Abstract
BackgroundAdults with cystic fibrosis (CF) have been reported to be at five to ten-fold risk (25 to 30 fold risk after solid organ transplant) of colorectal cancer (CRC) than the general population. Limited publications to date have reported on practical aspects of achieving adequate colonic cleanse producing good visualisation. In this study, we compared two bowel preparation regimens, standard bowel preparation and a modified CF bowel preparation.MethodsA non-randomised study of adults with CF attending a single centre, requiring colonoscopy investigation were selected. Between 2001 and 2015, 485 adults with CF attended the clinic; 70 adults with CF had an initial colonoscopy procedure. After five exclusions, standard bowel preparation was prescribed for 27 patients, and modified CF bowel preparation for 38 patients. Demographic and clinical data were collected for all consenting patients.ResultsThere was a significant difference between modified CF bowel preparation group and standard bowel preparation group in bowel visualisation outcomes, with the modified CF bowel preparation group having a higher proportion of “excellent/good” GI visualisation cleanse (50.0% versus 25.9%) and lower rates of “poor” visualisation cleanse (10.5% versus 44.5%) than standard bowel preparation (p = 0.006). Rates of “fair” GI cleanse visualisation were similar between the two groups (39.4% versus 29.6%) (Additional file 1: Table S1). Detection rates of adenomatous polyps at initial colonoscopy was higher in modified CF bowel preparation cohort than with standard preparation group (50.0% versus 18.5%, p < 0.01). Positive adenomatous polyp detection rate in patient’s age > 40 years of age was higher (62.5%) than those < 40 years of age (24.3%) (p = 0.003). Colonic adenocarcinoma diagnosis was similar in both groups.ConclusionThis study primarily highlights that standard colonoscopy bowel preparation is often inadequate in patients with CF, and that colonic lavage using modified CF bowel preparation is required to obtain good colonic visualisation. A higher rate of polyps in patients over 40 years of age (versus less than 40 years) was evident. These results support adults with CF considered for colonoscopy screening at 40 years of age, or prior to this if symptomatic; which is earlier than CRC screening in the non-CF Australian population.
Highlights
Adults with cystic fibrosis (CF) have been reported to be at five to ten-fold risk (25 to 30 fold risk after solid organ transplant) of colorectal cancer (CRC) than the general population
There were significant differences between the modified CF and standard bowel preparation groups in colonic cleanse outcomes, with the modified CF bowel preparation group having a higher proportion of “excellent/good” GI cleanse compared to standard preparation (50.0% versus 25.9%) and lower rates of “poor” cleanse in the modified CF bowel preparation group than standard bowel preparation (10.5% versus 44.5%) (p = 0.006)
The CF Foundation (CFF) colonoscopy screening recommendations emphasise that these were developed for asymptomatic CF patients and stated that “physicians should recognize that CF is a colon cancer syndrome and consider diagnostic evaluation when patients present with new, suggestive symptoms or laboratory abnormalities” individual assessment may be required in patients less than 40 years of age [6]
Summary
Adults with cystic fibrosis (CF) have been reported to be at five to ten-fold risk (25 to 30 fold risk after solid organ transplant) of colorectal cancer (CRC) than the general population. Cystic fibrosis (CF) affects more than 70,000 people globally, and adults outnumber children living with CF in many countries [1]. Colorectal cancer (CRC) has been reported in patients with CF, and is even greater in those who have undergone transplantation (lung transplantation in particular being more prevalent in those with CF) [3,4,5,6]. The detection of CRC by symptoms in the general population, can lead to delayed diagnosis and many countries have programs to assist early detection [7, 8]. Colonic stool clearance is incomplete in up to 25% of patients [12, 13]
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