Screening Colonoscopy Rates Research Articles

Virtual reality intervention to improve quality of care during colonoscopy: a hybrid type 1 randomized controlled trial

Background and AimsEffective management of patients’ pain, anxiety, and discomfort during colonoscopy is crucial for successful completion of the procedure, patient adherence to follow-up examinations, and patient satisfaction. Virtual Reality (VR) interventions, as a nonpharmacological and innovative solution, have demonstrated promising results in managing these outcomes. Nevertheless, there is limited evidence on their effectiveness and implementation. This trial aimed to test clinical effectiveness and identify factors to facilitate the implementation of VR during colonoscopy. MethodsA hybrid type 1 effectiveness-implementation, parallel randomized controlled, open-label trial was conducted. Fifty patients were randomized (1:1) to a VR or a control group. The effectiveness (pain, anxiety, discomfort, medication usage, and satisfaction) and implementation (reach, adoption, implementation, and maintenance) outcomes were assessed before, during, and after colonoscopy. ResultsPatients in the VR group reported significantly lower pain (p=0.043) and discomfort (p<0.0001) during colonoscopy, had a higher number of completed colonoscopy without sedation (p=0.003), and showed higher satisfaction (p=0.032). The major barrier to the implementation and maintenance of the VR intervention was inadequate VR content design. Staff were most worried about altered patient communications, unclear responsibilities, increasing workload, and patient safety. Patients expressed willingness to reuse VR glasses and to suggest them to other patients. ConclusionVR can be used as a nonpharmacological method for pain management and for overcoming anxiety and discomfort during colonoscopy. VR can improve patients’ satisfaction and diminish the need for sedative medications; accordingly, it has the potential to promote cooperation and compliance among patients and increase screening colonoscopy rates. Clinicaltrials.gov NCT05723861.

Role of Social Support in Screening Colonoscopy/Sigmoidoscopy Uptake among U.S. Adults

Colorectal cancer (CRC) is a major clinical and public health burden. Screening has been shown to be effective in preventing CRC. In 2021, less than 72% of adult Americans had received CRC screening based on the most recent guidelines. This study examined the relationship between social support and screening colonoscopy or sigmoidoscopy uptake among U.S. adults and the socioeconomic factors that impact the relationship. We conducted a cross-sectional study using the 2021 National Health Interview Survey (NHIS) data for 20,008 U.S. adults to assess the weighted rates of screening colonoscopy or sigmoidoscopy among individuals with strong, some, and weak social support. Adjusted binary logistic regression models were utilized to obtain the weighted odds of receiving a screening colonoscopy or sigmoidoscopy among adults with different levels of social support and socioeconomic status. About 58.0% of adults who reported having colonoscopy or sigmoidoscopy had strong social support, compared to 52.0% who had some or weak social support. In addition, compared to adults with weak social support, the weighted adjusted odds of having colonoscopy or sigmoidoscopy were 1.0 (95% C.I. = 0.994, 0.997; p &lt; 0.001) and 1.3 (95% C.I. = 1.260, 1.263; p &lt; 0.001) for adults with some and strong social support, respectively. Socioeconomic differences were observed in the odds of colonoscopy or sigmoidoscopy uptake based on having strong social support. Having strong social support is an important factor in increasing colonoscopy or sigmoidoscopy screening uptake. Policies and interventions that enhance social support among adults for screening colonoscopy or sigmoidoscopy are warranted.

Implementing a tailored communication intervention to increase colonoscopy screening rates among first-degree relatives of people with colorectal cancer: Lessons learned

PurposeTo report the process evaluation of a tailored communication intervention for first-degree relatives of colorectal cancer patients in a randomized controlled trial. MethodBased on the MRC process evaluation framework, the process of delivering a two-arm RCT intervention were evaluated on 3 themes: (1) implementation, (2) mechanism, and (3) contextual factors. Implementation data were collected through a logbook, online tool platform feedback, and questionnaire surveys. Subgroup analysis was conducted for implementation outcomes. The mechanism and contextual factors were analyzed by mediation and moderation analysis. ResultsFrom March 2019 to May 2019, 188 (57%) eligible participants were recruited to participate in this study in Shenzhen, China. In the intervention group, 68 (72.3%) participants received written and verbal sessions. Relatively high satisfaction rates (77.6%–100%) were achieved. The mediating effect was found for perceived barriers (95%CI = −0.880, −0.133) and cues to action (95%CI = 0.043, 0.679). No moderators were identified. People who received the first two sessions are more likely to receive a colonoscopy, whereas the time spent on intervention did not influence the colonoscopy uptake. ConclusionsPotential strategies to enlarge the tailored effect were identified, including tailoring communication on the perceived barriers and cues to action and reinforcing patients’ compliance in the first written and verbal sessions. To accomplish the difficult task of recruiting at-risk family members, direct approaches and adequate records on contact information of at-risk family members are suggested when the cancer cases were identified for the first time.

Impact of the coronavirus disease 2019 pandemic on trends and healthcare disparities in use of screening colonoscopy and adenoma detection rates

Impact of the coronavirus disease 2019 pandemic on trends and healthcare disparities in use of screening colonoscopy and adenoma detection rates

Implementing a Combined Phone and Mail Recall to Increase Screening Colonoscopy Rates in Adults With Chronic Ulcerative Colitis.

Implementing a Combined Phone and Mail Recall to Increase Screening Colonoscopy Rates in Adults With Chronic Ulcerative Colitis.

Impacts of COVID-19 on Appropriate Use of Screening Colonoscopy in a Large Integrated Healthcare Delivery System.

Decreasing low-value colonoscopy is critical to optimizing access for high-need patients, particularly in resource-constrained environments such as those created by the COVID-19 pandemic. We hypothesized that rates of screening colonoscopy overuse would decline during COVID compared to pre-COVID due to enhanced procedural scrutiny and prioritization in the setting of constrained access. To characterize impacts of COVID-19 on screening colonoscopy overuse DESIGN: Retrospective national cohort study using Veterans Health Administration administrative data PARTICIPANTS: Veterans undergoing screening colonoscopy in Q4 2019 (pre-COVID) and Q4 2020 (COVID) at 109 endoscopy facilities MAIN MEASURES: Rates of screening colonoscopy overuse KEY RESULTS: 18,376 screening colonoscopies were performed pre-COVID, 19% (3,641) of which met overuse criteria. While only 9,360 screening colonoscopies were performed in Q4 2020, 25% met overuse criteria. Overall change in median facility-level overuse during COVID compared to pre-COVID was 6% (95%CI 5%-7%), with significant variability across facilities (IQR: 2%-11%). Of colonoscopies meeting overuse criteria, the top reason for overuse in both periods was screening colonoscopy performed <9 years after previous screening procedure (55% pre-COVID, 49% during COVID). The largest shifts in overuse category were in screening procedures performed <9 years after prior screening colonoscopy (-6% decline COVID vs. pre-COVID) and screening procedures performed in patients below average-risk screening age (i.e., age <40 (5% increase COVID compared to pre-COVID), age 40-44 (4% increase COVID vs. pre-COVID)). Within facility performance was stable over time; 83/109 facilities changed their performance by <=1 quartile during COVID compared to pre-COVID. Despite pandemic-related resource constraints and enhanced procedural scrutiny and prioritization in the setting of COVID-related backlogs, screening colonoscopy overuse rates remained roughly stable during COVID compared to pre-COVID, with continued variability across facilities. These data highlight the need for systematic and concerted efforts to address overuse, even in the face of strong external motivating factors.

Implementing a Combined Phone and Mail Recall to Increase Screening Colonoscopy Rates in Adults With Chronic Ulcerative Colitis.

Colon cancer is the third leading cancer nationally. To prevent colon cancer and decrease healthcare costs, high-risk individuals such as adults with chronic ulcerative colitis are recommended to stay up-to-date on screening colonoscopies. Despite these recommendations, screening colonoscopy rates remain low both globally and locally. The purpose of this article is to increase surveillance colonoscopy rates among adult patients with chronic ulcerative colitis. Research supports increasing surveillance colonoscopy rates by implementing a combined phone and mail recall with included educational material on the risks of colon cancer. At a clinic for inflammatory bowel disease patients in Southeast Alabama, participants with chronic ulcerative colitis who were overdue for screening colonoscopies were issued two reminder phone calls and a reminder letter coupled with educational material. Both the calls and letters reminded participants that they were due for a surveillance colonoscopy and provided them with an option to schedule the procedure. A pre- and post-survey was used to evaluate screening colonoscopy rates before and after the intervention. The survey indicated whether a patient had scheduled a colonoscopy, intended to schedule a colonoscopy, or completed a colonoscopy within 3 months of project completion. Survey results revealed an 83% increase in screening colonoscopies post-intervention. A chart audit was also performed 3 months after project completion and results indicated a 70% increase in completed colonoscopy rates. The findings from this evidence-based practice project indicate that implementing a phone and mail recall is successful in increasing screening colonoscopy rates.

S2081 Rare Colonic Polyps: A Case of Langerhans Histiocytosis

Introduction: Langerhans Cell Histiocytosis (LCH) is a rare inflammatory myeloid disorder mostly seen in children before the age of 5. The clinical presentation is heterogeneous with potential for wide-ranging organ involvement, primarily in the bone, skin, and lungs. Gastrointestinal tract involvement is very rare in LCH, and in symptomatic patients, etiology could be confused with infectious, allergic, and autoimmune bowel diseases. In children, LCH GI tract involvement has been associated with decreased survival due to multisystem involvement and digestive complications including diarrhea, vomiting, malabsorption, and failure to thrive. Review of literature shows less than twenty adults with incidences of GI tract involvement of LCH and only 4 cases of adults with LCH colon polyps. Case Description/Methods: A 66-year-old man presented for screening colonoscopy. He reported generally good health without any GI or systemic symptoms or medical history. Family history was significant for leukemia in his brother. He currently smokes cigarettes and has a 2.5 pack-year history. On colonoscopy, 6 benign-appearing polyps were removed using cold snare polypectomy: 3 from the ascending colon (largest 0.5 cm in size), one from the splenic flexure of the transverse colon (0.4 cm in size), and 2 from the rectum (largest 0.4 cm in size). Quality of bowel preparation was excellent and the procedure was without complication. Rectal polyps were hyperplastic. Submucosal sections of the ascending and transverse colon polyps stained positive for CD1a, CD68, and S-100, consistent with Langerhans-type cells. The LCH diagnosis was further supported by irregular nuclei within focal nuclear grooves and an eosinophilic cytoplasm. Genomic testing of the colon sample revealed BRAFV600E mutation, the most recognized targetable mutation in LCH. He underwent further testing with PET scan and bone marrow biopsy, both of which were negative for LCH. Surveillance colonoscopy was recommended in 7 years (Figure 1). Discussion: With his lack of systemic disease and asymptomatic presentation, watchful waiting and Oncology follow-up was recommended. Given the unusual diagnosis of LCH via a colon polyp, it is possible for lesions to be clinically unsuspected and histologically overlooked. With increasing rates of screening colonoscopy, more polyps demonstrating LCH on histopathology may be identified. Reports of LCH in the GI tract and colon polyps are infrequent and characterization of outcomes will rely on further cases in this population.Figure 1.: Positive immunostaining for CD1a, classically expressed by Langerhans cells.

Mailed fecal testing and patient navigation versus usual care to improve rates of colorectal cancer screening and follow-up colonoscopy in rural Medicaid enrollees: a cluster-randomized controlled trial

BackgroundScreening reduces incidence and mortality from colorectal cancer (CRC), yet US screening rates are low, particularly among Medicaid enrollees in rural communities. We describe a two-phase project, SMARTER CRC, designed to achieve the National Cancer Institute Cancer MoonshotSM objectives by reducing the burden of CRC on the US population. Specifically, SMARTER CRC aims to test the implementation, effectiveness, and maintenance of a mailed fecal test and patient navigation program to improve rates of CRC screening, follow-up colonoscopy, and referral to care in clinics serving rural Medicaid enrollees.MethodsPhase I activities in SMARTER CRC include a two-arm cluster-randomized controlled trial of a mailed fecal test and patient navigation program involving three Medicaid health plans and 30 rural primary care practices in Oregon and Idaho; the implementation of the program is supported by training and practice facilitation. Participating clinic units were randomized 1:1 into the intervention or usual care. The intervention combines (1) mailed fecal testing outreach supported by clinics, health plans, and vendors and (2) patient navigation for colonoscopy following an abnormal fecal test result. We will evaluate the effectiveness, implementation, and maintenance of the intervention and track adaptations to the intervention and to implementation strategies, using quantitative and qualitative methods. Our primary effectiveness outcome is receipt of any CRC screening within 6 months of enrollee identification. Our primary implementation outcome is health plan- and clinic-level rates of program delivery, by component (mailed FIT and patient navigation). Trial results will inform phase II activities to scale up the program through partnerships with health plans, primary care clinics, and regional and national organizations that serve rural primary care clinics; scale-up will include webinars, train-the-trainer workshops, and collaborative learning activities.DiscussionThis study will test the implementation, effectiveness, and scale-up of a multi-component mailed fecal testing and patient navigation program to improve CRC screening rates in rural Medicaid enrollees. Our findings may inform approaches for adapting and scaling evidence-based approaches to promote CRC screening participation in underserved populations and settings.Trial registrationRegistered at clinicaltrial.gov (NCT04890054) and at the NCI’s Clinical Trials Reporting Program (CTRP #: NCI-2021-01032) on May 11, 2021.

Development and feasibility of an evidence-based and theory-driven tailored mHealth communication intervention to increase colonoscopy screening rate in first-degree relatives of people with colorectal cancer.

To develop and investigate the feasibility of an evidence-based and theory-driven tailored communication to increase colonoscopy screening rates amongst first-degree relatives of colorectal cancer patients. Based on the tailoring process and identified evidence from the systematic review conducted by the research team, the tailored communication was developed from four aspects: (1) tailoring variables (e.g., demographic, behavioural, and psychosocial characteristics), (2) decision rules, (3) tailored messages and (4) delivery plan. Expert (n=5) and layman review (n=5) were conducted to ensure the content validity of decision rules and tailored messages. A single-blinded, family-based cluster randomised controlled trial (n=21) tested the feasibility and acceptability of the intervention. A three-session mobile-based tailored intervention with clear decision rules and 27 tailored messages were developed. In the feasibility study, the recruitment rate was 34.4%. The response rate at 1-month post-intervention was 61.9%. After a voice call was added for nonresponders, the response rate at the 3-month post-intervention increased to 81%. All participants were satisfied with the intervention and agreed that the intervention helped them understand the risks and appropriate screening recommendations. The development of a three-session mobile-based tailored intervention with an integrated tailoring decision and message system was reported in this study. Given its remote nature, the mobile-based tailored intervention may encounter challenges in family recruitment and online assessment. Suggestions on (1) study design to avoid contamination, (2) recruitment approaches and (3) strategies to promote response to online questionnaires were made for a future definitive trial.

A Review of the Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: Implications and Solutions.

The COVID-19 pandemic has impacted all aspects of medical care, including cancer screening and preventative measures. Colorectal cancer screening declined significantly at the onset of the pandemic as the result of an intentional effort to conserve resources, prioritize emergencies and reduce risk of transmission. There has already been an increase in diagnosis at more advanced stages and symptomatic emergencies due to suspended screenings. As endoscopy units find their way back to pre-pandemic practices, a backlog of cases remains. The missed CRC diagnoses amongst the missed screenings carry a risk of increased morbidity and mortality which will only increase as time-to-diagnosis grows. This review discusses the impact of COVID-19 on colonoscopy screening rates, trends in stages/symptoms/circumstances at diagnosis, and economic and social impact of delayed diagnosis. Triaging and use of FITs are proposed solutions to the challenge of catching up with the large number of pandemic-driven missed CRC screenings.

The national FIT-based colorectal cancer screening program in the Netherlands during the COVID-19 pandemic

The COVID-19 pandemic has affected many healthcare services worldwide. Like many other nations, the Netherlands experienced large numbers of individuals affected by COVID-19 in 2020, leading to increased demands on hospitals and intensive care units. The Dutch Ministry of Health decided to suspend the Dutch biennial fecal immunochemical test (FIT) based colorectal cancer (CRC) screening program from March 16, 2020. FIT invitations were resumed on June 3. In this study, we describe the short-term effects of this suspension on a myriad of relevant screening outcomes. As a result of the suspension, a quarter of the individuals due for screening between March and November 2020 had not received their invitation for FIT screening by November 30, 2020. Furthermore, 57.8% of those who received a consecutive FIT between the restart and November 30, 2020, received it outside the upper limit of the standard screening interval (26 months). Median time between positive FIT and colonoscopy did not change as a result of the pandemic. Participation rates of FIT screening and follow-up colonoscopy in the months just before and during the suspension were significantly lower than expected, but returned to normal levels after the suspension. Based on the anticipated 2020 cohort size, we estimate that the number of individuals with advanced neoplasia currently detected up until November 2020 was 31.2% lower compared to what would have been expected without a pandemic. Future studies should monitor the impact on long-term screening outcomes as a result of the pandemic.

Mitigating the impact of COVID-19 on colorectal cancer screening: Organized service screening perspectives from the Asia-Pacific region

Colorectal cancer(CRC) is one of the most prevalent malignancies in the Asia-Pacific region, and many countries in this region have launched population CRC service screening. In this study, CRC screening key indicators, including the FIT(fecal immunochemical test) screening rate (or participation rate) and the rate of undergoing colonoscopy after positive FIT in 2019 and 2020, were surveyed in individual countries in the Asia-Pacific region. The impact of the pandemic on the effectiveness of CRC screening was simulated given different screening rates and colonoscopy rates and assuming the pandemic would persist or remain poorly controlled for a long period of time, using the empirical data from the Taiwanese program and the CRC natural history model.During the COVID-19 pandemic, most of the programs in this region were affected, but to different extents, which was largely influenced by the severity of the local pandemic. Most of the programs continued screening services in 2020, although a temporary pause occurred in some countries. The modeling study revealed that prolonged pauses of screening led to 6% lower effectiveness in reducing CRC mortality.Screening organizers should coordinate with health authorities to elaborate on addressing screening backlogs, setting priorities for screening, and applying modern technologies to overcome potential obstacles. Many novel approaches that were developed and applied during the COVID-19 pandemic, such as the risk-stratified approach that takes into account personal CRC risk and the local epidemic status, as well as new digital technologies, are expected to play important roles in CRC screening in the future.

Abstract S02-04: Drive By Flu-FIT: A novel way to mitigate the decrease in colorectal cancer screening during the COVID-19 pandemic

Abstract Background: During the height of the COVID-19 pandemic, screening colonoscopy rates decreased by 90%. The decreased screening rates will increase the burden of colorectal cancer (CRC) in communities. The pandemic has created a need for novel models for safely engaging and screening community members for CRC. Methods: We implemented NCI’s Screen to Save CRC screening campaign using a socially-distanced, Drive By Flu-FIT protocol and report the results of the FIT component of the program. In partnership with the leadership of Enon Tabernacle Church, the largest Baptist church in the Philadelphia region, we invited community members at average risk for CRC and between the ages of 45-75 to register for one of three Drive by Flu-FIT events held between Oct-Nov, 2020. Interested participants also completed eligibility, registration, and demographic questionnaires administered electronically via REDCap. Upon completion of these questionnaires, participants watched a 8-minute CRC screening educational video and pre- and post- CRC knowledge and intentions questionnaires. Participants who attended one of the three events received a Flu vaccine and/or FIT test and instructions to return the completed FIT to a medical collection box at Enon Tabernacle Church. This research was approved by the University of Pennsylvania’s Institutional Review Board. Results: Of the 335 participants that registered for the event, 80 (23.9%) did not show, 63 (18.8%) were ineligible and 192 attended the event and received a FIT (57.3%). Reasons for ineligibility were: age outside of the recommended age for screening (n=40); having had a recent colonoscopy (n=13); symptoms/signs of CRC including change in your bowel habits, rectal bleeding, abdominal pain, iron deficiency anemia, unexplained weight loss (n=10); a possible family history or possible Lynch syndrome (n=1). Patients with symptoms/signs and family history of CRC were referred to colonoscopy. The 192 participants that comprised this analytic had a mean (s.d.) age of 58.9 (9.5) years, 60.4% were female, 93.8% self-identified as Black, and 1.6% as Hispanic. The pre- and post-knowledge scores showed an increase after the video intervention (p=0.0006) as did the intention to screen scores (p=0.007). To date, of the 192 participants who received a FIT, 38 (19.7%) did not return the FIT, 141 (73.4%) had a negative FIT result and 13 (6.7%) had a positive FIT result and were referred to colonoscopy. The results of colonoscopy are pending. Conclusions This research shows that a socially-distanced Drive By Flu-FIT program is feasible, acceptable and effective in engaging the community in CRC education and screening during the COVID-19 pandemic. Novel programs such as this can help mitigate the significant decline in screening for CRC that has occurred as a result of the COVID-19 pandemic and, thus, can help reduce the burden of CRC in our diverse communities. Citation Format: Armenta Washington, Leroy Miles, Claudia Melendez, Brenda Bryant, Alexander Auchus, Michael Goldberg, Scott Melnick, Juanita Way, Danielle Grant, Kimberly Highsmith, Carmen E. Guerra. Drive By Flu-FIT: A novel way to mitigate the decrease in colorectal cancer screening during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S02-04.

Impact of COVID-19 pandemic on fecal immunochemical test screening uptake and compliance to diagnostic colonoscopy.

Background and AimDuring this COVID‐19 pandemic, Taiwan is one of the few countries where fecal immunochemical test and endoscopic activity for colorectal cancer screening keeps ongoing. We aimed to investigate how screening uptake and colonoscopy rate were affected in one of the biggest screening hubs in Northern Taiwan.MethodsWe conducted a prospective observational study tracing and analyzing the screening uptake and the trend of compliance to diagnostic colonoscopy in fecal immunochemical test‐positive subjects in the National Taiwan University Hospital screening hub since the outbreak of COVID‐19 and compared it with that of the corresponding periods in the past 3 years. Cancellation and rescheduling rates of colonoscopy and related reasons were also explored.ResultsScreening uptake during December 2019 to April 2020 was 88.8%, which was significantly lower than that in the corresponding period of the past 3 years (91.2–92.7%, P for trend < 0.0001). Colonoscopy rate in this period was 66.1%, which was also significantly lower than that in the past 3 years (70.2–77.5%, P for trend = 0.017). Rescheduling or cancellation rate was up to 10.9%, which was significantly higher than that in the past 3 years (P for trend = 0.023), and half of them was due to the fear of being infected.ConclusionFecal immunochemical test screening was significantly affected by COVID‐19 pandemic. In order to resume the practice in COVID‐19 era, screening organizers should consider various approaches to secure timely diagnosis of colorectal cancer.

237 Increased Polyp Detection Using a Novel 360 Degree Integrated View Colonoscope in Colon Models

INTRODUCTION: Colorectal cancer remains the second leading cause of cancer death in the world. Incidence has declined as rates of screening colonoscopy have increased, but colonoscopy is not perfect. Low adenoma detection rates (ADR's) have been associated with increased interval cancers. Both optical and mechanical devices for improving ADR have shown promising results. Here we demonstrate a novel colonoscope with a 360° integrated view to improve visualization behind folds (Figure 1). The aim of this study is to compare polyp detection rates using the novel 360° scope and a standard forward only view (FOV) scope in colon models. METHODS: 324 endoscopists around the US were enrolled in the study. 20 anatomic colon models (Champerlain Group, Great Barrington, MA) containing simulated 6–15 mm polyps were used. Polyps varied in number, location, and shape. Models were examined in a tandem fashion with the 360° scope and the FOV scope. Endoscopists were randomly assigned to perform the initial exam with either scope. The primary outcome was the number of polyps identified during withdrawal. Subgroup analysis was performed evaluating effects of order of examination, experience, and practice setting. Means were compared with a paired T-test and subgroups were compared with ANOVA. RESULTS: 153 endoscopists performed their initial exam with the 360° scope, and 171 with the FOV scope. The 360° view colonoscope identified significantly more polyps overall (13.2 vs 7.7, mean difference 5.5, P &lt; 0.0001). Each individual endoscopist identified more polyps with the 360° scope. The difference persisted regardless of which scope was used first. The difference also persisted between endoscopists of different experience and practice environments (Table 1). The only statistically significant difference was between endoscopists stratified by years of training, in which the &lt;5 year group had a larger difference in polyp detection (P = 0.0006). CONCLUSION: This study shows that the 360° integrated view colonoscope is more effective at polyp detection than a traditional colonoscope in simulated models. The increased polyp detection is not dependent on experience level or practice environment. The expanded field of view allows endoscopists to identify polyps that may be missed by a traditional scope such as behind folds. Further studies in humans will be needed to prove safety/efficacy for clinical use but these initial results show promise for increasing ADR using this novel colonoscope.

332 Effect of Behavioral Interventions on the Uptake of Screening Colonoscopy: A Systematic Review and Meta-Analysis

INTRODUCTION: Screening decreases colorectal cancer (CRC) incidence and mortality, but uptake in the United States remains suboptimal at 62%. Prior studies have investigated the effect of various interventions on overall CRC screening and stool-based testing, but the effect on colonoscopy—the predominant screening test in the US—has not been fully examined. We performed a systematic review and meta-analysis to assess the effect of behavioral interventions on screening colonoscopy uptake. METHODS: We searched PubMed, EMBASE, and Cochrane databases through June 2018 for controlled trials that assessed the effect of behavioral interventions on screening colonoscopy rates. Our search yielded a total of 6,952 titles. All abstracts and articles were screened by at least two independent reviewers and 54 manuscripts were selected for review. Relative risk estimates were extracted from the original article or calculated from the raw data. The primary outcome was the relative increase in screening colonoscopy completion with any behavioral intervention. Subgroup analysis by type of intervention was also performed. Random effects meta-analysis was performed using Stata. RESULTS: A total of 21 studies with 24 behavioral interventions were analyzed. The most common interventions were patient navigation (n = 8), a combination of multiple interventions (n = 7), and educational interventions (n = 4). Overall, behavioral interventions increased colonoscopy completion by 58% compared to controls (OR 1.58, 95% CI 1.33-1.88, Figure). Patient navigation (OR 1.80, 95% CI 1.22-2.67) and multiple interventions (OR 1.70, 95% CI 1.15-2.50) had the strongest effect on colonoscopy completion. Significant heterogeneity was observed both overall and by intervention type, which may be attributed to differences in study setting and control group selection. CONCLUSION: Behavioral interventions increase screening colonoscopy completion and should be considered in clinical practice. In particular, patient navigation and multiple interventions are the best-studied and most effective interventions.

324 Anesthesia Assistance in Screening Colonoscopy and Adenoma Detection Rate Among Trainees

INTRODUCTION: The use of anesthesia assistance (AA) with propofol sedation for screening colonoscopy has been increasing over the past decade, raising concerns about possibly increased complication rates without a proven improvement in colonoscopy quality indicators like adenoma detection rate (ADR). The effect of AA on ADR has not been extensively studied in trainees learning colonoscopy. We aimed to determine if type of sedation used during screening colonoscopy affects trainee ADR. METHODS: Using the endoscopy databases of two hospitals in our medical center, we identified all screening colonoscopies performed by 15 trainees from July 2014 through June 2018, including all screening examinations where the cecum was reached. We recorded patient demographics, trainee ADR, year of training, mean withdrawal time, bowel preparation quality, supervising attending ADR (excluding procedures with trainees), and type of sedation used for each procedure. Multivariable analysis was used to determine factors independently associated with trainee ADR. RESULTS: We identified 1,420 unique patients who underwent screening colonoscopy by a trainee during the defined time period meeting the inclusion criteria. Of these, 459 (32.3%) were performed with AA. Overall trainee ADR was 39.6%, with ADR increasing from 35.0% in year one of training to 42.8% in year three (P = 0.047). ADR for cases with AA was 37.9% while ADR for conscious sedation (CS) cases was 32.0% (P = 0.374). Despite this absolute difference of 5.9%, the use of AA was not associated with finding an adenoma on colonoscopy on multivariable analysis when controlling for all covariables (OR 0.86; 95% CI 0.67-1.10). Factors independently associated with trainee ADR included male gender (OR 1.66; 95% CI 1.33, 2.08), patient age (OR for patients ages 70-79 compared to ages 50-59: 1.84 [1.33, 2.52]), optimal bowel preparation quality (OR 1.58; 95% CI 1.07, 2.33), and supervising attending ADR (OR for attending ADR 30-39% and ≥40% compared to attending ADR &lt; 20%: 4.22 [1.58, 11.027] and 3.67 [1.37, 9.87], respectively). CONCLUSION: Despite providing the ability to more comfortably sedate patients for screening colonoscopy, potentially providing the increased time required to improve trainee ADR, we found that the use of AA for screening colonoscopy did not affect trainee ADR. These results on trainee ADR and sedation type suggest that the overall lack of association between AA use and colonoscopy quality indicators is applicable to the trainee setting.

Anesthesia Assistance in Screening Colonoscopy and Adenoma Detection Rate Among Trainees.

The use of anesthesia assistance (AA) for screening colonoscopy has been increasing substantially over the past decade, raising concerns about procedure safety and cost without demonstrating a proven improvement in overall quality indicators such as adenoma detection rate (ADR). The effect of AA on ADR has not been extensively studied among trainees learning colonoscopy. We aimed to determine whether type of sedation used during screening colonoscopy affects trainee ADR. Using the electronic endoscopy databases of two hospitals in our medical center, we identified colonoscopies performed by 15 trainees from 2014 through 2018, including all screening examinations in which the cecum was reached. Multivariable logistic regression was used to determine factors associated with adenoma detection. We identified 1420 unique patients who underwent screening colonoscopy by a trainee meeting the inclusion criteria. Of these, 459 (32.3%) were performed with AA. Overall trainee ADR was 39.6%, with ADR increasing from 35.0% in year one of training to 42.8% in year three (p = 0.047). ADR for cases with AA was 37.9%, while ADR for conscious sedation cases was 32.0% (p = 0.374). Despite this 5.9% absolute difference, the use of AA was not associated with finding an adenoma on multivariable analysis when controlling for patient age, sex, smoking status, body mass index, trainee year of training, mean withdrawal time, supervising attending ADR, and bowel preparation quality (OR 0.85; 95% CI 0.67-1.09). Despite providing the ability to more consistently sedate patients, the use of AA did not affect trainee ADR. These results on trainee ADR and sedation type suggest that the overall lack of association between AA use and ADR is applicable to the trainee setting.

Patient-Reported Barriers to Completing a Diagnostic Colonoscopy Following Abnormal Fecal Immunochemical Test Among Uninsured Patients.

For colorectal cancer (CRC) screening to improve survival, patients with an abnormal fecal immunochemical test (FIT) must follow-up with a diagnostic colonoscopy. Adherence to follow-up is low and patient-level barriers for suboptimal adherence have yet to be explored. To characterize barriers for non-completion of diagnostic colonoscopy after an abnormal FIT reported by under- and uninsured patients receiving care in a safety-net health system. A longitudinal, cohort study of CRC screening outreach to 8565 patients using mailed FIT kits. Patients with abnormal FIT results received telephonic navigation to arrange for a no-cost diagnostic colonoscopy. Adults aged 50-64years receiving care at a North Texas safety-net health system. Descriptive analyses characterized the patient sample and reasons for lack of follow-up after abnormal FIT over the 3-year outreach program. Thematic qualitative analyses characterized reasons for lack of follow-up with a colonoscopy after the abnormal FIT. Of 689 patients with an abnormal FIT, 45% (n = 314) did not complete a follow-up colonoscopy. Among the 314 non-completers, 184 patients reported reasons for not completing a follow-up colonoscopy included health insurance-related challenges (38%), comorbid conditions (37%), social barriers such as transportation difficulties and lack of social support (29%), concerns about FIT/colonoscopy process (12%), competing life priorities (12%), adverse effects of bowel preparation (3%), and poor health literacy (3%). Among the 314 non-completers, 131 patients did not report a barrier, as 51% reported that that had completed a previous colonoscopy in the past 10years, 10% refused with no reason, and 10% were never reached by phone. Future studies aimed at improving FIT screening and subsequent colonoscopy rates need to address the unique needs of patients for effective and sustainable screening programs. NCT01946282.