight false-negative cases, a subsequent CT scan identified HCC. The mean AFP level in this group of patients was 32,325 ng/mL; only two patients had a level lower than 20 ng/mL.

In the 75 patients with a true negative ultrasound, the mean AFP level was 17 ng/mL.

In all, 9% of the patients in this group had an AFP greater than 20 ng/mL, and one patient had a level of more than 400 ng/mL.

“In this series alone, 74 CT or MRI studies could have been avoided with the combined use of ultrasound and AFP for screening,” said Dr. Soloway, the Marie B. Gale Centennial Professor of Medicine at the University of Texas Medical Branch, Galveston. “Ultrasound can eliminate more expensive imaging studies until confirmation is necessary, thus reducing the overall cost of medical monitoring for patients in HCC screening populations.”

Dr. Jason B. Welch, also of the University of Texas Medical Branch at Galveston, was a coinvestigator on the study.

Disclosures: None of the researchers reported having relevant financial disclosures.

NEW ORLEANS — A combination of ultrasound and alpha-fetoprotein testing identified almost all hepatocellular carcinomas in patients with cirrhosis associated primarily with chronic hepatitis C, according to the findings of a retrospective study.

At an alpha-fetoprotein cutoff level of greater than 20 ng/mL, the combination has 100% specificity and 87% sensitivity, making it an accurate and cost-effective screening method for these patients, Dr. Roger Soloway said at the annual Digestive Disease Week.

Because patients with cirrhosis are at significantly increased risk of developing hepatocellular carcinoma (HCC), the American Association for the Study of Liver Diseases recommends that they have liver cancer screening every 6–12 months.

Although Dr. Soloway noted that CT and MRI are the “gold standard” in identifying HCC, they are too expensive to employ as a first-line method on a frequent basis.

He and his colleagues examined the medical records of 140 patients with cirrhosis who were screened for HCC with an initial ultrasound liver scan and alpha-fetoprotein (AFP) test, and then had a follow-up CT or MRI within 6 months.

There were 35 cases of HCC in the group. Ultrasound alone detected HCC in 26, for a sensitivity of 77% and a specificity of 99%. There were eight false negatives and one false positive.

In the eight false-negative cases, a subsequent CT scan identified HCC. The mean AFP level in this group of patients was 32,325 ng/mL; only two patients had a level lower than 20 ng/mL.

In the 75 patients with a true negative ultrasound, the mean AFP level was 17 ng/mL.

In all, 9% of the patients in this group had an AFP greater than 20 ng/mL, and one patient had a level of more than 400 ng/mL.

“In this series alone, 74 CT or MRI studies could have been avoided with the combined use of ultrasound and AFP for screening,” said Dr. Soloway, the Marie B. Gale Centennial Professor of Medicine at the University of Texas Medical Branch, Galveston. “Ultrasound can eliminate more expensive imaging studies until confirmation is necessary, thus reducing the overall cost of medical monitoring for patients in HCC screening populations.”

Dr. Jason B. Welch, also of the University of Texas Medical Branch at Galveston, was a coinvestigator on the study.

Disclosures: None of the researchers reported having relevant financial disclosures.

NATIONAL HARBOR, MD. — Gastric bypass surgery that corrects hypertension and diabetes can save thousands of dollars in medication costs over a lifetime, according to a retrospective study of more than 100 patients.

Even patients whose diseases improve but do not remit after surgery will see a significant cost benefit in their medications, Dr. Saber Ghiassi said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

He identified the savings in a population of Veterans Affairs patients, who have access to very inexpensive medications. Savings would be much greater in the general population, where drug costs are not controlled, he noted.

Dr. Ghiassi, a postdoctoral surgical fellow at Stanford (Calif.) University, reviewed the charts of 106 patients who underwent Roux-en-Y gastric bypass at the Palo Alto Veterans Affairs Medical Center from 2001 to 2007.

Dr. Ghiassi and his coinvestigators, Dr. John Morton and Dr. Dan Eisenberg (also of Stanford University), observed medication costs at 1 year after surgery, and compared them with presurgical medication costs. They calculated lifetime cost savings based on the Centers for Disease Control and Prevention life charts, with adjustments from the Framingham Heart Study survival statistics.

The patients were mostly men (77%). Their mean age was 52 years, and mean body mass index was 47 kg/m

At 1 year post surgery, the patients had lost a mean of 69% of their excess body weight. Hypertension had resolved in 44% and diabetes in 80%.

The projected lifetime cost of antihypertensive medication was $1,039 before surgery. For those whose hypertension resolved, that cost dropped significantly to $286. Savings were also evident in patients whose hypertension improved but did not resolve. Before surgery, the projected lifetime medication cost was $1,349. This decreased to $513.

There were no significant differences in age, BMI, or weight loss between these two groups of patients. However, patients who saw a resolution of hypertension lost significantly more excess body weight than those who saw only an improvement in hypertension (76% vs. 62%).

The projected lifetime cost of diabetes medication was $10,505. For those whose diabetes resolved completely, the projected lifetime cost decreased significantly, to $1,139. Savings were even greater in patients whose diabetes improved but did not resolve. For those patients, the projected lifetime cost of diabetes medication before surgery was $22,427. That dropped to $5,697 after surgery.

Several discussants commented on the study. Dr. Edward Felix, director of the Advanced Bariatric Center, Fresno, Calif., pointed out that the lifetime medication costs in the study “are far less than what we would see in just 1 year” of treating hypertension and diabetes in an obese population.

Dr. Phillip Schauer, a bariatric surgeon at the Cleveland Clinic, suggested that similar cost savings might be evident in other disorders comorbid with obesity. “These medication savings vastly underestimate the true cost savings of bariatric surgery,” he said. “You didn't look at other issues, like sleep apnea and dyslipidemia, which are also very costly. And the biggest cost savings is probably the reduction in complications of ineffectively treated diseases, like dialysis, coronary bypass surgery, and hip surgery.

“It's quite puzzling that, despite this overall evidence of cost benefit, most insurance carriers still don't cover bariatric surgery,” Dr. Schauer commented.

Disclosures: None of the investigators had any potential financial conflicts of interest.

NATIONAL HARBOR, MD. — Gastric bypass surgery that corrects hypertension and diabetes can save thousands of dollars in medication costs over a lifetime, according to a retrospective study of more than 100 patients.

Even patients whose diseases improve but do not remit after surgery will see a significant cost benefit in their medications, Dr. Saber Ghiassi said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

He identified the savings in a population of Veterans Affairs patients, who have access to very inexpensive medications. Savings would be much greater in the general population, where drug costs are not controlled, he noted.

Dr. Ghiassi, a postdoctoral surgical fellow at Stanford (Calif.) University, reviewed the charts of 106 patients who underwent Roux-en-Y gastric bypass at the Palo Alto Veterans Affairs Medical Center from 2001 to 2007.

Dr. Ghiassi and his coinvestigators, Dr. John Morton and Dr. Dan Eisenberg (also of Stanford University), observed medication costs at 1 year after surgery, and compared them with presurgical medication costs. They calculated lifetime cost savings based on the Centers for Disease Control and Prevention life charts, with adjustments from the Framingham Heart Study survival statistics.

The patients were mostly men (77%). Their mean age was 52 years, and mean body mass index was 47 kg/m

At 1 year post surgery, the patients had lost a mean of 69% of their excess body weight. Hypertension had resolved in 44% and diabetes in 80%.

The projected lifetime cost of antihypertensive medication was $1,039 before surgery. For those whose hypertension resolved, that cost dropped significantly to $286. Savings were also evident in patients whose hypertension improved but did not resolve. Before surgery, the projected lifetime medication cost was $1,349. This decreased to $513.

There were no significant differences in age, BMI, or weight loss between these two groups of patients. However, patients who saw a resolution of hypertension lost significantly more excess body weight than those who saw only an improvement in hypertension (76% vs. 62%).

The projected lifetime cost of diabetes medication was $10,505. For those whose diabetes resolved completely, the projected lifetime cost decreased significantly, to $1,139. Savings were even greater in patients whose diabetes improved but did not resolve. For those patients, the projected lifetime cost of diabetes medication before surgery was $22,427. That dropped to $5,697 after surgery.

Several discussants commented on the study. Dr. Edward Felix, director of the Advanced Bariatric Center, Fresno, Calif., pointed out that the lifetime medication costs in the study “are far less than what we would see in just 1 year” of treating hypertension and diabetes in an obese population.

Dr. Phillip Schauer, a bariatric surgeon at the Cleveland Clinic, suggested that similar cost savings might be evident in other disorders comorbid with obesity. “These medication savings vastly underestimate the true cost savings of bariatric surgery,” he said. “You didn't look at other issues, like sleep apnea and dyslipidemia, which are also very costly. And the biggest cost savings is probably the reduction in complications of ineffectively treated diseases, like dialysis, coronary bypass surgery, and hip surgery.

“It's quite puzzling that, despite this overall evidence of cost benefit, most insurance carriers still don't cover bariatric surgery,” Dr. Schauer commented.

Disclosures: None of the investigators had any potential financial conflicts of interest.

NATIONAL HARBOR, MD. — Gastric bypass surgery that corrects hypertension and diabetes can save thousands of dollars in medication costs over a lifetime, according to a retrospective study of more than 100 patients.

Even patients whose diseases improve but do not remit after surgery will see a significant cost benefit in their medications, Dr. Saber Ghiassi said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

He identified the savings in a population of Veterans Affairs patients, who have access to very inexpensive medications. Savings would be much greater in the general population, where drug costs are not controlled, he noted.

Dr. Ghiassi, a postdoctoral surgical fellow at Stanford (Calif.) University, reviewed the charts of 106 patients who underwent Roux-en-Y gastric bypass at the Palo Alto Veterans Affairs Medical Center from 2001 to 2007.

Dr. Ghiassi and his coinvestigators, Dr. John Morton and Dr. Dan Eisenberg (also of Stanford University), observed medication costs at 1 year after surgery, and compared them with presurgical medication costs. They calculated lifetime cost savings based on the Centers for Disease Control and Prevention life charts, with adjustments from the Framingham Heart Study survival statistics.

The patients were mostly men (77%). Their mean age was 52 years, and mean body mass index was 47 kg/m

At 1 year post surgery, the patients had lost a mean of 69% of their excess body weight. Hypertension had resolved in 44% and diabetes in 80%.

The projected lifetime cost of antihypertensive medication was $1,039 before surgery. For those whose hypertension resolved, that cost dropped significantly to $286. Savings were also evident in patients whose hypertension improved but did not resolve. Before surgery, the projected lifetime medication cost was $1,349. This decreased to $513.

There were no significant differences in age, BMI, or weight loss between these two groups of patients. However, patients who saw a resolution of hypertension lost significantly more excess body weight than those who saw only an improvement in hypertension (76% vs. 62%).

The projected lifetime cost of diabetes medication was $10,505. For those whose diabetes resolved completely, the projected lifetime cost decreased significantly, to $1,139. Savings were even greater in patients whose diabetes improved but did not resolve. For those patients, the projected lifetime cost of diabetes medication before surgery was $22,427. That dropped to $5,697 after surgery.

Several discussants commented on the study. Dr. Edward Felix, director of the Advanced Bariatric Center, Fresno, Calif., pointed out that the lifetime medication costs in the study “are far less than what we would see in just 1 year” of treating hypertension and diabetes in an obese population.

Dr. Phillip Schauer, a bariatric surgeon at the Cleveland Clinic, suggested that similar cost savings might be evident in other disorders comorbid with obesity. “These medication savings vastly underestimate the true cost savings of bariatric surgery,” he said. “You didn't look at other issues, like sleep apnea and dyslipidemia, which are also very costly. And the biggest cost savings is probably the reduction in complications of ineffectively treated diseases, like dialysis, coronary bypass surgery, and hip surgery.

“It's quite puzzling that, despite this overall evidence of cost benefit, most insurance carriers still don't cover bariatric surgery,” Dr. Schauer commented.

Disclosures: None of the investigators had any potential financial conflicts of interest.

NEW ORLEANS — Adults who have been overweight since early adulthood are nearly twice as likely to have colon adenomas as those with a history of normal weight.

The findings reinforce the benefit of maintaining a healthy weight throughout life, Dr. Fritz Francois of New York University said in a written statement.

“Our conclusions suggest that the chronicity of obesity is a significant risk factor for developing colon cancer. Given the continued rise in early-onset obesity, especially in minority populations, there is a need for interventions and lifestyle modifications earlier in life.”

The researchers conducted a prospective study of 1,865 patients referred for a screening colonoscopy, said Ian Fagan, a fourth-year medical student who presented the findings at the meeting. Their mean age was 57 years. Body mass index (BMI) was normal in 38%, whereas 39% were overweight and 23% were obese. A total of 12% were current smokers.

The patients provided information allowing the researchers to estimate their BMI and waist circumference at age 10 and age 20. The investigators compared the past weights to the finding of any adenoma, including advanced neoplasia, during the colonoscopy.

The subjects were divided into three groups: those who had normal weights at age 20 and at present, those who had a normal weight at 20 and were now overweight or obese, and those who had been overweight or obese since age 20.

“Race and ethnicity had a significant impact on weight change,” Mr. Fagan said. Sixty-one percent of Hispanics fell into the group that changed from normal weight to overweight or obese, as well as 50% of blacks, 46% of whites, and 7% of Asians.

Adenomas were significantly more common among patients who had been overweight or obese since age 10 (at a rate of 27%) and among those who went from normal weight to overweight (19%), compared with those who had maintained a normal weight (13%).

After controlling for age, gender, current BMI, U.S. birth, and red meat consumption, the investigators found that becoming overweight or obese in early adulthood almost doubled the risk of an adenoma on screening colonoscopy (odds ratio 1.8). Mr. Fagan did not present a risk analysis for subjects who had been overweight since childhood, saying that the number of subjects in that group was not sufficient.

Disclosures: Neither Mr. Fagan nor Dr. Francois had financial conflicts.

Adenomas were significantly more common among patients who had been overweight or obese since age 10.

Source: Ian Fagan

NEW ORLEANS — Adults who have been overweight since early adulthood are nearly twice as likely to have colon adenomas as those with a history of normal weight.

The findings reinforce the benefit of maintaining a healthy weight throughout life, Dr. Fritz Francois of New York University said in a written statement.

“Our conclusions suggest that the chronicity of obesity is a significant risk factor for developing colon cancer. Given the continued rise in early-onset obesity, especially in minority populations, there is a need for interventions and lifestyle modifications earlier in life.”

The researchers conducted a prospective study of 1,865 patients referred for a screening colonoscopy, said Ian Fagan, a fourth-year medical student who presented the findings at the meeting. Their mean age was 57 years. Body mass index (BMI) was normal in 38%, whereas 39% were overweight and 23% were obese. A total of 12% were current smokers.

The patients provided information allowing the researchers to estimate their BMI and waist circumference at age 10 and age 20. The investigators compared the past weights to the finding of any adenoma, including advanced neoplasia, during the colonoscopy.

The subjects were divided into three groups: those who had normal weights at age 20 and at present, those who had a normal weight at 20 and were now overweight or obese, and those who had been overweight or obese since age 20.

“Race and ethnicity had a significant impact on weight change,” Mr. Fagan said. Sixty-one percent of Hispanics fell into the group that changed from normal weight to overweight or obese, as well as 50% of blacks, 46% of whites, and 7% of Asians.

Adenomas were significantly more common among patients who had been overweight or obese since age 10 (at a rate of 27%) and among those who went from normal weight to overweight (19%), compared with those who had maintained a normal weight (13%).

After controlling for age, gender, current BMI, U.S. birth, and red meat consumption, the investigators found that becoming overweight or obese in early adulthood almost doubled the risk of an adenoma on screening colonoscopy (odds ratio 1.8). Mr. Fagan did not present a risk analysis for subjects who had been overweight since childhood, saying that the number of subjects in that group was not sufficient.

Disclosures: Neither Mr. Fagan nor Dr. Francois had financial conflicts.

Adenomas were significantly more common among patients who had been overweight or obese since age 10.

Source: Ian Fagan

NEW ORLEANS — Adults who have been overweight since early adulthood are nearly twice as likely to have colon adenomas as those with a history of normal weight.

The findings reinforce the benefit of maintaining a healthy weight throughout life, Dr. Fritz Francois of New York University said in a written statement.

“Our conclusions suggest that the chronicity of obesity is a significant risk factor for developing colon cancer. Given the continued rise in early-onset obesity, especially in minority populations, there is a need for interventions and lifestyle modifications earlier in life.”

The researchers conducted a prospective study of 1,865 patients referred for a screening colonoscopy, said Ian Fagan, a fourth-year medical student who presented the findings at the meeting. Their mean age was 57 years. Body mass index (BMI) was normal in 38%, whereas 39% were overweight and 23% were obese. A total of 12% were current smokers.

The patients provided information allowing the researchers to estimate their BMI and waist circumference at age 10 and age 20. The investigators compared the past weights to the finding of any adenoma, including advanced neoplasia, during the colonoscopy.

The subjects were divided into three groups: those who had normal weights at age 20 and at present, those who had a normal weight at 20 and were now overweight or obese, and those who had been overweight or obese since age 20.

“Race and ethnicity had a significant impact on weight change,” Mr. Fagan said. Sixty-one percent of Hispanics fell into the group that changed from normal weight to overweight or obese, as well as 50% of blacks, 46% of whites, and 7% of Asians.

Adenomas were significantly more common among patients who had been overweight or obese since age 10 (at a rate of 27%) and among those who went from normal weight to overweight (19%), compared with those who had maintained a normal weight (13%).

After controlling for age, gender, current BMI, U.S. birth, and red meat consumption, the investigators found that becoming overweight or obese in early adulthood almost doubled the risk of an adenoma on screening colonoscopy (odds ratio 1.8). Mr. Fagan did not present a risk analysis for subjects who had been overweight since childhood, saying that the number of subjects in that group was not sufficient.

Disclosures: Neither Mr. Fagan nor Dr. Francois had financial conflicts.

Adenomas were significantly more common among patients who had been overweight or obese since age 10.

Source: Ian Fagan

NEW ORLEANS — Patients with inflammatory bowel disease were significantly more likely than the general population to develop pancreatic cancer, in the first prospective study to assess standardized incidence rates of both disorders.

Men with ulcerative colitis were at a particularly high risk—more than 6 times as likely to develop pancreatic cancer than were men without ulcerative colitis, Dr. Jason Schwartz said at the annual Digestive Disease Week.

If the data are confirmed in larger studies, they may justify population-based screening for patients with either ulcerative colitis or Crohn’s disease—particularly men. “It’s too early right now to make screening recommendations, but providers should keep in mind that males with ulcerative colitis may harbor an inclination to develop pancreatic cancer,” said Dr. Schwartz, assistant professor of surgery at the University of Utah, Salt Lake City. “This study may open the door to screening for pancreatic cancer in patients with inflammatory bowel disease, similar to what we now do for patients with IBD, who have an increased risk of colon cancer.”

Dr. Schwartz and his colleagues extracted 10-year data on inflammatory bowel disease and pancreatic cancer cases in Utah from the University of Utah Health Care System and the Utah Cancer Registry in conjunction with the NCI’s Surveillance, Epidemiology and End Results (SEER) database.

From 1996 to 2006, there were 2,877 adult cases of inflammatory disease in the database. The investigators matched these cases to pancreatic cancer cases in the cancer registry and the Utah population database. “We felt there would be an association, but we were surprised by the strength of it,” Dr. Schwartz said. The researchers found 12 cases with both IBD and pancreatic cancer. After excluding five cases—because the cancer was diagnosed before the IBD—the association remained strong. “The expected rate of pancreatic cancer in Utah is 4/100,000 person-years,” he said. “The association that we saw worked out to be 7/15,000 person-years.”

All of these cases occurred in men with ulcerative colitis. So while the overall risk for pancreatic cancer in any patient with either ulcerative colitis or Crohn’s disease was 3.4, men with ulcerative colitis were 6.2 times more likely to develop the cancer than were men without ulcerative colitis.

The pathologic connection between IBD and pancreatic cancer has not been fully explored, but repeated bouts of inflammation probably are involved, he said. “The intestines also become more permeable and allow bacteria to come into contact with the pancreas and liver,” Dr. Schwartz said. There could also
be a genetic link between the two conditions, but more research is needed. ■

Disclosures: Dr. Schwartz had no financial disclosures relevant to the study

NEW ORLEANS — Patients with inflammatory bowel disease were significantly more likely than the general population to develop pancreatic cancer, in the first prospective study to assess standardized incidence rates of both disorders.

Men with ulcerative colitis were at a particularly high risk—more than 6 times as likely to develop pancreatic cancer than were men without ulcerative colitis, Dr. Jason Schwartz said at the annual Digestive Disease Week.

If the data are confirmed in larger studies, they may justify population-based screening for patients with either ulcerative colitis or Crohn’s disease—particularly men. “It’s too early right now to make screening recommendations, but providers should keep in mind that males with ulcerative colitis may harbor an inclination to develop pancreatic cancer,” said Dr. Schwartz, assistant professor of surgery at the University of Utah, Salt Lake City. “This study may open the door to screening for pancreatic cancer in patients with inflammatory bowel disease, similar to what we now do for patients with IBD, who have an increased risk of colon cancer.”

Dr. Schwartz and his colleagues extracted 10-year data on inflammatory bowel disease and pancreatic cancer cases in Utah from the University of Utah Health Care System and the Utah Cancer Registry in conjunction with the NCI’s Surveillance, Epidemiology and End Results (SEER) database.

From 1996 to 2006, there were 2,877 adult cases of inflammatory disease in the database. The investigators matched these cases to pancreatic cancer cases in the cancer registry and the Utah population database. “We felt there would be an association, but we were surprised by the strength of it,” Dr. Schwartz said. The researchers found 12 cases with both IBD and pancreatic cancer. After excluding five cases—because the cancer was diagnosed before the IBD—the association remained strong. “The expected rate of pancreatic cancer in Utah is 4/100,000 person-years,” he said. “The association that we saw worked out to be 7/15,000 person-years.”

All of these cases occurred in men with ulcerative colitis. So while the overall risk for pancreatic cancer in any patient with either ulcerative colitis or Crohn’s disease was 3.4, men with ulcerative colitis were 6.2 times more likely to develop the cancer than were men without ulcerative colitis.

The pathologic connection between IBD and pancreatic cancer has not been fully explored, but repeated bouts of inflammation probably are involved, he said. “The intestines also become more permeable and allow bacteria to come into contact with the pancreas and liver,” Dr. Schwartz said. There could also
be a genetic link between the two conditions, but more research is needed. ■

Disclosures: Dr. Schwartz had no financial disclosures relevant to the study

NEW ORLEANS — Patients with inflammatory bowel disease were significantly more likely than the general population to develop pancreatic cancer, in the first prospective study to assess standardized incidence rates of both disorders.

Men with ulcerative colitis were at a particularly high risk—more than 6 times as likely to develop pancreatic cancer than were men without ulcerative colitis, Dr. Jason Schwartz said at the annual Digestive Disease Week.

If the data are confirmed in larger studies, they may justify population-based screening for patients with either ulcerative colitis or Crohn’s disease—particularly men. “It’s too early right now to make screening recommendations, but providers should keep in mind that males with ulcerative colitis may harbor an inclination to develop pancreatic cancer,” said Dr. Schwartz, assistant professor of surgery at the University of Utah, Salt Lake City. “This study may open the door to screening for pancreatic cancer in patients with inflammatory bowel disease, similar to what we now do for patients with IBD, who have an increased risk of colon cancer.”

Dr. Schwartz and his colleagues extracted 10-year data on inflammatory bowel disease and pancreatic cancer cases in Utah from the University of Utah Health Care System and the Utah Cancer Registry in conjunction with the NCI’s Surveillance, Epidemiology and End Results (SEER) database.

From 1996 to 2006, there were 2,877 adult cases of inflammatory disease in the database. The investigators matched these cases to pancreatic cancer cases in the cancer registry and the Utah population database. “We felt there would be an association, but we were surprised by the strength of it,” Dr. Schwartz said. The researchers found 12 cases with both IBD and pancreatic cancer. After excluding five cases—because the cancer was diagnosed before the IBD—the association remained strong. “The expected rate of pancreatic cancer in Utah is 4/100,000 person-years,” he said. “The association that we saw worked out to be 7/15,000 person-years.”

All of these cases occurred in men with ulcerative colitis. So while the overall risk for pancreatic cancer in any patient with either ulcerative colitis or Crohn’s disease was 3.4, men with ulcerative colitis were 6.2 times more likely to develop the cancer than were men without ulcerative colitis.

The pathologic connection between IBD and pancreatic cancer has not been fully explored, but repeated bouts of inflammation probably are involved, he said. “The intestines also become more permeable and allow bacteria to come into contact with the pancreas and liver,” Dr. Schwartz said. There could also
be a genetic link between the two conditions, but more research is needed. ■

Disclosures: Dr. Schwartz had no financial disclosures relevant to the study

Major Finding: Patients who were allowed to choose their colorectal screening method were significantly more likely to follow through with the test, with an adherence rate of 70%, than were those referred to only one method (adherence of 38% or 67%, depending on method).

Data Source: A randomized trial of 1,000 patients who were diverse in terms of language and race/ethnicity.

Disclosures: None reported.

NEW ORLEANS — Patients given a choice between different screening methods are significantly more likely to follow through on colorectal cancer screening than are those told to undergo either colonoscopy or fecal occult blood testing.

“We usually assume that the presence of choices can paralyze people into indecision, and instead of making the choice, they defer,” Dr. John M. Inadomi said at the annual Digestive Disease Week. “We were concerned that, in the case of colorectal screening, giving a choice of screening methods might actually lead to noncompliance.”

Dr. Inadomi of the University of California, San Francisco, and his colleagues found just the opposite when they conducted a randomized trial on the issue with 1,000 patients at an average risk of colorectal cancer. The participants were randomized to one of three screening recommendations: fecal occult blood testing (FOBT), colonoscopy, or the individual patient's choice between the two. The investigators then followed each group for 12 months to evaluate compliance with the screening.

The study was conducted in San Francisco, and the participants reflected the city's diverse population: 34% were Latino, 30% were Asian, 18% were black, 15% were white, and 3% were other; a total of 53% were women. The investigators tried to remove as many barriers to health care adherence as possible by reducing or eliminating cost, providing rides, giving instructions for preparation in the patient's preferred language, allowing direct screening access without a gastroenterology referral, and limiting wait time to 2 weeks.

Overall, 65% of patients followed through on their recommended screening. But there were significant differences in adherence between the groups. Patients referred to colonoscopy alone had the lowest rate of adherence (38%), followed by those referred to fecal occult blood testing (67%). The highest rate of adherence, 70%, was found for patients given a choice between colonoscopy and FOBT.

“Even though significantly more patients followed through on the fecal occult blood testing [compared with colonoscopy], the number was still significantly less than the 70% who were given the choice between the two methods,” Dr. Inadomi said.

At baseline, patients also filled out a survey about their health beliefs. The investigators found that fears of the test results, procedure complications, the preparation and procedure, and of cancer in general significantly reduced adherence to screening. Patients were significantly more likely to follow through on screening if they had good self-perceived health and believed that colorectal cancer screening could prevent cancer.

Dr. Inadomi noted that race/ethnicity and language also had an apparent impact on adherence. Asians and Latinos had significantly higher rates of compliance overall (73% and 70%, respectively) than did whites and blacks (55% and 56%). Different groups seemed to prefer different methods, he said. “Asians and Latinos assigned to fecal occult blood testing adhered more frequently than did whites and blacks. Conversely, whites seemed to prefer colonoscopy,” with a 52% adherence rate, compared with 27% in the nonwhite groups.

Language was a factor as well. “Patients with limited English proficiency actually had greater adherence,” as they received their instructions in their native language. “In a multivariate model, race and ethnicity fell out, and language was the only significant factor that remained,” Dr. Inadomi said. “In a system where access is provided and language is not a barrier, we see that immigrants have the tools to access the health care system in the same way they would in their own country.”

Major Finding: Patients who were allowed to choose their colorectal screening method were significantly more likely to follow through with the test, with an adherence rate of 70%, than were those referred to only one method (adherence of 38% or 67%, depending on method).

Data Source: A randomized trial of 1,000 patients who were diverse in terms of language and race/ethnicity.

Disclosures: None reported.

NEW ORLEANS — Patients given a choice between different screening methods are significantly more likely to follow through on colorectal cancer screening than are those told to undergo either colonoscopy or fecal occult blood testing.

“We usually assume that the presence of choices can paralyze people into indecision, and instead of making the choice, they defer,” Dr. John M. Inadomi said at the annual Digestive Disease Week. “We were concerned that, in the case of colorectal screening, giving a choice of screening methods might actually lead to noncompliance.”

Dr. Inadomi of the University of California, San Francisco, and his colleagues found just the opposite when they conducted a randomized trial on the issue with 1,000 patients at an average risk of colorectal cancer. The participants were randomized to one of three screening recommendations: fecal occult blood testing (FOBT), colonoscopy, or the individual patient's choice between the two. The investigators then followed each group for 12 months to evaluate compliance with the screening.

The study was conducted in San Francisco, and the participants reflected the city's diverse population: 34% were Latino, 30% were Asian, 18% were black, 15% were white, and 3% were other; a total of 53% were women. The investigators tried to remove as many barriers to health care adherence as possible by reducing or eliminating cost, providing rides, giving instructions for preparation in the patient's preferred language, allowing direct screening access without a gastroenterology referral, and limiting wait time to 2 weeks.

Overall, 65% of patients followed through on their recommended screening. But there were significant differences in adherence between the groups. Patients referred to colonoscopy alone had the lowest rate of adherence (38%), followed by those referred to fecal occult blood testing (67%). The highest rate of adherence, 70%, was found for patients given a choice between colonoscopy and FOBT.

“Even though significantly more patients followed through on the fecal occult blood testing [compared with colonoscopy], the number was still significantly less than the 70% who were given the choice between the two methods,” Dr. Inadomi said.

At baseline, patients also filled out a survey about their health beliefs. The investigators found that fears of the test results, procedure complications, the preparation and procedure, and of cancer in general significantly reduced adherence to screening. Patients were significantly more likely to follow through on screening if they had good self-perceived health and believed that colorectal cancer screening could prevent cancer.

Dr. Inadomi noted that race/ethnicity and language also had an apparent impact on adherence. Asians and Latinos had significantly higher rates of compliance overall (73% and 70%, respectively) than did whites and blacks (55% and 56%). Different groups seemed to prefer different methods, he said. “Asians and Latinos assigned to fecal occult blood testing adhered more frequently than did whites and blacks. Conversely, whites seemed to prefer colonoscopy,” with a 52% adherence rate, compared with 27% in the nonwhite groups.

Language was a factor as well. “Patients with limited English proficiency actually had greater adherence,” as they received their instructions in their native language. “In a multivariate model, race and ethnicity fell out, and language was the only significant factor that remained,” Dr. Inadomi said. “In a system where access is provided and language is not a barrier, we see that immigrants have the tools to access the health care system in the same way they would in their own country.”

Major Finding: Patients who were allowed to choose their colorectal screening method were significantly more likely to follow through with the test, with an adherence rate of 70%, than were those referred to only one method (adherence of 38% or 67%, depending on method).

Data Source: A randomized trial of 1,000 patients who were diverse in terms of language and race/ethnicity.

Disclosures: None reported.

NEW ORLEANS — Patients given a choice between different screening methods are significantly more likely to follow through on colorectal cancer screening than are those told to undergo either colonoscopy or fecal occult blood testing.

“We usually assume that the presence of choices can paralyze people into indecision, and instead of making the choice, they defer,” Dr. John M. Inadomi said at the annual Digestive Disease Week. “We were concerned that, in the case of colorectal screening, giving a choice of screening methods might actually lead to noncompliance.”

Dr. Inadomi of the University of California, San Francisco, and his colleagues found just the opposite when they conducted a randomized trial on the issue with 1,000 patients at an average risk of colorectal cancer. The participants were randomized to one of three screening recommendations: fecal occult blood testing (FOBT), colonoscopy, or the individual patient's choice between the two. The investigators then followed each group for 12 months to evaluate compliance with the screening.

The study was conducted in San Francisco, and the participants reflected the city's diverse population: 34% were Latino, 30% were Asian, 18% were black, 15% were white, and 3% were other; a total of 53% were women. The investigators tried to remove as many barriers to health care adherence as possible by reducing or eliminating cost, providing rides, giving instructions for preparation in the patient's preferred language, allowing direct screening access without a gastroenterology referral, and limiting wait time to 2 weeks.

Overall, 65% of patients followed through on their recommended screening. But there were significant differences in adherence between the groups. Patients referred to colonoscopy alone had the lowest rate of adherence (38%), followed by those referred to fecal occult blood testing (67%). The highest rate of adherence, 70%, was found for patients given a choice between colonoscopy and FOBT.

“Even though significantly more patients followed through on the fecal occult blood testing [compared with colonoscopy], the number was still significantly less than the 70% who were given the choice between the two methods,” Dr. Inadomi said.

At baseline, patients also filled out a survey about their health beliefs. The investigators found that fears of the test results, procedure complications, the preparation and procedure, and of cancer in general significantly reduced adherence to screening. Patients were significantly more likely to follow through on screening if they had good self-perceived health and believed that colorectal cancer screening could prevent cancer.

Dr. Inadomi noted that race/ethnicity and language also had an apparent impact on adherence. Asians and Latinos had significantly higher rates of compliance overall (73% and 70%, respectively) than did whites and blacks (55% and 56%). Different groups seemed to prefer different methods, he said. “Asians and Latinos assigned to fecal occult blood testing adhered more frequently than did whites and blacks. Conversely, whites seemed to prefer colonoscopy,” with a 52% adherence rate, compared with 27% in the nonwhite groups.

Language was a factor as well. “Patients with limited English proficiency actually had greater adherence,” as they received their instructions in their native language. “In a multivariate model, race and ethnicity fell out, and language was the only significant factor that remained,” Dr. Inadomi said. “In a system where access is provided and language is not a barrier, we see that immigrants have the tools to access the health care system in the same way they would in their own country.”

Major Finding: The projected lifetime cost of antihypertensive medication dropped from $1,039 before gastric bypass surgery to $286 in the 44% of patients whose hypertension had resolved, and from $1,349 to $513, respectively, in patients who remained hypertensive.

Data Source: A retrospective study of 106 patients.

Disclosures: None of the investigators had any potential financial conflicts of interest.

NATIONAL HARBOR, MD. — Gastric bypass surgery that corrects hypertension and diabetes can save thousands of dollars in medication costs over a lifetime, according to a retrospective study of more than 100 patients.

Even patients whose diseases improve but do not remit after surgery will see a significant cost benefit in their medications, Dr. Saber Ghiassi said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

He identified the savings in Veterans Affairs patients who have access to inexpensive medications. Savings would be much greater in the general population, where drug costs are not controlled, he noted.

Dr. Ghiassi, a postdoctoral surgical fellow at Stanford (Calif.) University, reviewed the charts of 106 patients who underwent Roux-en-Y gastric bypass at the VA Palo Alto Health Care System hospital from 2001 to 2007. It is “a unique place to study this issue because computerized patient records allow us to follow many patient factors, such as medications,” Dr. Ghiassi said. “Also, all our patients are subject to the same drug pricing.”

Dr. Ghiassi and his colleagues compared medication costs at 1 year after surgery with presurgical costs. They calculated lifetime cost savings based on the Centers for Disease Control and Prevention life charts, with adjustments from the Framingham Heart Study survival statistics.

Most (77%) of the patients were men, mean age was 52 years, and mean body mass index was 47 kg/m

For those whose hypertension resolved, the projected lifetime cost of antihypertensive medication dropped significantly from $1,039 before surgery to $286 post surgery. For patients whose hypertension improved but did not resolve, the presurgical projected lifetime medication cost of $1,349 dropped to $513.

There were no significant differences in age or baseline BMI between the two patient groups, but patients whose hypertension resolved lost significantly more excess body weight than did those who saw only an improvement in hypertension (76% vs. 62%).

The projected lifetime cost of diabetes medication was $10,505. For those whose diabetes resolved completely, that cost dropped significantly to $1,139. Savings were greater in patients whose diabetes improved but did not resolve: The projected lifetime cost of diabetes medication of $22,427 before surgery dropped to $5,697 after surgery. There were no significant differences in age, BMI, or weight loss between the two groups.

Several discussants commented on the study. Dr. Edward Felix, director of the Advanced Bariatric Center, Fresno, Calif., noted that the lifetime medication costs in the study “are far less than what we would see in just 1 year” of treating hypertension and diabetes in an obese population.

“These are very conservative estimates,” Dr. Ghiassi agreed. “The cost savings in non-VA patients will be much greater because the VA is a government entity that negotiates lower drug prices.”

Dr. Phillip Schauer, a bariatric surgeon at the Cleveland Clinic, said similar savings might result with other comorbid disorders, but “the biggest cost savings is probably the reduction in complications of ineffectively treated diseases, like dialysis, coronary bypass surgery, and hip surgery.”

Major Finding: The projected lifetime cost of antihypertensive medication dropped from $1,039 before gastric bypass surgery to $286 in the 44% of patients whose hypertension had resolved, and from $1,349 to $513, respectively, in patients who remained hypertensive.

Data Source: A retrospective study of 106 patients.

Disclosures: None of the investigators had any potential financial conflicts of interest.

NATIONAL HARBOR, MD. — Gastric bypass surgery that corrects hypertension and diabetes can save thousands of dollars in medication costs over a lifetime, according to a retrospective study of more than 100 patients.

Even patients whose diseases improve but do not remit after surgery will see a significant cost benefit in their medications, Dr. Saber Ghiassi said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

He identified the savings in Veterans Affairs patients who have access to inexpensive medications. Savings would be much greater in the general population, where drug costs are not controlled, he noted.

Dr. Ghiassi, a postdoctoral surgical fellow at Stanford (Calif.) University, reviewed the charts of 106 patients who underwent Roux-en-Y gastric bypass at the VA Palo Alto Health Care System hospital from 2001 to 2007. It is “a unique place to study this issue because computerized patient records allow us to follow many patient factors, such as medications,” Dr. Ghiassi said. “Also, all our patients are subject to the same drug pricing.”

Dr. Ghiassi and his colleagues compared medication costs at 1 year after surgery with presurgical costs. They calculated lifetime cost savings based on the Centers for Disease Control and Prevention life charts, with adjustments from the Framingham Heart Study survival statistics.

Most (77%) of the patients were men, mean age was 52 years, and mean body mass index was 47 kg/m

For those whose hypertension resolved, the projected lifetime cost of antihypertensive medication dropped significantly from $1,039 before surgery to $286 post surgery. For patients whose hypertension improved but did not resolve, the presurgical projected lifetime medication cost of $1,349 dropped to $513.

There were no significant differences in age or baseline BMI between the two patient groups, but patients whose hypertension resolved lost significantly more excess body weight than did those who saw only an improvement in hypertension (76% vs. 62%).

The projected lifetime cost of diabetes medication was $10,505. For those whose diabetes resolved completely, that cost dropped significantly to $1,139. Savings were greater in patients whose diabetes improved but did not resolve: The projected lifetime cost of diabetes medication of $22,427 before surgery dropped to $5,697 after surgery. There were no significant differences in age, BMI, or weight loss between the two groups.

Several discussants commented on the study. Dr. Edward Felix, director of the Advanced Bariatric Center, Fresno, Calif., noted that the lifetime medication costs in the study “are far less than what we would see in just 1 year” of treating hypertension and diabetes in an obese population.

“These are very conservative estimates,” Dr. Ghiassi agreed. “The cost savings in non-VA patients will be much greater because the VA is a government entity that negotiates lower drug prices.”

Dr. Phillip Schauer, a bariatric surgeon at the Cleveland Clinic, said similar savings might result with other comorbid disorders, but “the biggest cost savings is probably the reduction in complications of ineffectively treated diseases, like dialysis, coronary bypass surgery, and hip surgery.”

Major Finding: The projected lifetime cost of antihypertensive medication dropped from $1,039 before gastric bypass surgery to $286 in the 44% of patients whose hypertension had resolved, and from $1,349 to $513, respectively, in patients who remained hypertensive.

Data Source: A retrospective study of 106 patients.

Disclosures: None of the investigators had any potential financial conflicts of interest.

NATIONAL HARBOR, MD. — Gastric bypass surgery that corrects hypertension and diabetes can save thousands of dollars in medication costs over a lifetime, according to a retrospective study of more than 100 patients.

Even patients whose diseases improve but do not remit after surgery will see a significant cost benefit in their medications, Dr. Saber Ghiassi said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

He identified the savings in Veterans Affairs patients who have access to inexpensive medications. Savings would be much greater in the general population, where drug costs are not controlled, he noted.

Dr. Ghiassi, a postdoctoral surgical fellow at Stanford (Calif.) University, reviewed the charts of 106 patients who underwent Roux-en-Y gastric bypass at the VA Palo Alto Health Care System hospital from 2001 to 2007. It is “a unique place to study this issue because computerized patient records allow us to follow many patient factors, such as medications,” Dr. Ghiassi said. “Also, all our patients are subject to the same drug pricing.”

Dr. Ghiassi and his colleagues compared medication costs at 1 year after surgery with presurgical costs. They calculated lifetime cost savings based on the Centers for Disease Control and Prevention life charts, with adjustments from the Framingham Heart Study survival statistics.

Most (77%) of the patients were men, mean age was 52 years, and mean body mass index was 47 kg/m

For those whose hypertension resolved, the projected lifetime cost of antihypertensive medication dropped significantly from $1,039 before surgery to $286 post surgery. For patients whose hypertension improved but did not resolve, the presurgical projected lifetime medication cost of $1,349 dropped to $513.

There were no significant differences in age or baseline BMI between the two patient groups, but patients whose hypertension resolved lost significantly more excess body weight than did those who saw only an improvement in hypertension (76% vs. 62%).

The projected lifetime cost of diabetes medication was $10,505. For those whose diabetes resolved completely, that cost dropped significantly to $1,139. Savings were greater in patients whose diabetes improved but did not resolve: The projected lifetime cost of diabetes medication of $22,427 before surgery dropped to $5,697 after surgery. There were no significant differences in age, BMI, or weight loss between the two groups.

Several discussants commented on the study. Dr. Edward Felix, director of the Advanced Bariatric Center, Fresno, Calif., noted that the lifetime medication costs in the study “are far less than what we would see in just 1 year” of treating hypertension and diabetes in an obese population.

“These are very conservative estimates,” Dr. Ghiassi agreed. “The cost savings in non-VA patients will be much greater because the VA is a government entity that negotiates lower drug prices.”

Dr. Phillip Schauer, a bariatric surgeon at the Cleveland Clinic, said similar savings might result with other comorbid disorders, but “the biggest cost savings is probably the reduction in complications of ineffectively treated diseases, like dialysis, coronary bypass surgery, and hip surgery.”

Major Finding: Weight loss at 2 years in patients undergoing sleeve gastrectomy was similar to that achieved by gastric bypass surgery.

Data Source: A review of 446 consecutive cases.

Disclosures: Dr. Topart disclosed that he has received travel support and research grants from Ethicon Endo-Surgery and W.L. Gore, and research grants from Santinov.

NATIONAL HARBOR, MD. — Although sleeve gastrectomy has a higher rate of complications compared with other bariatric procedures, 2-year weight loss was similar to that seen after gastric bypass in a study of 446 patients.

“Gastric staple line leaks are the main concern in this procedure,” Dr. Philippe Topart said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. “Twenty-three of the major complications were gastric leaks.”

But at 2 years, his patients had lost a mean of 55% of their excess body weight, said Dr. Topart of the Clinique D'Anjou, Angers, France.

His series included procedures in 14 facilities in France and Switzerland. The patients' mean age was 43 years; 25% had failed a prior gastric banding. Most (83%) were female. Body mass index was more than 50 kg/m

Most patients (65%) had at least one comorbid condition, including metabolic syndrome (52%) hypertension (38%), dyslipidemia (24%), diabetes (23%), and nonalcoholic steatohepatitis (1%).

The majority of cases (99%) were performed laparoscopically. Mean length of hospital stay was 7 days. There were no postoperative deaths. The overall complication rate of 17% was attributable to dysphagia in 23 patents, postoperative bleeding in 1, and obstruction in 1, along with minor complications in 23 patients.

Gastric leaks occurred in 23 patients (5%). The leak rate was reduced in patients with staple line reinforcement (0% vs. 4.5% in nonreinforced staple lines) and in patients with oversewing (35% vs. 6%), Dr. Topart said.

“However, this was not a significant difference and the only prognostic factor was the operation duration,” he said.

Patients with a lower BMI (35–49 kg/m

Males and patients with multiple comorbidities lost significantly less weight than did women or patients with no comorbidities. Prior gastric banding did not significantly affect weight loss.

“Sleeve gastrectomy appears to be a reasonable option as a primary bariatric surgical treatment, although the complication rate—especially gastric leaks—is far from being negligible,” Dr. Topart said in an interview.

Since 2008, 150 sleeve gastrectomies have been performed in his practice, with a complication rate slightly higher than that seen in the 400 Roux-en-Y gastric bypasses performed.

“However, as reported in the multicenter retrospective study, there were no postoperative deaths, while with our gastric bypass we had a 0.25% 90-day death rate.”

Evidence in favor of sleeve gastrectomy has mounted to the point that two major U.S. insurance companies—Aetna Inc. and UnitedHealthcare—announced that they will cover the procedure. Aetna began coverage in April. UnitedHealthcare began coverage in October 2009 when sleeve gastrectomy was was done as part of other related procedures, but now covers it as a stand-alone procedure, according to spokeswoman Cheryl Randolph.

The major concern is still the long-term weight-loss outcomes, Dr. Topart said. But a 2009 position statement by the American Society for Metabolic and Bariatric Surgery (ASMBS) appeared to be the tipping point for Aetna to decide to cover the surgery. “ASMBS determined that sleeve gastrectomy is an 'approved bariatric surgical procedure,' despite finding only 'limited' intermediate-term data and a lack of long-term data on the effectiveness of the procedure,” the Aetna policy states.

ASMBS accepted sleeve gastrectomy as an approved procedure because of its potential value for high-risk patients, primarily those with an average BMI of 60 kg/m

“Although the published intermediate-term 3- to 5-year follow-up data after sleeve gastrectomy are increasing, the data remain limited. The ASMBS has accepted sleeve gastrectomy as an approved bariatric surgical procedure primarily because of its potential value as a first-stage operation for high-risk patients, with the full realization that successful long-term weight reduction in an individual patient after the procedure would obviate the need for a second-stage procedure,” the statement said.

It is unclear how often sleeve gastrectomy patients will require a different bariatric procedure.

The ASMBS paper noted that long-term data “might or might not ultimately confirm that the procedure should remain in the category of a staged treatment intervention.” Sleeve gastrectomy can cause long-term nutritional deficits because the resected stomach absorbs some vitamins and nutrients less readily than it did before surgery, the paper stated.

Major Finding: Weight loss at 2 years in patients undergoing sleeve gastrectomy was similar to that achieved by gastric bypass surgery.

Data Source: A review of 446 consecutive cases.

Disclosures: Dr. Topart disclosed that he has received travel support and research grants from Ethicon Endo-Surgery and W.L. Gore, and research grants from Santinov.

NATIONAL HARBOR, MD. — Although sleeve gastrectomy has a higher rate of complications compared with other bariatric procedures, 2-year weight loss was similar to that seen after gastric bypass in a study of 446 patients.

“Gastric staple line leaks are the main concern in this procedure,” Dr. Philippe Topart said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. “Twenty-three of the major complications were gastric leaks.”

But at 2 years, his patients had lost a mean of 55% of their excess body weight, said Dr. Topart of the Clinique D'Anjou, Angers, France.

His series included procedures in 14 facilities in France and Switzerland. The patients' mean age was 43 years; 25% had failed a prior gastric banding. Most (83%) were female. Body mass index was more than 50 kg/m

Most patients (65%) had at least one comorbid condition, including metabolic syndrome (52%) hypertension (38%), dyslipidemia (24%), diabetes (23%), and nonalcoholic steatohepatitis (1%).

The majority of cases (99%) were performed laparoscopically. Mean length of hospital stay was 7 days. There were no postoperative deaths. The overall complication rate of 17% was attributable to dysphagia in 23 patents, postoperative bleeding in 1, and obstruction in 1, along with minor complications in 23 patients.

Gastric leaks occurred in 23 patients (5%). The leak rate was reduced in patients with staple line reinforcement (0% vs. 4.5% in nonreinforced staple lines) and in patients with oversewing (35% vs. 6%), Dr. Topart said.

“However, this was not a significant difference and the only prognostic factor was the operation duration,” he said.

Patients with a lower BMI (35–49 kg/m

Males and patients with multiple comorbidities lost significantly less weight than did women or patients with no comorbidities. Prior gastric banding did not significantly affect weight loss.

“Sleeve gastrectomy appears to be a reasonable option as a primary bariatric surgical treatment, although the complication rate—especially gastric leaks—is far from being negligible,” Dr. Topart said in an interview.

Since 2008, 150 sleeve gastrectomies have been performed in his practice, with a complication rate slightly higher than that seen in the 400 Roux-en-Y gastric bypasses performed.

“However, as reported in the multicenter retrospective study, there were no postoperative deaths, while with our gastric bypass we had a 0.25% 90-day death rate.”

Evidence in favor of sleeve gastrectomy has mounted to the point that two major U.S. insurance companies—Aetna Inc. and UnitedHealthcare—announced that they will cover the procedure. Aetna began coverage in April. UnitedHealthcare began coverage in October 2009 when sleeve gastrectomy was was done as part of other related procedures, but now covers it as a stand-alone procedure, according to spokeswoman Cheryl Randolph.

The major concern is still the long-term weight-loss outcomes, Dr. Topart said. But a 2009 position statement by the American Society for Metabolic and Bariatric Surgery (ASMBS) appeared to be the tipping point for Aetna to decide to cover the surgery. “ASMBS determined that sleeve gastrectomy is an 'approved bariatric surgical procedure,' despite finding only 'limited' intermediate-term data and a lack of long-term data on the effectiveness of the procedure,” the Aetna policy states.

ASMBS accepted sleeve gastrectomy as an approved procedure because of its potential value for high-risk patients, primarily those with an average BMI of 60 kg/m

“Although the published intermediate-term 3- to 5-year follow-up data after sleeve gastrectomy are increasing, the data remain limited. The ASMBS has accepted sleeve gastrectomy as an approved bariatric surgical procedure primarily because of its potential value as a first-stage operation for high-risk patients, with the full realization that successful long-term weight reduction in an individual patient after the procedure would obviate the need for a second-stage procedure,” the statement said.

It is unclear how often sleeve gastrectomy patients will require a different bariatric procedure.

The ASMBS paper noted that long-term data “might or might not ultimately confirm that the procedure should remain in the category of a staged treatment intervention.” Sleeve gastrectomy can cause long-term nutritional deficits because the resected stomach absorbs some vitamins and nutrients less readily than it did before surgery, the paper stated.

Major Finding: Weight loss at 2 years in patients undergoing sleeve gastrectomy was similar to that achieved by gastric bypass surgery.

Data Source: A review of 446 consecutive cases.

Disclosures: Dr. Topart disclosed that he has received travel support and research grants from Ethicon Endo-Surgery and W.L. Gore, and research grants from Santinov.

NATIONAL HARBOR, MD. — Although sleeve gastrectomy has a higher rate of complications compared with other bariatric procedures, 2-year weight loss was similar to that seen after gastric bypass in a study of 446 patients.

“Gastric staple line leaks are the main concern in this procedure,” Dr. Philippe Topart said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. “Twenty-three of the major complications were gastric leaks.”

But at 2 years, his patients had lost a mean of 55% of their excess body weight, said Dr. Topart of the Clinique D'Anjou, Angers, France.

His series included procedures in 14 facilities in France and Switzerland. The patients' mean age was 43 years; 25% had failed a prior gastric banding. Most (83%) were female. Body mass index was more than 50 kg/m

Most patients (65%) had at least one comorbid condition, including metabolic syndrome (52%) hypertension (38%), dyslipidemia (24%), diabetes (23%), and nonalcoholic steatohepatitis (1%).

The majority of cases (99%) were performed laparoscopically. Mean length of hospital stay was 7 days. There were no postoperative deaths. The overall complication rate of 17% was attributable to dysphagia in 23 patents, postoperative bleeding in 1, and obstruction in 1, along with minor complications in 23 patients.

Gastric leaks occurred in 23 patients (5%). The leak rate was reduced in patients with staple line reinforcement (0% vs. 4.5% in nonreinforced staple lines) and in patients with oversewing (35% vs. 6%), Dr. Topart said.

“However, this was not a significant difference and the only prognostic factor was the operation duration,” he said.

Patients with a lower BMI (35–49 kg/m

Males and patients with multiple comorbidities lost significantly less weight than did women or patients with no comorbidities. Prior gastric banding did not significantly affect weight loss.

“Sleeve gastrectomy appears to be a reasonable option as a primary bariatric surgical treatment, although the complication rate—especially gastric leaks—is far from being negligible,” Dr. Topart said in an interview.

Since 2008, 150 sleeve gastrectomies have been performed in his practice, with a complication rate slightly higher than that seen in the 400 Roux-en-Y gastric bypasses performed.

“However, as reported in the multicenter retrospective study, there were no postoperative deaths, while with our gastric bypass we had a 0.25% 90-day death rate.”

Evidence in favor of sleeve gastrectomy has mounted to the point that two major U.S. insurance companies—Aetna Inc. and UnitedHealthcare—announced that they will cover the procedure. Aetna began coverage in April. UnitedHealthcare began coverage in October 2009 when sleeve gastrectomy was was done as part of other related procedures, but now covers it as a stand-alone procedure, according to spokeswoman Cheryl Randolph.

The major concern is still the long-term weight-loss outcomes, Dr. Topart said. But a 2009 position statement by the American Society for Metabolic and Bariatric Surgery (ASMBS) appeared to be the tipping point for Aetna to decide to cover the surgery. “ASMBS determined that sleeve gastrectomy is an 'approved bariatric surgical procedure,' despite finding only 'limited' intermediate-term data and a lack of long-term data on the effectiveness of the procedure,” the Aetna policy states.

ASMBS accepted sleeve gastrectomy as an approved procedure because of its potential value for high-risk patients, primarily those with an average BMI of 60 kg/m

“Although the published intermediate-term 3- to 5-year follow-up data after sleeve gastrectomy are increasing, the data remain limited. The ASMBS has accepted sleeve gastrectomy as an approved bariatric surgical procedure primarily because of its potential value as a first-stage operation for high-risk patients, with the full realization that successful long-term weight reduction in an individual patient after the procedure would obviate the need for a second-stage procedure,” the statement said.

It is unclear how often sleeve gastrectomy patients will require a different bariatric procedure.

The ASMBS paper noted that long-term data “might or might not ultimately confirm that the procedure should remain in the category of a staged treatment intervention.” Sleeve gastrectomy can cause long-term nutritional deficits because the resected stomach absorbs some vitamins and nutrients less readily than it did before surgery, the paper stated.

Major Finding: The rate of late-onset bloodstream infections in very low-birth-weight infants dropped from 38% to 23% after a hospital instituted a comprehensive infection control program, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None was reported.

PHILADELPHIA — A comprehensive infection control protocol significantly decreased the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

The protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, decreased the rate of infections from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital.

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines. Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69; 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

Major Finding: The rate of late-onset bloodstream infections in very low-birth-weight infants dropped from 38% to 23% after a hospital instituted a comprehensive infection control program, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None was reported.

PHILADELPHIA — A comprehensive infection control protocol significantly decreased the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

The protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, decreased the rate of infections from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital.

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines. Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69; 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

Major Finding: The rate of late-onset bloodstream infections in very low-birth-weight infants dropped from 38% to 23% after a hospital instituted a comprehensive infection control program, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None was reported.

PHILADELPHIA — A comprehensive infection control protocol significantly decreased the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

The protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, decreased the rate of infections from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital.

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines. Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69; 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

PHILADELPHIA — After presenting to a busy pediatric emergency department, only 3% of children admitted had suspected pandemic influenza during the peak of the outbreak last year.

“Our cases of influenzalike illness were relatively mild and associated with a much lower hospital admission rate than cases we saw for other reasons,” Dr. Jeffrey Chen said at the annual meeting of the Eastern Society for Pediatric Research. “Most of the admissions [for suspected pandemic flu] were younger children and were associated with pulmonary disease.”

Dr. Chen and his associates at St. Barnabas Hospital in New York assessed the 2009 pandemic flu season by reviewing the charts of patients admitted from April 29 to June 15—the peak of the outbreak in New York City. During the study period, 4,921 patients were seen in the facility—an increase of 77% from the same period in 2008. Of those, 52% (2,543) fulfilled the criteria for flulike illness set forth by the Centers for Disease Control and Prevention: fever, cough, sore throat, myalgia, vomiting, or diarrhea.

Most of the patients with flulike illness (2,472) were discharged; 71 patients (3%) were admitted to the hospital.

Pulmonary symptoms were significantly more common among those admitted with suspected flu than among those discharged (27% vs. 5%).

Despite the finding of probable flu, most patients had no confirmatory testing: 58% of admitted patients were not tested, and 70% of those discharged were not tested.

Disclosures: None was reported.

PHILADELPHIA — After presenting to a busy pediatric emergency department, only 3% of children admitted had suspected pandemic influenza during the peak of the outbreak last year.

“Our cases of influenzalike illness were relatively mild and associated with a much lower hospital admission rate than cases we saw for other reasons,” Dr. Jeffrey Chen said at the annual meeting of the Eastern Society for Pediatric Research. “Most of the admissions [for suspected pandemic flu] were younger children and were associated with pulmonary disease.”

Dr. Chen and his associates at St. Barnabas Hospital in New York assessed the 2009 pandemic flu season by reviewing the charts of patients admitted from April 29 to June 15—the peak of the outbreak in New York City. During the study period, 4,921 patients were seen in the facility—an increase of 77% from the same period in 2008. Of those, 52% (2,543) fulfilled the criteria for flulike illness set forth by the Centers for Disease Control and Prevention: fever, cough, sore throat, myalgia, vomiting, or diarrhea.

Most of the patients with flulike illness (2,472) were discharged; 71 patients (3%) were admitted to the hospital.

Pulmonary symptoms were significantly more common among those admitted with suspected flu than among those discharged (27% vs. 5%).

Despite the finding of probable flu, most patients had no confirmatory testing: 58% of admitted patients were not tested, and 70% of those discharged were not tested.

Disclosures: None was reported.

PHILADELPHIA — After presenting to a busy pediatric emergency department, only 3% of children admitted had suspected pandemic influenza during the peak of the outbreak last year.

“Our cases of influenzalike illness were relatively mild and associated with a much lower hospital admission rate than cases we saw for other reasons,” Dr. Jeffrey Chen said at the annual meeting of the Eastern Society for Pediatric Research. “Most of the admissions [for suspected pandemic flu] were younger children and were associated with pulmonary disease.”

Dr. Chen and his associates at St. Barnabas Hospital in New York assessed the 2009 pandemic flu season by reviewing the charts of patients admitted from April 29 to June 15—the peak of the outbreak in New York City. During the study period, 4,921 patients were seen in the facility—an increase of 77% from the same period in 2008. Of those, 52% (2,543) fulfilled the criteria for flulike illness set forth by the Centers for Disease Control and Prevention: fever, cough, sore throat, myalgia, vomiting, or diarrhea.

Most of the patients with flulike illness (2,472) were discharged; 71 patients (3%) were admitted to the hospital.

Pulmonary symptoms were significantly more common among those admitted with suspected flu than among those discharged (27% vs. 5%).

Despite the finding of probable flu, most patients had no confirmatory testing: 58% of admitted patients were not tested, and 70% of those discharged were not tested.

Disclosures: None was reported.

PHILADELPHIA — Rapid testing of umbilical cord or newborn blood quickly and reliably identified infants exposed in utero to the human immunodeficiency virus, according to Dr. Prabi Rajbhandari.

The rapid test was just as accurate as the standard enzyme-linked immunosorbent assay (ELISA), with 100% sensitivity and 100% negative predictive value in a small prospective study, Dr. Rajbhandari said at the annual meeting of the Eastern Society of Pediatric Research. None of the rapid HIV test kits have been studied in newborns.

Time is of the essence for babies who have been exposed to the virus, Dr. Rajbhandari said in an interview. “The rapid test is complete in 20–30 minutes, compared to the ELISA, which can take days or even weeks to get a confirmed result,” said Dr. Rajbhandari of the Bronx-Lebanon Hospital Center, New York. “This is a very important factor, because if we know the baby has been exposed, we can start interventions right away to prevent vertical transmission, with no danger of missing the critical period of intervention.”

In New York, all pregnant women are offered HIV testing in the first trimester and, if living in an area of high HIV rates, again in the third trimester. If there is no record of the mother's HIV status at the time of labor, she is asked again to provide a blood sample for testing. Infants of mothers who refuse that test can be tested for HIV exposure without consent.

This prospective study included infants born to 54 mothers; 14 of the women were positive for HIV and 40 were negative. Test samples consisted of blood collected at the time of newborn screening or of cord plasma. Samples were tested with both the OraQuick test and ELISA.

For newborn blood, the tests showed perfect concordance for the exposed infants, she said. “The rapid test and the ELISA were both positive for all 14 samples from the positive mothers.” There were 33 blood samples available for testing from the 40 infants from HIV-negative mothers; seven samples did not have enough blood for the additional test. Again, the rapid test and ELISA were in complete agreement, showing negative results for all 33 samples.

There were 11 cord blood samples available from HIV-positive mothers; all of these samples tested positive by both the rapid test and ELISA. The tests were also perfectly concordant with the 32 cord blood samples available for HIV-negative mothers.

No relevant financial disclosure were reported.

PHILADELPHIA — Rapid testing of umbilical cord or newborn blood quickly and reliably identified infants exposed in utero to the human immunodeficiency virus, according to Dr. Prabi Rajbhandari.

The rapid test was just as accurate as the standard enzyme-linked immunosorbent assay (ELISA), with 100% sensitivity and 100% negative predictive value in a small prospective study, Dr. Rajbhandari said at the annual meeting of the Eastern Society of Pediatric Research. None of the rapid HIV test kits have been studied in newborns.

Time is of the essence for babies who have been exposed to the virus, Dr. Rajbhandari said in an interview. “The rapid test is complete in 20–30 minutes, compared to the ELISA, which can take days or even weeks to get a confirmed result,” said Dr. Rajbhandari of the Bronx-Lebanon Hospital Center, New York. “This is a very important factor, because if we know the baby has been exposed, we can start interventions right away to prevent vertical transmission, with no danger of missing the critical period of intervention.”

In New York, all pregnant women are offered HIV testing in the first trimester and, if living in an area of high HIV rates, again in the third trimester. If there is no record of the mother's HIV status at the time of labor, she is asked again to provide a blood sample for testing. Infants of mothers who refuse that test can be tested for HIV exposure without consent.

This prospective study included infants born to 54 mothers; 14 of the women were positive for HIV and 40 were negative. Test samples consisted of blood collected at the time of newborn screening or of cord plasma. Samples were tested with both the OraQuick test and ELISA.

For newborn blood, the tests showed perfect concordance for the exposed infants, she said. “The rapid test and the ELISA were both positive for all 14 samples from the positive mothers.” There were 33 blood samples available for testing from the 40 infants from HIV-negative mothers; seven samples did not have enough blood for the additional test. Again, the rapid test and ELISA were in complete agreement, showing negative results for all 33 samples.

There were 11 cord blood samples available from HIV-positive mothers; all of these samples tested positive by both the rapid test and ELISA. The tests were also perfectly concordant with the 32 cord blood samples available for HIV-negative mothers.

No relevant financial disclosure were reported.

PHILADELPHIA — Rapid testing of umbilical cord or newborn blood quickly and reliably identified infants exposed in utero to the human immunodeficiency virus, according to Dr. Prabi Rajbhandari.

The rapid test was just as accurate as the standard enzyme-linked immunosorbent assay (ELISA), with 100% sensitivity and 100% negative predictive value in a small prospective study, Dr. Rajbhandari said at the annual meeting of the Eastern Society of Pediatric Research. None of the rapid HIV test kits have been studied in newborns.

Time is of the essence for babies who have been exposed to the virus, Dr. Rajbhandari said in an interview. “The rapid test is complete in 20–30 minutes, compared to the ELISA, which can take days or even weeks to get a confirmed result,” said Dr. Rajbhandari of the Bronx-Lebanon Hospital Center, New York. “This is a very important factor, because if we know the baby has been exposed, we can start interventions right away to prevent vertical transmission, with no danger of missing the critical period of intervention.”

In New York, all pregnant women are offered HIV testing in the first trimester and, if living in an area of high HIV rates, again in the third trimester. If there is no record of the mother's HIV status at the time of labor, she is asked again to provide a blood sample for testing. Infants of mothers who refuse that test can be tested for HIV exposure without consent.

This prospective study included infants born to 54 mothers; 14 of the women were positive for HIV and 40 were negative. Test samples consisted of blood collected at the time of newborn screening or of cord plasma. Samples were tested with both the OraQuick test and ELISA.

For newborn blood, the tests showed perfect concordance for the exposed infants, she said. “The rapid test and the ELISA were both positive for all 14 samples from the positive mothers.” There were 33 blood samples available for testing from the 40 infants from HIV-negative mothers; seven samples did not have enough blood for the additional test. Again, the rapid test and ELISA were in complete agreement, showing negative results for all 33 samples.

There were 11 cord blood samples available from HIV-positive mothers; all of these samples tested positive by both the rapid test and ELISA. The tests were also perfectly concordant with the 32 cord blood samples available for HIV-negative mothers.

No relevant financial disclosure were reported.