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BACKGROUND Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths in the United States. Still, 1 in 3 adults aged 50 years to 75 years have not been screened for CRC. Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality. AIM To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina. The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening. METHODS This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic. Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year, Cologuard in the past three years, flexible sigmoidoscopy/virtual colonoscopy in the past five years, or colonoscopy in the past ten years. Data on patient socioeconomic status, comorbid conditions, and other determinants of health compliance were included as covariates. RESULTS Age [odds ratio (OR) = 1.058; P = 0.017], no-show rate percent (OR= 0.962; P < 0.05), patient history of obstructive sleep apnea (OR = 1.875; P = 0.025), compliance with flu vaccinations (OR = 1.673; P < 0.05), compliance with screening mammograms (OR = 2.130; P < 0.05), and compliance with screening pap smears (OR = 2.708; P < 0.05) were important factors in determining whether a patient will receive CRC screening. Race, gender, insurance or employment status, use of blood thinners, family history of CRC, or other comorbid conditions including diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening. CONCLUSION Patient age, history of sleep apnea, and compliance with other health maintenance tests were significant facilitators to CRC screening, while no-show rate percent was a significant barrier in our patient population. This study will be of benefit to physicians in addressing and improving the CRC screening rates in our community.

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Background: Standard management of benign gastrointestinal strictures (GI) typically involves endoscopic balloon dilation. This method usually involves multiple endoscopic sessions for serial dilation of the strictures. With a greater number of invasive procedures comes increased risk of complications. Placing a covered metal stent is an option. But traditional covered metal stents are long and have a high migration rate. Lumen apposing metal stents (LAMS) are short (1 cm long) covered metal stents with a unique shape. LAMS has several advantages, including varying diameter (10 mm, 15 mm, 20 mm), a saddle-shaped design that decreases migration risk, and an easy deployment system allowing high technical success. We aimed to study the safety and efficacy of using LAMS (AXIOS, Boston Scientific, Marlborough, USA) in the treatment of gastrointestinal strictures. Methods: We retrospectively reviewed our endoscopic database to identify patients in whom LAMS was placed for management of gastrointestinal strictures in last 2 years. Patient demographics, location of the stricture, previous treatments, indication for the stent, size of the LAMS used, intraprocedural adverse events, post procedural adverse events, follow up data was collected. Technical success (successful placement of LAMS across the stricture), clinical success (complete resolution of the stricture on repeat endoscopy for benign strictures and being asymptomatic for malignant strictures), and intra-procedure and post-procedure adverse events were measured. Results: A total of 22 patients had LAMS placement for GI stricture. Most of the patients with benign strictures had failed prior conventional balloon dilations or were poor surgical candidates. Nineteen patients had benign strictures, 3 patients had malignant strictures. Technical success rate was 100% (22/ 22). Four patients were lost to follow up, and 2 are awaiting follow up endoscopy. In patients in whom follow up data is available, the clinical success rate is 87.5% (14/16). No intraprocedural or post procedural adverse events were noted. Please see Table 1 for details. Conclusion: LAMS can be successfully utilized as a safe and effective alternative for dilation of short segment benign GI strictures and as a palliative measure in malignant strictures. Larger studies are necessary to determine their overall long-term efficacy and safety.