Complete Colonoscopy Research Articles

Clinical and endoscopic outcomes of patients with colonic Crohn's disease treated with 5-aminosalicylates as monotherapy

BackgroundIn spite of the lack of evidence regarding the clinical benefits of oral 5-aminosalicylic acid (5-ASA) compounds in Crohn's disease (CD), these drugs are frequently used in daily clinical practice, particularly for colonic CD. Our aim is to assess the use and clinical outcomes of 5-ASA of those patients with colonic CD treated with 5-ASA as monotherapy. MethodsPatients diagnosed with isolated colonic CD and treated with 5-ASA but never exposed to immunosuppressants or biologicals were identified from the local databases of five referral centres. A retrospective review of clinical and endoscopic outcomes was performed. ResultsOut of 545 patients with isolated colonic CD, 106 (19%) were treated with oral 5-ASA in monotherapy as maintenance therapy. The median follow-up was 144 months (interquartile range [IQR], 48–234). Almost all of the patients (92%) presented an inflammatory pattern and 11% developed perianal disease. Half of the patients had already received 5-ASA at diagnosis, and the median duration of 5-ASA treatment was 107 months (IQR 22.5–187). Endoscopic remission, as defined by the absence of ulcers at the last complete colonoscopy, was observed in 65% of those patients undergoing at least one colonoscopy during follow-up. Male gender and extraintestinal manifestations were associated with a lower likelihood of achieving endoscopic remission. Nine patients required colectomy, but mostly soon after CD diagnosis. Conclusions5-ASA seems to be of benefit in the long-term in one fifth of patients with colonic CD as the only maintenance therapy and should be considered in fragile patients with Crohn's colitis.

Patient attitudes towards changes in colorectal cancer surveillance: An application of the Health Belief Model

This is to determine whether health beliefs regarding colorectal cancer (CRC) screening could predict discomfort with a change to CRC surveillance proposing regular faecal immunochemical tests (FIT) instead of colonoscopy. Eight hundred individuals enrolled in a South Australian colonoscopy surveillance programme were invited to complete a survey on surveillance preferences. Responses were analysed using binary logistic regression predicting discomfort with a hypothetical FIT-based surveillance change. Predictor variables included constructs based on the Health Belief Model: perceived threat of CRC, perceived confidence to complete FIT and colonoscopy (self-efficacy), perceived benefits from current surveillance and perceived barriers to FIT and colonoscopy. A total of 408 participants (51%) returned the survey (complete data n = 303; mean age 62 years, 52% male). Most participants (72%) were uncomfortable with FIT-based surveillance reducing colonoscopy frequency. This attitude was predicted by a higher perceived threat of CRC (OR = 1.03 [95% CI 1.01-1.04]), higher colonoscopy self-efficacy (OR = 1.34 [95% CI 1.13-1.59]) and lower perceived barriers to colonoscopy (OR = 0.92 [95% CI 0.86-0.99]). Health beliefs regarding colonoscopy and perceived threat of CRC may be important to consider when changing CRC surveillance protocols. If guideline changes were introduced, these factors should be addressed to provide patients reassurance concerning the efficacy of the alternative protocol.

Reversal of Hartmann's procedure: timelines, preoperative investigations and early outcomes. A single Australian institution's ten-year experience.

Real-world data on outcomes following Hartmann's reversal is necessary to help optimize the patient experience. We have explored the timing between the index operation and its reversal; what investigations were carried out prior to this, and the associated short-term outcomes. A retrospective study of all patients who underwent Hartmann's reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann's procedure had a subsequent reversal. Complete patient data was available for 83 of these patients. The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10-23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n=2), patient refusal (n=1) and emergency reversal (n=1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n=28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n=21, 75%). Reversal was associated with a morbidity rate of 47% (n=39). Surgical site infections (SSIs) (n=21, 25%) were the most common type of complications encountered, with the majority being superficial (n=15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p=0.03) and greater hospital length of stay (6 versus 10 days, p=0.03). Only a quarter of emergency Hartmann's procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity.

Bowel preparation using 2-L split-dose polyethylene glycol regimen plus lubiprostone versus 4-L split-dose polyethylene glycol regimen: a randomized controlled trial

BackgroundColonoscopy is a standard procedure for evaluating colon diseases and screening for colorectal cancer, and bowel cleanliness prior to colonoscopy is key. The aim of this study was to compare the bowel cleansing efficacy of low-volume (2 L) split-dose polyethylene glycol (PEG) plus single-dose (24 µg) lubiprostone (LB) and high-volume (4 L) split-dose PEG.MethodsPatients scheduled to undergo outpatient colonoscopy between December 2019 and June 2021 at Rajavithi Hospital were enrolled and randomized into two groups: 2 L PEG + LB or 4 L PEG. Colon cleanliness was evaluated using the Boston Bowel Preparation Scale (BBPS) by reviewing images of the colon after completion of colonoscopy. Secondary outcomes comprised cecal intubation rate, procedure time, withdrawal time, polyp detection rate, adenoma detection rate, patient satisfaction, compliance (based on complete ingestion of bowel preparation regimen), willingness to repeat the preparation regimen, and associated adverse events.ResultsOne hundred and forty patients were included, with 70 in each group. The mean total and segment-specific BBPS scores were not significantly different between groups. However, the rate of adequate bowel preparation was significantly higher in the 2 L PEG + LB group than the 4 L PEG group (100% [95% CI 94.6–100] versus 88.4% [95% CI 78.4–94.9], p = 0.004) in the per-protocol analysis. Colonic polyps were the most common finding. The polyp detection rate, adenoma detection rate, and all secondary outcomes were statistically similar in the two groups (p > 0.05).ConclusionsThe combination of 2 L split-dose PEG plus LB improves bowel cleanliness (based on BBPS scores) to a comparable degree to the standard 4 L split-dose PEG, without additional adverse events and with a lower PEG volume.

Impact of an Abdominal Compression Bandage on the Completion of Colonoscopy for Obese Adults: A Prospective Randomized Controlled Trial

Methods Eligible patients were randomly allocated into the abdominal bandage and conventional groups during a routine colonoscopy. The primary outcome was CCR. Results A total of 250 eligible patients were randomly assigned to the abdominal bandage and conventional groups from January 2021 to April 2021. Eleven patients (five in the abdominal bandage group and six in the conventional group) were excluded due to schedule cancellation after randomization, and 239 patients were eventually included in the final analysis. There were no significant differences between the two groups regarding baseline characteristics (P > 0.05). Furthermore, no significant differences were observed in terms of advanced adenoma detection rate (AADR), polyp detection rate (PDR), bowel preparation scale (BBPS), bubble scale (BS), and withdrawal time between the two groups (P > 0.05). However, compared with the conventional group, the cecal insertion time (CIT) of the abdominal bandage group was significantly shortened (279.00 (234.50–305.75) vs. 421.00 (327.00–485.00), P < 0.001), and the CCR (96.7% vs. 88.2%, P = 0.01) and adenoma detection rate (ADR) (47.5% vs. 32.8%, P < 0.001) were improved. Besides, logistic regression analysis showed that body mass index (BMI) and abdominal compression bandage were associated with CCR. Conclusions Abdominal compression bandages could effectively shorten CIT and improve CCR and ADR for obese patients during a routine colonoscopy. This trial is registered with the Chinese Clinical Trial Registry (No. ChiCTR2100043556).

Fall in colonoscopy completion rates is short lived after a break in performing colonoscopy: a study of how the COVID-19-impacted period affected colonoscopy performance.

Fall in colonoscopy completion rates is short lived after a break in performing colonoscopy: a study of how the COVID-19-impacted period affected colonoscopy performance.

Abstract CT164: A culturally adapted decision support navigation trial to increase colorectal cancer screening among Chinese and Korean American primary care patients

Abstract Background: Colorectal cancer (CRC) is the second most common cancer among Asian Americans. However, cancer screening rates among Chinese- and Korean Americans are lower than other racial/ethnic groups in the United States. To address this disparity, we tested the effectiveness of a culturally adapted decision support navigation trial. Methods: The STOP CRC (Screening TO Prevent CRC) program, a cluster randomized controlled trial, recruited 24 Chinese and Korean primary care physicians (PCP) from Maryland and northern Virginia. Then, 400 Chinese and Korean Americans were recruited through the PCPs’ clinics. Participants randomized to a decision support navigation intervention group (n=200) received an informational booklet, instructions to access colonoscopy screening, and a free fecal immunochemical test (FIT) kit at baseline. A bilingual patient navigator also guided them through an exercise to facilitate screening test choices. Six months after enrollment, participants randomized to the control group (n=200) received the informational booklet, colonoscopy instructions, and a FIT kit. Participants selected a method of CRC screening between the FIT or colonoscopy. Screening (completion of FIT or colonoscopy) was measured at 6 and 12 months after enrollment by medical record review and self-report. Generalized estimating equations (GEE) models with an exchangeable working correlation matrix to account for clustering effects at the PCP level were employed to examine intervention effects on CRC screening outcomes. Results: Intervention and control participants were comparable on socio-demographic background and access to healthcare at baseline. The mean age of participants was 58 years, and 53% of participants were female. The majority of participants (85%) were married, 34% had less than or equal to high school education, 32% had annual household income less than $40,000, and 21% did not have health insurance. At 6 months, screening adherence in the intervention group was (91%) predominantly greater than in the control group (8%) (Prevalence Ratio: 11.31, 95% confidence interval: 6.95-18.43). At 12 months, although the gap between the two groups was reduced, the screening adherence in the intervention group was (93%) still substantially higher than in the control group (63%) (Prevalence Ratio: 1.51, 95% confidence interval: 1.37-1.66). Conclusions: The STOP CRC program, a culturally and linguistically adapted decision support navigation intervention, is effective in increasing CRC screening among Chinese and Korean American primary care patients who are not up-to-date with the screening. This program can potentially be adapted and implemented for other Asian Americans who are not up-to-date with the CRC screening in the U.S. Citation Format: Sunmin Lee, Soomin Ryu, Carissa Kwan, Ronald E. Myers, Yuxi Shi, Luohua Jiang, Brittany N. Morey. A culturally adapted decision support navigation trial to increase colorectal cancer screening among Chinese and Korean American primary care patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT164.

Abstract SY30-03: Colorectal cancer screening in underserved populations: COVID, silver linings, and challenges ahead

Abstract Colorectal cancer (CRC) screening and appropriate follow-up can reduce incidence and mortality, but screening and abnormal test follow-up rates are suboptimal among medically underserved populations. The United States Preventive Services Task Force (USPSTF) recommends CRC screening through a variety of invasive and noninvasive tests for adults aged 50 to 75 years (grade A) and for individuals aged 45 to 49 years (grade B). Evidence-based interventions and other strategies exist to promote CRC screening, but adoption and implementation of these are limited, especially among medically underserved individuals and those receiving care at community health centers (CHCs) in the United States. Aside from low screening uptake, low colonoscopy follow-up of abnormal stool tests is common in CHCs, estimated to be approximately 50%. Lack of colonoscopy completion for abnormal stool tests defeats the purpose of screening because early-stage cancers go undetected, resulting in higher CRC mortality. Reasons for lack of colonoscopy completion are poorly understood. Cancer screening rates have plummeted as a result of the coronavirus disease 2019 (COVID-19) pandemic, resulting in an estimated 10,000 deaths from breast and CRC alone in the U.S. over the next 10 years. The impact of this drop specific to racial/ethnic groups and communities facing barriers prior to the pandemic is unknown. Prior to the onset of the pandemic, the National Cancer Institute invested in CRC screening research as a result of the Cancer Moonshot’s Blue Ribbon Panel recommendation through its Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) initiative. ACCSIS supports research to build the evidence base on multilevel interventions to increase CRC screening, follow-up, and referral to care. Five ACCSIS research projects and a 3-site American Indian project are supported through this initiative, all focusing on underserved populations across the US. This presentation will provide an overview of the key components of the ACCSIS program, challenges faced resulting from the pandemic, and opportunities for overcoming these. In its 2022 report, the President’s Cancer Panel called for equitable cancer screening as a top public health priority. The report emphasizes that overcoming barriers to CRC screening and follow-up among underserved populations must be addressed to ensure that the benefits reach all populations. This provides a timely opportunity to address the extraordinary CRC screening challenges and disparities faced by vulnerable populations. Citation Format: Maria Elena Martinez. Colorectal cancer screening in underserved populations: COVID, silver linings, and challenges ahead [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr SY30-03.

Comparison of ciprofol (HSK3486) versus propofol for the induction of deep sedation during gastroscopy and colonoscopy procedures: A multi‐centre, non‐inferiority, randomized, controlled phase 3 clinical trial

Ciprofol is a propofol analogue with improved pharmacokinetic properties. A multi‐centre, non‐inferiority trial was conducted to compare the deep sedation properties of ciprofol and propofol with a non‐inferiority margin of 8% in patients undergoing gastroscopy and colonoscopy. In total, 289 patients were randomly allocated for surgery (259 colonoscopy and 30 gastroscopy) at a 1:1 ratio to be given intravenous injections of ciprofol (0.4 mg/kg) or propofol (1.5 mg/kg). The primary outcome was the success rate of colonoscopy defined as colonoscopy completion with no need for an alternative sedative or >5 ciprofol or propofol top up doses within any 15‐min time period. The success rate of colonoscopy was 100% in the ciprofol group vs. 99.2% in the propofol group (mean difference 0.8%, 95% CI: −2.2% to 4.2%). Except for the gastrointestinal lesions found during the gastroscopy and colonoscopy procedures, the occurrence rates of adverse drug reactions in the ciprofol and propofol groups were 31.3% and 62.8%, respectively (P < 0.001). Pain on injection was less common in the ciprofol group (4.9% vs. 52.4%, P < 0.001). The outcomes demonstrated that ciprofol was non‐inferior to propofol with regard to successful sedation for gastroscopy or colonoscopy procedures and no obvious important adverse events occurred.

What size cutoff level should be used to implement optical polyp diagnosis?

BACKGROUND : The risk of advanced pathology increases with polyp size, as does the potential for mismanagement when optical diagnosis is used. This study aimed to evaluate the proportion of patients who would be assigned inadequate surveillance intervals when different size cutoffs are adopted for use of optical diagnosis. METHODS : In a post hoc analysis of three prospective studies, the use of optical diagnosis was evaluated for three polyp size groups: 1-3, 1-5, and 1-10 mm. The primary outcome was the proportion of patients in whom advanced adenomas were found and optical diagnosis resulted in delayed surveillance. Secondary outcomes included agreements between surveillance intervals based on high confidence optical diagnosis and pathology outcomes, reduction in histopathological examinations, and proportion of patients who could receive an immediate surveillance recommendation. RESULTS : We included 3374 patients (7291 polyps ≤ 10 mm) undergoing complete colonoscopies (median age 66.0 years, 75.2 % male, 29.6 % for screening). The percentage of patients with advanced adenomas and either 2- or 7-year delayed surveillance intervals (n = 79) was 3.8 %, 15.2 %, and 25.3 % for size cutoffs of 1-3, 1-5, and 1-10 mm polyps, respectively (P < 0.001). Surveillance interval agreements between pathology and optical diagnosis for the three groups were 97.2 %, 95.5 %, and 94.2 %, respectively. Total reductions in pathology examinations for the three groups were 33.5 %, 62.3 %, and 78.2 %, respectively. CONCLUSION : A 3-mm cutoff for clinical implementation of optical diagnosis resulted in a very low risk of delayed management of advanced neoplasia while showing high surveillance interval agreement with pathology and a one-third reduction in overall requirement for pathology examinations.

Increasing colorectal screenings with navigation at federally qualified health centers.

e18566 Background: From 2017 to 2019 there were a total of 423 federally qualified health center colonoscopy referrals (FQHC's) and only 81 (19%) patients followed through and had colonoscopies completed, identifying a significant gap in cancer care within an at risk populations. Methods: The Community Outreach team used a team based problem solving tools and data analytics to increase the number of patients who received colon screenings from FQHC’s. The team held brief, weekly huddles using a variety of continuous improvement tools to identify possible causes of the problem. The team identified 14 potential causes of the 19% gap in FQHC referrals to colonoscopy screenings. The potential causes were analyzed and 4 were identified as the root cause and grouped by common themes into the following opportunities for improvement: Poor engagement with FQHC's. Lack of knowledge on FQHC healthcare effectiveness data and information sets. No standardized workflow for FQHC referrals within the navigation process. Inefficient process for filling the number of screening appointment slots. After identifying the key potential causes, the team developed a task list with countermeasures for improvement and met weekly until the tasks were completed. Through root cause analysis the following key countermeasures were identified: Countermeasure 1: Increased engagement through weekly calls and monthly in person meetings at FQHC's. Countermeasure 2: Developed a quarterly newsletter for FQHC's to review colonoscopy referrals and completed screenings. Countermeasure 3: Developed and implemented a standardized process flow for receiving referrals from FQHC's. Countermeasure 4: Worked with the analytics team to create a dashboard to analyze the real time referrals and completed screenings along with sending e-mail notifications to the navigation program manager providing daily visual management of the number of new patient referrals from FQHC's. Results: After implementing the countermeasures, the community outreach team improved the number of FQHC referrals, from 423 in January of 2017 thru January 2019 to 1399 from January 2020 of December 2021.This was a 160% improvement. They also increased the number of completed colonoscopies from FQHC's from 81 in January of 2017 thru January of 2019 to 328 in January of 2020 thru December of 2021. This was a 200% improvement. The completed screening rate is 23% up from 18%. Conclusions: This project demonstrates the value of utilizing problem solving, visual management and data analytics for continuous quality improvement projects related to patient care. Cross-disciplinary collaboration should be explored with the use of visual tools and other resources to facilitate communication that is understood by all disciplines. The use of patient navigation to schedule patient screening appointments, reminders calls and resolved barriers improved no show rates.

Barriers associated with inadequate follow-up of abnormal fecal immunochemical test results in a safety-net system: A mixed-methods analysis

In safety-net healthcare systems, colonoscopy completion within 1-year of an abnormal fecal immunochemical test (FIT) result rarely exceeds 50%. Understanding how electronic health records (EHR) documented reasons for missed colonoscopy match or differ from patient-reported reasons, is critical to optimize effective interventions to address this challenge. We conducted a convergent mixed-methods study which included a retrospective analysis of EHR data and semi-structured interviews of adults 50–75 years old, with abnormal FIT results between 2014 and 2020 in a large safety-net healthcare system. Of the 299 patients identified, 59.2% (n = 177) did not complete a colonoscopy within one year of their abnormal result. EHR abstraction revealed a documented reason for lack of follow-up colonoscopy in 49.2% (n = 87/177); patient-level (e.g., declined colonoscopy; 51.5%) and multi-factorial reasons (e.g., lost to follow-up; 37.9%) were most common. In 18 patient interviews, patient (e.g., fear of colonoscopy), provider (e.g., lack of result awareness), and system-level reasons (e.g., scheduling challenges) were most common. Only three reasons for lack of colonoscopy overlapped between EHR data and patient interviews (competing health issues, lack of transportation, and abnormal FIT result attributed to another cause). In a cohort of safety-net patients with abnormal FIT results, the most common reasons for lack of follow-up were patient-related. Our analysis revealed a discordance between EHR documented and patient-reported reasons for lack of colonoscopy after an abnormal FIT result. Mixed-methods analyses, as in the present study, may give us the greatest insight into modifiable determinants to develop effective interventions beyond quantitative and qualitative data analysis alone.

Effect of Patient-Directed Messaging on Colorectal Cancer Screening

Colorectal cancer (CRC) screening is underused in the US. Tailored message interventions have shown benefit for increasing screening uptake of mammography and Papanicolaou testing, but their role in CRC screening is less clear. To evaluate the effectiveness of a tailored message telephone intervention prior to scheduling of a screening or surveillance colonoscopy and its effect on CRC screening completion rates. This randomized clinical trial was conducted from July 2017 through August 2018 at the University of Pennsylvania Health System (UPHS), an urban academic medical center. Participants were asymptomatic patients aged 50 to 75 years who were eligible for CRC screening or surveillance, had been referred for colonoscopy, and did not have a scheduled colonoscopy appointment. Data analysis was conducted from January to September 2019. Patients underwent block randomization in a 1:1:1 ratio to 1 of 3 study arms. Participants in the usual care group were contacted via a mailed letter and instructed to call to schedule a colonoscopy. In the generic message group, participants were contacted by telephone, completed an assessment, and received a uniform, nontailored message encouraging colonoscopy scheduling. Participants in the tailored message group were contacted by telephone, completed an assessment, and received a tailored message encouraging colonoscopy scheduling based on their identified assessment cohort. The primary outcome was colonoscopy completion rate within 120 days of enrollment. The secondary outcome was colonoscopy scheduling rate appointment within 120 days of enrollment. A total of 600 participants (median [IQR] age, 56 [51-63] years; 373 women [62.2%]) were enrolled, including 200 participants randomized to usual care, 200 participants randomized to the generic message, and 200 participants randomized to the tailored message. The total sample included 12 Asian participants (2.0%), 324 Black participants (54.0%), and 227 White participants (37.8%), and 9 participants (1.5%) were of Latino or Hispanic ethnicity. Colonoscopy completion was significantly higher for both the tailored message group (69 participants [34.5%]) and the generic message group (64 participants [32.0%]) compared with the usual care group (37 participants [18.5%]) (P < .001 and P = .002, respectively). Scheduling rates were also significantly higher in both groups, with 106 participants (53.0%) in the tailored message group and 105 participants (52.5%) in the generic message group scheduling appointments, compared with 54 participants (27.0%) in the usual care arm (P < .001 for both). In this randomized clinical trial among individuals whose CRC screening was not up to date, both a tailored message intervention and a generic message intervention were significantly more effective at increasing colonoscopy scheduling and completion rates compared with usual care. These findings suggest that individualized health communications can increase individual motivation to obtain CRC screening. ClinicalTrials.gov Identifier: NCT03310892.

Efficacy of Remimazolam for Procedural Sedation in American Society of Anesthesiologists (ASA) I to IV Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis.

Remimazolam is made by combining midazolam and remifentanil as an alternative to conventional sedatives. To evaluate the efficacy of remimazolam for sedation in patients undergoing colonoscopy, we conducted a systematic review and meta-analysis of the available randomized controlled trials (RCTs) comparing remimazolam and midazolam. A search was conducted using PubMed, Cochrane Library, and clinicaltrial.gov from inception till December 26, 2021, for RCTs that investigated the efficacy of remimazolam during the above-mentioned procedure. There was no restriction of language. A quality assessment was performed using the Cochrane Risk-of-Bias tool. The data were pooled, and a meta-analysis was completed. The systemic review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guideline statement. Three randomized controlled trials involving 539 patients were included in the meta-analysis. Compared with midazolam during colonoscopy, remimazolam results in reduced need for top-up doses (RR= 3.45, 95% CI=1.07 to 11.14; P=0.04, I2=84%). The need for rescue medication was reduced with remimazolam as compared to midazolam (RR=2.42, 95%CI=1.04 to 5.61; P=0.04, I2=96%). There was no significant difference observed between the two drugs on completion of colonoscopy and the overall procedural sedation, but the sensitivity analysis favored remimazolam over midazolam for procedural sedation (RR=4.08, 95%CI=2.35 to 7.09; P<0.00001, I2=39%). This analysis demonstrates the advantages of remimazolam over other agents and sets a platform for relevant future studies.

Faecal haemoglobin concentration in adenoma, before and after polypectomy, approaches the ideal tumour marker.

BackgroundPolypectomy may be performed at colonoscopy and then subsequent surveillance undertaken. It is thought that faecal haemoglobin concentration (f-Hb), estimated by quantitative faecal immunochemical tests (FIT), might be a useful tumour marker.MethodsConsecutive patients enrolled in colonoscopy surveillance were approached at two hospitals. A specimen for FIT was provided before colonoscopy and, ideally after 3 weeks, a second FIT sample from those who had polypectomy. A single FIT system (OC-Sensor io, Eiken Chemical Co., Ltd) was used to generate f-Hb.Results1103 Patients were invited; 643 returned a FIT device (uptake: 58.3%). Four patients had known inflammatory bowel disease (IBD) and were excluded, leaving 639 (57.9%) with an age range of 25–90 years (median 64 years), 54.6% male. Of 593 patients who had a f-Hb result and completed colonoscopy, advanced neoplasia was found in 41 (6.9%); four colorectal cancer (CRC): 0.7% and 37 advanced adenoma (AA): 6.3%, and a further 127 (21.4%) had non-advanced adenoma (NAA). The median f-Hb was significantly greater in AA as compared to NAA; 6.0 versus 1.0 μg Hb/g faeces, p < 0.0001.134/164 (81.7%) of invited patients returned a second FIT device: 28 were patients with AA in whom median pre-polypectomy f-Hb was 19.2, falling to 3.5 μg Hb/g faeces post-polypectomy, p = 0.01, and 106 with NAA had median pre-polypectomy f-Hb 0.8 compared to 1.0 μg Hb/g faeces post-polypectomy, p = 0.96.ConclusionsQuantitative FIT could provide a good tumour marker in post-polypectomy surveillance, reduce colonoscopy requirements and minimise potential risk to patients.

REducing Colonoscopies in patients without significant bowEl DiseasE: the RECEDE Study - protocol for a prospective diagnostic accuracy study

IntroductionDemand for colonoscopies and CT colonography (CTC) is exceeding capacity in National Health Service Trusts. In many patients colonoscopies and CTCs show no significant bowel disease (SBD). Faecal Immunochemical Testing...

A107 WHAT SIZE CUT-OFF LEVEL SHOULD BE USED TO IMPLEMENT OPTICAL POLYP DIAGNOSIS?

BackgroundThe risk of advanced pathology and potential mismanagement increases with polyp size while performing optical diagnosis. We hypothesized that a lower polyp size cut-off (e.g., 1–3 mm) would be associated with a lower risk of misclassifying advanced neoplasia or even cancer when using optical diagnosis.AimsThis study aimed to evaluate the proportion of patients undergoing inadequate surveillance intervals associated with different size cut-offs when using optical diagnosis.MethodsIn a post-hoc analysis of three prospective studies, the use of optical diagnosis was evaluated for three polyp size groups: 1–3, 1–5, and 1–10 mm. The primary outcome was the proportion of patients in which advanced adenomas were found and optical diagnosis resulted in delayed surveillance in each group. Secondary outcomes included agreements between surveillance intervals based on high-confidence optical diagnosis and pathology outcomes, reduction in histopathological examinations, and proportion of patients who could receive an immediate surveillance recommendation.ResultsWe included 3374 patients (7291 polyps ≤10 mm) undergoing complete colonoscopies (median age 66.0 years, 75.2% male, 29.6% for screening). Among polyp sized 1–3 mm, 1–5 mm, and 1–10 mm, 0.5%, 0.6%, and 1.2% of polyps, respectively, were found to have advanced pathology ( P <.0001). The percentage of patients with advanced adenomas and either 2- or 7- year delayed surveillance intervals (n=79) was 3.8%, 15.2%, and 25.3% for size cut-offs of 1–3, 1–5, and 1–10 mm polyps, respectively ( P<.0001). Surveillance interval agreements between pathology and high-confidence optical diagnosis for the three groups were 97.2%, 95.5%, and 94.2%, respectively. In the cohort of patients in which patients with normal colonoscopy, polyps >10 mm, and poor bowel preparation were excluded, the surveillance interval agreements between pathology and high-confidence optical diagnosis for the three groups were 96.2%, 93.6%, and 92.1%, respectively. Total reduction in pathology examinations for the three groups were 33.5%, 62.3%, and 78.2%, respectively. Furthermore, optical diagnosis could have allowed 41.0%, 58.2%, and 73.3% of patients, respectively, to be given immediate surveillance interval recommendations.ConclusionsThis study showed that limiting optical diagnosis to polyps 1–3 mm resulted in an excellent safety profile with a very low risk for inappropriate management of advanced adenomas, which makes routine clinical implementation of the “resect and discard” strategy feasible. Implementing a 3 mm cut-off could be a starting point for endoscopists to feel comfortable with the “resect and discard” strategy, with the potential of implementing a 5 mm cut-off, once optical diagnosis becomes more popular, and endoscopists become more comfortable with its use. Figure 1. The percentage of surveillance interval agreement (correct assignment of surveillance intervals) between histopathology and optical diagnosis in all patients with valid determination of surveillance intervals, and in patients for whom optical diagnosis could have affected their next recommended surveillance intervals, using the NICE classification.Funding AgenciesNoneNA

A Global Evaluation of the Performance Indicators of Colorectal Cancer Screening with Fecal Immunochemical Tests and Colonoscopy: A Systematic Review and Meta-Analysis.

Simple SummaryThis study is a systematic review and meta-analysis of international literature on the achievements of various performance indicators for colorectal cancer screening programs. We systematically summarized performance indicators of organized colorectal cancer screening that used fecal immunochemical test as a primary screening modality, and colonoscopy as a subsequent confirmatory test, from 93 studies involving nearly 90 million people-times, and reported their pooled achievements based on random-effects models. We also performed meta-regression and subgroup analyses to explore the heterogeneity. Our findings could help to identify the areas that could be improved and finally optimize the organized colorectal cancer screening programs.(1) Background: To summarize the achievements of the performance indicators of colorectal cancer (CRC) screening programs that used the fecal immunochemical test (FIT) as a primary screening modality and colonoscopy as a subsequent confirmatory test. (2) Methods: PubMed, Ovid MEDLINE, Embase, and Cochrane were searched from inception to September 2020. We included original articles published in English, and performed hand searching for relevant national reports. We generated pooled achievement estimates of the performance indicators by “metaprop” (R software 3.6.3). Meta-regression analyses and subgroup analyses were also conducted. (3) Results: We included 93 studies involving nearly 90 million people-times. The participation rate ranged from 6.80% to 95.98%, which was associated with study type, continents, FIT number, age, and round. The pooled FIT invalid rate and positivity rate were 1.08% and 7.28%, respectively. The pooled estimates of FIT detection were 2.26% for adenoma, 1.26% for advanced adenoma, and 0.28% for CRC. In addition, only seven studies reported that their colonoscopy compliance rate reached 90% among 69 studies. The colonoscopy completion rate (21/40 studies > 95%) and the complication rate (18/27 studies < 0.5%) were acceptable. (4) Conclusions: Our findings could help to identify the areas that could be improved and finally optimize the CRC screening programs.

Decreasing colorectal cancer screening disparities: A culturally tailored patient navigation program for Hispanic patients.

Colorectal cancer (CRC) is the second leading cause of cancer-related death in Hispanic patients. Screening colonoscopy has been shown to reduce the incidence and mortality of CRC. However, utilization among Hispanic patients and other minority groups is low. The objective of this study was to evaluate colonoscopy utilization among Hispanic patients with a culturally tailored patient navigation program (CTPNP) in place. A CTPNP was designed to meet the needs of the authors' Hispanic patient population and their health care system characteristics. A CTPNP protocol was created, and a Spanish-speaking navigator/coordinator was hired. Enrolled patients received a Spanish-language introductory letter, an initial phone call for patient education, and follow-up calls to ensure that all potential barriers to colonoscopy were overcome. Colonoscopy completion (CC), colonoscopy cancellation (CN), and colonoscopy no-show (NS) rates were recorded and compared with historical rates in Rhode Island. Over a 28-month period, 773 patients were referred to the CTPNP, and 698 (53% female and 47% male) were enrolled in the program. The overall CC rate was 85% (n=592) with no difference between males and females. The CN rate was 9% (n=62), and the NS rate was 6% (n=44). The most common reasons for CN and NS were cost and an inability to contact the patient after referral. Within the CC group, 43% (n=254) of patients underwent polypectomy, and 1.3% (n=8) required colectomy. Ninety percent (n=530) of the CC group reported that they would not have completed colonoscopy without the CTPNP. Implementation of a CTPNP is an effective intervention to improve the CC rate and eliminate the historical gender gap in utilization among Hispanic patients.

ADEQUACY OF SIGMOIDOSCOPY IN COMPARISION TO COLONOSCOPY TO ASSESS DISEASE ACTIVITY DURING FOLLOW UP IN PATIENTS WITH ULCERATIVE COLITIS

Abstract BACKGROUND Endoscopic remission is the current treatment target in patients with Ulcerative Colitis (UC). Literature on adequacy of sigmoidoscopy in comparison to colonoscopy to assess endoscopic and histologic activity during follow up is sparse. METHODS This is an interim analysis of a prospective study of patients diagnosed with UC with disease extent proximal to the sigmoid colon. Fifty adult patients underwent a complete colonoscopy with segmental biopsies. Endoscopic disease activity was graded using Mayo Endoscopic Subscore (MES) and the Ulcerative Colitis Endoscopic Index of Severity score (UCEIS). The histological grading was done using the Nancy score, Robarts Histopathology Index (RHI) and Simplified Geboes Score (SGS). The maximum rectosigmoid disease activity was compared with the maximum disease activity in the rest of the colon. RESULTS Endoscopic Correlation: Sigmoidoscopic evaluation using MES showed good correlation with pan colonoscopic evaluation for disease activity with a sensitivity of 92.11%, specificity of 66.67%, accuracy of 86% (95% CI – 73.26% to 94.18%), kappa value (k) of 0.58 (p value &amp;lt; 0.001) and Area under curve (AUC) of 0.82 (95% CI- 0.74 to 0.942). Similarly, sigmoidoscopic evaluation using UCEIS score showed good correlation with pan colonoscopic evaluation for disease activity with a sensitivity of 95.0%, specificity of 70%, accuracy of 90% (95% CI – 78.19% to 96.67%), k of 0.68 (p value &amp;lt; 0.001) and AUC of 0.895 (95% CI- 0.805 to 0.924). Disease activity in the colon missed by performing a sigmoidoscopy using MES and UCEIS score is only 6% and 4% respectively. Histological Correlation: Histologic findings in rectosigmoid showed good correlation with histologic findings in rest of the colon using Nancy’s score [Sensitivity of 97.96%, specificity of 100%, accuracy of 98% (95% CI – 89.35% to 99.95%), k of 0.658 (p value &amp;lt; 0.001) and AUC of 0.99 (95% CI- 0.959 to 1.0)], Simplified Geboes Score [Sensitivity of 97.92%, specificity of 100%, accuracy of 98% (95% CI – 89.35% to 99.95%), k of 0.79 (p value &amp;lt; 0.001) and AUC of 0.99 (95% CI- 0.962 to 1.0)], and Robarts Histopathology Index [Sensitivity of 95.56%, specificity of 80%, accuracy of 94% (95% CI – 83.45% to 98.75%), k of 0.694 (p value &amp;lt; 0.001) and AUC of 0.878 (95% CI- 0.667 to 1.0) ]. Histologic disease activity in the colon missed by performing a sigmoidoscopy using Nancy score, SGS and RHI is only 2%, 2% and 4% respectively. CONCLUSION In patients diagnosed with UC and having disease extent proximal to the sigmoid colon, sigmoidoscopic evaluation has good correlation with pan colonoscopic evaluation for grading endoscopic and histological disease activity. A sigmoidoscopic examination is adequate to assess the disease activity in patients with disease extent proximal to the sigmoid colon.