Mo1675 COLONOSCOPIC SURVEILLANCE AMONG INDIVIDUALS WITH LARGE TUBULAR ADENOMAS

Abstract

Individuals with high risk adenomas (HRA) detected during screening colonoscopy have increased risk for the future development of colorectal cancer (CRC). Thus, national guidelines recommend that patients with HRA undergo surveillance colonoscopy at 3 years. Large tubular adenomas (TA), a subcategory of HRA often defined in the literature as size≥2cm, have been associated with greater risk of malignancy. However, little is known about adherence to 3-year surveillance for individuals in this group. In this study, we examined colonoscopic surveillance uptake in patients with large TAs in a large, academic health center to determine if additional strategies are needed to improve surveillance uptake. We identified a random sample of patients: (1) age 50-75; (2) with a diagnosis of HRA on index colonoscopy (1 or more TA with villous histology or high grade dysplasia, TA ≥1 cm, or 3 or more TA of any size) between 3/1/2013 and 1/1/2016; and (3) assignment to a primary care provider (PCP). We then selected the subgroup of patients with TA ≥2cm on either colonoscopy or pathology report. Several trained chart abstractors performed a manual electronic health record (EHR) chart review to collect data on patient demographics (age, gender, race, ethnicity, insurance), clinical factors (family history, healthcare utilization, index colonoscopy findings), and completion and timing of surveillance colonoscopy. The primary outcome was surveillance colonoscopy within 3.5 years of index colonoscopy (a 0.5-year grace period was allowed). We summarized patient characteristics and calculated surveillance uptake. The HRA cohort included 405 patients. There were 36 patients that met large TA size criteria. Mean age was 62.1 years, 63.9% (23/36) were male, and 77.8 (28/36) were white. In all, 50.0% (18/36) completed surveillance by 3.5 years, which is higher than the overall HRA surveillance rate at our institution (42.5%). By 5 years, 58.3% (21/36) of individuals with large TAs had completed surveillance. Surveillance increased sharply from 38.9% (14/36) by 3 years to 50% (18/36) by 3.5 years. We also observed that 36.1% (13/36) TAs were resected piecemeal (Table). For the subgroup of HRA patients with large TAs≥2cm, completion of surveillance colonoscopy was suboptimal, however higher than the mean HRA surveillance rate. In addition, one-third of large TAs were resected piecemeal. Future work will include the development of a larger cohort of large TAs as well as bigger studies to investigate surveillance in this subgroup and factors that influence patients and providers to pursue timely surveillance when polyps are large. In addition, there is need for consensus guidelines and provider education regarding large polyp resection.View Large Image Figure ViewerDownload Hi-res image Download (PPT)