Complete Colonoscopy Research Articles

Delays in Diagnostic Colonoscopy After Positive FIT in an Integrated Healthcare System.

Colorectal cancer screening with fecal immunochemical testing (FIT) is a process that depends on diagnostic colonoscopy for those with a positive test and completion of colonoscopy after positive FIT is an essential element of program effectiveness. We examined how the COVID-19 pandemic influenced completion of diagnostic colonoscopy after positive FIT in our integrated healthcare system. This was a retrospective study of all positive FIT over a 5-year period. FITs were characterized as being done in pre-pandemic, early pandemic, or late pandemic time periods. The primary outcome was proportion of timely diagnostic colonoscopy completed within 6 months of positive FIT. Among 2157 patients with positive FIT, 50% received diagnostic colonoscopy within 6 months, 20% received colonoscopy after 6 months, and 30% received no colonoscopy. 56% of patients had timely colonoscopy during the pre-pandemic period as compared to 39% in the early pandemic and 49% in the late pandemic (p value < 0.01 for all comparisons). Those who had their colonoscopy done via community care referral were less likely to do so within 6 months. Among patients with no colonoscopy, the most common reasons included patient declined (48%), clinicians deferred due to comorbid conditions (26%), or the patient died (21%). Before and during the pandemic, we found low rates of completion of colonoscopy after a positive FIT, which highlights an important barrier to program effectiveness. Many FIT were inappropriate given the high proportion of patients who either died or were recommended not to complete a colonoscopy.

P0417 Impact of Cytomegalovirus infection on patients with Inflammatory Bowel Disease in the Southern Area of Gran Canaria: a case-control study

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic condition affecting the digestive tract. During refractory flare-ups, cytomegalovirus (CMV) infection should be ruled out. Objectives: To analyse the characteristics, risk factors, and subsequent outcomes of IBD associated with CMV infection. Methods A retrospective case-control study included 50 cases and 50 randomly selected controls with IBD flare-ups between January 2018 and December 2023. CMV infection was diagnosed using PCR on colonic mucosa samples. Epidemiological, clinical, and complication data were analysed. Results No differences were observed regarding sex or type of IBD. Significant differences (p&amp;lt;0.05) were found between cases and controls: age during the episode 51 vs 41 years; age at IBD diagnosis 47 vs 36 years; clinical presentation with bloody diarrhea 90% (45) vs 32% (16)); prior immunosuppressive therapy 30% (15) vs 16% (8); clinician-driven biopsy indication 70% (35) vs 60% (30); and hospital-based diagnosis 52% (26) vs 12% (6). The onset of IBD during the episode was less frequent in cases, 16% (8) vs 30% (15), and complete colonoscopy was performed less often, 24% (12) vs 72% (36). Multivariate analysis identified independent risk factors, including treatment with intravenous methylprednisolone, moderate-severe clinical presentation, and corticosteroid-refractory disease. Conclusion In our patients, CMV infection during IBD flare-ups was associated with (1) treatment with intravenous methylprednisolone, moderate-severe clinical severity, and corticosteroid refractory; (2) when the indication for a biopsy is based on clinical criteria; and (3) it does not lead to future therapeutic escalations, although it does higher rates of colectomy.

P0332 Optimization and assessment of colonoscopy preparation in Inflammatory Bowel Disease: a comprehensive single-center analysis with focus on disease-specific factors

Abstract Background Colonoscopy remains a cornerstone in inflammatory bowel disease (IBD) management, yet comprehensive data on preparation quality and tolerability in this specific population remains limited. We aimed to evaluate bowel preparation efficacy, tolerability, and colonoscopy outcomes in IBD patients while analyzing disease-specific influencing factors. Methods We conducted a prospective single-center study of 78 IBD patients (45 ulcerative colitis [UC] and 33 Crohn’s disease [CD]) undergoing routine colonoscopy surveillance. All patients received a split-dose 4L polyethylene glycol preparation. We collected comprehensive data including clinical parameters, Boston Bowel Preparation Scale (BBPS) scores, sedation requirements, and procedure tolerability using Visual Analogue Scale (VAS, 0-100mm). Disease activity was assessed using standardized endoscopic scores. Results Mean age was 47.2 ± 14.5 years for UC and 43.8 ± 13.9 years for CD patients. Adequate bowel preparation (BBPS ≥6) was achieved in 85.7% (67/78) of patients, with a mean total BBPS score of 6.3 ± 1.4. Female patients showed slightly higher preparation quality scores compared to males (BBPS 6.5 ± 1.3 vs 6.1 ± 1.4, p=0.12), though this difference was not statistically significant. Complete colonoscopy was successfully performed in 93.6% (73/78) of cases. No significant differences in BBPS scores were observed between UC and CD patients (6.4 ± 1.5 vs 6.2 ± 1.3, p=0.62), or between patients with active disease versus those in remission (6.3 ± 1.4 vs 6.2 ± 1.5, p=0.85). Preparation tolerability was rated as good or excellent (VAS ≥70) in 76.9% (60/78) of patients, with similar ratings between genders (females: 77.8%, males: 75.9%, p=0.83). Notably, 32.1% (25/78) of IBD patients required increased sedation compared to standard doses, with a higher proportion in CD patients (42.4%, 14/33) compared to UC patients (24.4%, 11/45, p=0.047), and in female patients (37.2%, 16/43) compared to males (25.7%, 9/35, p=0.038). Disease-related factors including disease duration, location, and previous surgery did not significantly impact preparation quality. Conclusion Our study demonstrates that high-quality bowel preparation can be achieved in IBD patients regardless of gender and disease characteristics, with good tolerability rates. However, increased sedation requirements, particularly in CD patients and females, should be anticipated. These findings support the implementation of standardized preparation protocols in IBD patients while emphasizing the need for personalized sedation strategies based on both disease and demographic factors.

Multilevel intervention for follow-up of abnormal FIT in the safety-net: IMProving Adherence to Colonoscopy through Teams and Technology (IMPACTT).

Fecal immunochemical testing (FIT) is a widely used first step for colorectal cancer (CRC) screening. Abnormal FIT results require a colonoscopy for screening completion and CRC diagnosis, but the rate of timely colonoscopy is low, especially among patients in safety-net settings. Multi-level factors at the clinic- and patient-levels influence colonoscopy completion after an abnormal FIT. Our study aims to implement a multi-level approach consisting of a clinic- and patient-level intervention to improve the completion of diagnostic colonoscopy after an abnormal FIT. We will test a multilevel intervention with one safety-net system across 12 primary care clinics - a clinic-level intervention using a stepped wedge design and a patient-level intervention with patient-level randomization. At the clinic level, we will implement a "best practices bundle" to improve workflow for primary care providers and staff using a stepped-wedge design. At the patient level, we will randomize 2000 patients to receive text messages and call reminders or usual care. For the main analysis, we will use a mixed effects logistic model to assess the impact of the clinic intervention on the primary outcome (completion of colonoscopy within 180 days after abnormal FIT). Secondary outcomes include median days to colonoscopy completion, rate of referral to colonoscopy at 42 days, rate of scheduled colonoscopy at 56 days, and bowel preparation quality at colonoscopy. This study will assess the extent to which a multi-level intervention can improve timely colonoscopy completion in a diverse patient population cared for in a safety-net setting. NCT, NCT06191185. Registered 20 December 2023, https://clinicaltrials.gov/study/NCT06191185.

Relationship Between Adenoma Detection Rate and Respective Withdrawal Time in Different Colon Segments: A Retrospective, Single-Center Study.

The 6-min withdrawal time for colonoscopy is widely considered the standard of care. However, there may not be appropriate if the 6-min is equally divided into various colon segments. Since the adenoma detection in each colon segment is not the same, there may be differences with the withdrawal time in different colon segments. Our objective was to evaluate the relationships between adenoma detection rate (ADR) and respective withdrawal time in different colon segments. Outpatients, age range 18-75 years, undertaking complete colonoscopy were enrolled in this study from November 2019 to November 2020 in the digestive endoscopy center. The entire colon was divided into four different segments: ascending colon, transverse colon, descending colon and rectosigmoid colon. The respective withdrawal time and ADR in each colon segment were recorded respectively. A total of 586 outpatients (279 males, 307 females) enrolled in this study and the general ADR was 38.2%. The positive withdrawal time (adenomas detected) was longer than negative withdrawal time (non-adenomas detected) (334.04 ± 24.21 s vs. 303.65 ± 5.20 s, t = 1.26, p < 0.001). ADR in ascending colon, transverse colon, descending colon and rectosigmoid colon were respectively 30.5%, 2.9%, 3.1% and 7.5%. While all of their positive withdrawal time were longer than negative withdrawal time (94.34 ± 33.76 s vs. 70.40 ± 41.84 s, t = 3.31, p = 0.001; 85.40 ± 49.76 s vs. 71.66 ± 36.87 s, t = 1.95, p = 0.025; 80.29 ± 39.85 s vs. 69.73 ± 35.96 s, t = 1.40, p = 0.016;100.95 ± 55.92 s vs. 80.96 ± 42.87 s, t = 3.61; p < 0.001, respectively). The withdrawal time threshold in the ascending colon, transverse colon, descending colon, rectosigmoid colon determined by receiver operating characteristic (ROC) curve were 77, 61, 56 and 109 s, respectively. In the ascending colon, ADR was significantly higher (47.0% vs. 33.1%, p < 0.001) when the colonoscopy withdrawal time was ≥ 77 s. When the withdrawal time was ≥ 61 s in the transverse colon (42.7% vs. 32.7%, p = 0.013), ≥ 59 s in the descending colon (42.3% vs. 29.9%, p = 0.004) and ≥ 109 s in rectosigmoid colon (52.2% vs. 33.9%, p < 0.001), ADR was also significantly higher. After adjusting for age, sex and BMI, Logistic regression analysis showed that withdrawal time ≥ 77 s in the ascending colon (OR, 1.796; 95% CI, 1.273-2.532; p < 0.001), ≥ 61 s in the transverse colon (OR, 1.535; 95% CI, 1.094-2.155; p = 0.013), ≥ 56 s in the descending colon (OR, 1.722; 95% CI, 1.193-2.486; p = 0.004) and ≥ 109 s in the rectosigmoid colon (OR, 2.134; 95% CI, 1.446-2.350; p < 0.001) were independent risk factors for the increase of ADR. ADR and withdrawal time are all various in individual colon segments. During the operation of colonoscopy, withdrawal time in the ascending colon may be shortened appropriately. The adenomas in the rectosigmoid colon are more likely to be detected and do not take longer withdrawal times. We need to choose the appropriate time according to different colon segments.

Clinical Efficacy Between Intravenous Paracetamol and Intravenous Fentanyl for Propofol Deep Sedation in Colonoscopy: A Randomized Controlled Trial.

Sedation practices for colonoscopy indeed vary widely around the globe. Due to a lack of data on intravenous paracetamol, we aimed to investigate the clinical efficacy of intravenous paracetamol compared to intravenous fentanyl under propofol deep sedation for colonoscopy. A total of 225 patients who underwent colonoscopy at Siriraj Hospital were randomly assigned to two groups. All patients underwent deep sedation with propofol and received intravenous (iv) paracetamol (group P, n = 113) or iv fentanyl (group F, n = 112). All patients received a premedication of 0.02-0.03 mg/kg of midazolam intravenously. Fifteen to thirty minutes before the procedure, patients in group P were administered 1000 mg of iv paracetamol, while those in group F received 0.001 mg/kg of iv fentanyl. All patients were oxygenated with 100% O2 via a nasal cannula, and deep sedated with titrated intravenous propofol. The primary outcome measure was the success rate of colonoscopy. The colonoscope reaching the ileocecal valve was an important marker for a successful colonoscopy. Secondary outcome measures included endoscopist and patient satisfaction, patient tolerance, ease of the procedure, and sedation-related complications during and immediately after the procedure. All colonoscopies were successfully completed. There were no significant differences in patient characteristics, duration of the procedure, endoscopist and patient satisfaction, patient tolerance, or ease of the procedure between the two groups. However, group F experienced significantly higher rates of upper airway obstruction and oxygen desaturation during the procedure compared to group P. No serious complications were observed in either group. Intravenous paracetamol with propofol deep sedation in adult patients is non-inferior to intravenous fentanyl for successful colonoscopy completion. Sedation-related complications were relatively lower in the propofol deep sedation with iv paracetamol group compared to the propofol deep sedation with iv fentanyl group. This trial was registered with the Thai Clinical Trial Registry (TCTR 20190321002).

Peutz-Jeghers Syndrome: A Case Report and Literature Review in Indonesia

Background: Peutz-Jeghers Syndrome (PJS) is a rare hereditary polyposis syndrome that is autosomal dominant and has the main characteristics of hamartoma polyps, mucocutaneous pigmentation, and increased susceptibility to malignancy. Case: This case report presented a 19-year-old man referred from a secondary hospital with complaints of diarrhea for one month before hospital administration. The symptoms happened five times a day with residue in the stool. Mucus or bleeding was not found. Around ten days prior, the polyp came out from the anus, but the patient could pull it back by himself. Diarrhea had been recurring since 2014. The patient then underwent polypectomy (while still children) and until now has undergone polypectomy 11 times. Abdominal CT scan showed multiple polyps with varying morphology in the luminal mucosa of the duodenum, jejunum, ileum, descending colon, sigmoid colon, and rectum, in accordance with the presentation of Peutz-Jeghers syndrome. The colonoscopy examination found a Peutz-Jeghers appearance after a polypectomy with a hemoclip installed. The patient was diagnosed with Peutz-Jeghers Syndrome post polypectomy. The patient received a plan for post-operative complete blood count examinations and periodic colonoscopies. Conclusion: PJS is an important diagnosis to consider in young patient with polyposis, even without mucocutaneous pigmentation.Keywords: Peutz-Jeghers syndrome, polyposis, polypectomy

How Good Is Good Enough? What Should Be the Target for CRC Screening?

Colorectal Cancer (CRC) screening of average-risk individuals has been shown to reduce CRC mortality and incidence. Incidence is reduced by detection and removal of cancer precursor lesions (CPLs), resulting in cancer prevention. Mortality reduction is achieved with detection of curable CRC, as well as prevention by removing CPLs before cancer develops. Targets of screening include both curable CRC and CPLs. Non-invasive stool tests are a multi-step screening program which can detect curable cancers and less likely to detect CPLs than invasive screening. The non-invasive programs depend on completion of colonoscopy if the test is positive. Invasive screening with colonoscopy is a one-step test program, with excellent detection of both curable CRCs and CPLs, if performed with high-quality. Current evidence suggests that either program could be effective, despite different targets. Patient adherence and program quality are perhaps the important determinants of program effectiveness.

Effectiveness of Colonoscopy in Reducing Incidence of Late-stage Colorectal Cancer Within an Opportunistic Screening Program.

The effectiveness of colonoscopy in preventing colorectal cancer (CRC) within opportunistic screening programs has not been clearly established. The aim of this study was to analyze the effectiveness of colonoscopy within an opportunistic screening program using nested case-control study. Subjects who received a diagnosis of CRC (CG) between the ages of 50 and 90 years were included and matched by age and gender in a 1:5 ratio with patients without CRC diagnosis (COG) during the period 2015 to 2023. Using conditional regression analyses, we tested the association between screening colonoscopy and CRC. Subgroup analyses were then performed for CRC location, endoscopist specialty, and colonoscopy quality. Of the 134 patients in CG, 19 (14.18%) had a colonoscopy in the preceding 5 years compared with 258 out of 670 (38.51%) in COG (AOR, 0.24; 95% CI: 0.14-0.41). Any colonoscopy was strongly associated with decreased odds for left-sided CRC (AOR, 0.09; 95% CI: 0.04-0.24) but not for right-sided CRC (AOR, 0.58; 95% CI: 0.29-1.17). Only complete colonoscopy (AOR, 0.41; 95% CI: 0.19-0.89) and colonoscopy with satisfactory bowel preparation (AOR, 0.38; 95% CI: 0.15-0.98) were associated with decreased odds for right-sided CRC. No significant differences in colonoscopy outcomes were found when stratifying by endoscopist specialty. In the setting of an opportunistic screening program, exposure to any colonoscopy significantly reduced left-sided CRC incidence; however, only high-quality colonoscopy was associated with a lower incidence of right-sided CRC. Therefore, every possible effort should be made to optimize the quality and cost-effectiveness of colonoscopy within an opportunistic screening program.

Undetected Dysplasia at Colectomy in Patients With Inflammatory Bowel Diseases. What Are We Missing?

Patients with inflammatory bowel disease (IBD) have a higher risk of developing colorectal dysplasia and colorectal cancer compared to the general population. Although the use of surveillance protocols has improved the ability to detect dysplasia, some lesions are still missed at colonoscopy. This study aims to determine the rate of dysplastic lesions that are undetected at colonoscopies in IBD patients undergoing colectomy and to identify factors associated with missed dysplasia. Patients who had received a total or subtotal colectomy at Mayo Clinic (Rochester, Minnesota), between January 2003 and December 2022, and had a complete colonoscopy within 5 years before surgery were retrospectively enrolled. Data abstracted included demographic information, disease-related data, colonoscopy and pathology reports, and surgery pathology reports. Colonoscopy and surgery findings were compared, and patients were divided into 3 groups: no dysplasia at both, detected dysplasia, and undetected dysplasia. Among 1320 IBD patients undergoing colectomy, 5.4% had undetected dysplastic lesions identified only at surgery. Factors independently associated with dysplasia detection were endoscopic remission or mild endoscopic disease activity (odds ratio [OR], 2.326; P = .0081; 95% CI, 1.246-4.342), prior dysplasia detection (OR, 1.876; P = .0491; 95% CI, 1.002-3.511), colonoscopy performed for surveillance (OR, 2.380; P = .0048; 95% CI, 1.302-4.350), and longer disease duration at surgery (OR, 1.039; P = .0085; 95% CI, 1.010-1.070). Clinicians should be aware of the risk of missing dysplastic lesions, especially when endoscopic disease activity is moderate/severe, and not only for longstanding disease. Efforts should be made to obtain endoscopic remission to make the "invisible" visible.

Terminal ileal intubation is not necessary in routine colonoscopy: data from a large-scale retrospective study.

Terminal ileal intubation (TII) demonstrates a complete colonoscopy, but whether it should be performed in routine colonoscopies remains uncertain. We aimed to explore the diagnostic yield of TII in routine colonoscopy and investigate the association of TII and the detection of lesion. We conducted a retrospective study included patients who underwent colonoscopy with cecal intubation at our endoscopic center between November 1 2022 and July 31 2023. Macroscopic and histologic findings of terminal ileum were recorded. We used propensity score matching to adjust for differences between groups and further analyzed the difference of polyp detection rate (PDR), adenoma detection rate (ADR), sessile serrated lesion detection rate (SSDR) and lesion detection rate of right-sided colon, cecum and ascending colon between patients underwent TII or not. There were 13,372 patients with cecal intubation colonoscopy, including 7599 (56.8%) with TII and 5773 (43.2%) without TII. Abnormal endoscopic findings were observed in 150 of 7599 unselected individuals and only 7 of these cases were regarded as pathologically significant. Likewise, abnormal endoscopic findings were found in 62 of 3502 asymptomatic individuals with 54 nonspecific ileitis determined by histopathology. After PSM, there were no significant differences in PDR (52.0% vs. 52.3%, P = 0.761), ADR (30.9% vs. 32.2%, P = 0.208), SSDR (1.6% vs. 1.5%, P = 0.541), right-sided lesion detection rate (16.9% vs. 16.8%, P = 0.908), lesion detection rate of cecum (4.9% vs. 4.7%, P = 0.613) and ascending colon (13.5% vs. 13.2%, P = 0.656) between the two groups. TII was not necessary in routine colonoscopy, owing to the limited diagnostic value and lack of superiority on lesion detection.

Multi-faceted strategies to advance health equity in colorectal cancer screening in primary care setting: quality improvement project

BackgroundThe aim of this quality improvement (QI) project was to increase Colorectal Cancer (CRC) screening in patients ages 50–75 years from a baseline of 27–40% within 12 months in a primary care clinic in limited resource communities.MethodsThe multidisciplinary QI-team applied the Plan-Do-Study-Act method and developed stakeholder analysis, an Ishikawa fish bone diagram, a process flow map, and a driver diagram. Major barriers to suboptimal CRC screening included limited health literacy, language preferences, absence of stool test options, and knowledge gaps among patients and providers. The outcome measure was CRC screening rates, while stool test and colonoscopy completion rates served as process measures. Major interventions included the use of a patient-navigator, leveraging digital health technology to create a novel CRC screening data dashboard, educating patients and providers, patient centered-shared decision making, and creating messages and educational videos in patient’s preferred languages. We used monthly run charts and statistical process control charts (SPC) for data analysis.ResultsWe observed a sustainable, steady increase in CRC screening rates from baseline rates of 27.0–40.0% (n = 1304/3271) during the study period and 45.6% (n = 1493/3,271) six months post-study, with median rates of 34.0% in the run chart and mean rates of 43.0% in the SPC chart. Furthermore, we observed an increase in colonoscopy completion rates during the study and six months post-study to 65.0% (n = 411/631) and 72.9% (n = 461/631) respectively, from a baseline rate of 25.0%, with a median of 63.0% in the monthly run chart.ConclusionThe increase in CRC screening rates highlights the effectiveness of addressing barriers such as health literacy, language preferences, and knowledge gaps. This underscores the value of a multifaceted approach and the role of a patient navigator in enhancing preventive, patient-centered care. This project focused on population health and addressing social determinants of health to overcome disparities and improve CRC screening in a primary care setting. Continued emphasis on these strategies is likely to further advance colorectal cancer screening efforts.

Centralized Colorectal Cancer Screening Outreach in Federally Qualified Health Centers

Colorectal cancer (CRC) screening is effective but remains underused in federally qualified health centers (FQHCs). To assess the effectiveness of a centralized CRC screening outreach intervention involving mailed fecal immunochemical testing (FIT) outreach and patient navigation to colonoscopy after abnormal results of FIT. A pragmatic randomized clinical trial was conducted, using intention-to-treat analysis. Participants were enrolled from July 6, 2020, to September 17, 2021, and analyses were performed from July 6, 2023, to January 31, 2024. The study was conducted at independent FQHCs comprising 12 clinical delivery sites in North Carolina. The outreach intervention was centralized at an academic cancer center. Active individuals aged 50 to 75 years at average risk for CRC and not current with screening per US Preventive Services Task Force recommendations were included. In addition to usual care, intervention participants received mailed screening outreach materials including an introductory letter, FIT kit packet with instructions and return postage, and 2 reminder letters if needed. Intervention participants with positive results of mailed FIT were offered navigation to facilitate follow-up colonoscopy completion. Control participants received usual care alone. The primary outcome was completion of a US Preventive Services Task Force-recommended CRC screening test within 6 months determined by electronic health record review. Secondary outcomes were colonoscopy completion within 6 months after positive FIT results and detection of advanced colorectal neoplasia, defined as advanced adenoma or CRC. A total of 4002 participants were included (mean [SD] age, 59.6 [6.8] years; 2256 [56.4%] female; 364 (9.1%) Hispanic; 1082 [27.0%] non-Hispanic Black; 2288 [57.2%] non-Hispanic White; 1198 [29.9%] commercially insured; 617 [15.4%] Medicaid; 1227 [30.7%] Medicare; and 960 [24.0%] uninsured), with 2001 randomized to each group. Compared with controls, intervention participants were more likely to complete screening within 6 months of randomization (30.0% vs 9.7%; difference, 20.29 percentage points; 95% CI, 17.85-22.73 percentage points). The intervention was effective in all insurance types. In the intervention arm, 33 of 48 participants with positive FIT results (68.8%) completed follow-up colonoscopy within 6 months compared with 8 of 18 participants (44.4%) in the control arm (difference, 24.3 percentage points; 95% CI, -2.13 to 50.74 percentage points). Advanced colorectal neoplasia was detected in 29 intervention participants (1.4%) and 15 control participants (0.7%) (difference, 0.68 percentage points; 95% CI, 0.05-1.35 percentage points). In this randomized clinical trial of centralized screening outreach intervention in diverse patients served by independent FQHCs, CRC screening completion and advanced colorectal neoplasia detection were substantially increased. Future studies should examine the cost and scalability of this intervention in this context. ClinicalTrials.gov Identifier: NCT04406714.

A Cohort Study of Lt. Col. Luke J. Weathers VA Medical Center Patients with Positive FIT and Incomplete GI Evaluation during the COVID-19 Pandemic.

The reasons for and incidence of delay in screening colonoscopies during the coronavirus disease 2019 (COVID-19) pandemic are of major public health interest. The risks and reasons for delay likely vary between public and private institutions. This research sought to analyze data regarding the completion of screening colonoscopies after a positive fecal immunochemical test (FIT) before and during the COVID-19 pandemic and the reasons for a delay in obtaining these results at the Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center. The goals were to evaluate the institutional resilience and analyze the problems associated with this major healthcare crisis. This closed cohort study included all positive FITs from our local Veterans Affairs (VA) medical center from October 2019 to January 2020 and July 2020 to May 2021. A total of 115 VA patients with a positive FIT prepandemic and 157 VA patients with a positive FIT during the pandemic were included. Completion rates within 180 days were measured, and charts were reviewed to identify the reasons for lack of completion. Both community and local VA procedures for veterans were included. Univariate and multivariable analyses were applied to calculate odds ratios (ORs). The Pearson χ2 test was applied to calculate P values. VA patients' percentage of timely completion was lower pre-COVID-19 than it was during the pandemic, and the percentage of delayed completion was higher pre-COVID-19 than it was during the pandemic. Comparing patients who completed a colonoscopy with those who did not, increasing age had an OR of 0.947 (95% CI 0.920-0.975), and White race had an OR of 0.504 (95% CI 0.291-0.873). Evaluating delays in colonoscopy completion, VA colonoscopies versus referral to the community had an OR of 4.472 (95% CI 1.602-12.483), and pre-COVID-19 completion versus during COVID-19 had an OR of 4.663 (95% CI 1.727-12.594) with multivariable logistic regression. There was a statistically significant increase in timely colonoscopy completion during the study period when compared with the pre-COVID-19 period. The completion rate was higher at the Lt. Col. Luke Weathers, Jr. VA Medical Center than a large population average in 2020, possibly related to community colonoscopies and an aggressive case management system. In addition, increasing age and White race were associated with decreased colonoscopy completion. Predictors of an increased delay in colonoscopy completion included a pre-COVID-19 positive FIT and colonoscopies performed within the VA rather than being referred to providers in the community. A common reason for delay in all of the groups was patients declining intervention and delay/lack of referral.

Impact of the COVID-19 pandemic on adherence to diagnostic colonoscopy after a positive non-invasive screening test for colorectal cancer in two Indiana healthcare systems

ObjectiveTo describe trends in the use of non-invasive tests (NIST) and the interval between a positive NIST and diagnostic colonoscopy. MethodsUsing a retrospective time-trend design, we examined medical records of patients within two large Indiana integrated healthcare systems who had a positive NIST between January 2019 and June 2021 and quantified the proportion of patients who had not completed colonoscopy within 60, 90, and 180 days to determine the interval between NIST result and diagnostic colonoscopy in days. ResultsOf 1379 patients with positive NISTs, 930 (68 %) underwent diagnostic colonoscopy during the 30-month study timeframe. Median time to colonoscopy completion was significantly longer in 2020 compared to 2019 (50 vs. 37 days, p < 0.01) and 2021 (46 days, p = 0.06). The proportion of patients completing colonoscopy within 90 days of a positive FIT in 2019, 2020, and 2021 were 79 %, 83 %, and 72 %, respectively (p = 0.63), and were 86 %, 78 %, and 84 %, respectively, after positive FIT/DNA (p = 0.07). Median time to diagnostic colonoscopy completion was significantly longer in 2020, likely due to the COVID-19 pandemic. ConclusionsStudies of outcomes in those who declined or delayed colonoscopy in 2020 are needed to estimate the potential subsequent colorectal cancer disease burden.

Inclusion of a Society-Endorsed Practice Guideline in Computed Tomography Reports Improves Postdiverticulitis Colonoscopy Adherence.

The American Gastroenterological Association (AGA) recommends a follow-up colonoscopy within 6-8 weeks of an episode of complicated diverticulitis or the first episode of uncomplicated diverticulitis if no colonoscopy had been performed within the prior year to rule-out colorectal cancer. Available data suggest that adherence to this recommendation is suboptimal. We conducted a pre/post intervention study to determine whether inclusion of the AGA practice guideline in the diagnostic CT reports increased post-diverticulitis colonoscopy rates. Post-diverticulitis colonoscopy order and completion rates were significantly higher in the intervention group. Adherence was highest among individuals whose CT reports included the AGA recommendation. Inclusion of a guideline-based recommendation in the diagnostic CT report increases post-diverticulitis colonoscopy adherence rates. The intervention is cheap, easy to implement and amenable to widespread dissemination.

The Utility of Multitarget Stool DNA Testing for Colorectal Cancer Screening After a Normal Colonoscopy.

Multitarget stool DNA (MT-sDNA) tests (here, Cologuard®) are currently used in average-risk patients as a primary method of screening for colorectal cancer. However, MT-sDNA testing has also been used in patients who previously underwent colonoscopy who wish to avoid repeat colonoscopy. Here, in a large primary care practice setting, our aim was to evaluate the diagnostic performance of MT-sDNA testing in patients with a previously normal colonoscopy. This retrospective cohort study included 5827 patients from 35 different primary locations in South Carolina. Patients aged 45 and above with a previously documented normal, high-quality colonoscopy prior to the MT-sDNA test date were included. High-risk patients and those with a previous negative MT-sDNA result were excluded. Of 5827 ordered MT-sDNA tests, 248 patients had a prior normal colonoscopy. The average time from initial colonoscopy to MT-sDNA testing was 7.3years. Of the 63 patients who had a positive MT-sDNA test, 41 patients (65%) completed follow-up colonoscopy and 40 patients had complete colonoscopy data. Of these 40 patients, 12 patients (30%) had advanced adenomas and none had colorectal cancer. Compared to patients without a previous colonoscopy, patients with prior colonoscopies had fewer adenomas of all types (1.6 vs 2.4) and fewer advanced adenomas (1.4 vs 2.0). Patients with a previously negative colonoscopy and subsequent positive MT-sDNA test were found to have a high rate of advanced adenomas on follow-up colonoscopy (30%). Thus, in patients with a previously negative colonoscopy, MT-sDNA testing may be a reasonable alternative screening option.

Evaluation of the Danish Colorectal Cancer Screening Program Among People With Cystic Fibrosis.

We aimed to evaluate the Danish CRC screening program, estimate colonic neoplasia's prevalence, and assess the utilized BP regimens. People with cystic fibrosis (pwCF) have an increased risk of precancerous polyps and colorectal cancer (CRC), with occurrence at an earlier age compared with the general population. Consequently, colonoscopy screening is recommended. PwCF requires specific bowel preparation (BP) regimens to ensure an adequate colonoscopy. We conducted a national retrospective cohort study, which included all pwCF eligible for colonoscopy according to international recommendations in 26 months. Among 119 eligible pwCF, 58 completed colonoscopies during the screening period. The screening was omitted in 25% of pwCF. Among the pwCF undergoing colonoscopy screening, precancerous polyps were found in 24% and none with CRC. One patient developed CRC before being offered screening. Risk factors for neoplasia were old age and male sex. The quality of BP was high, even though most pwCF received standard BP. The best quality was found in nonorgan transplanted, pwCF who received modulator treatment and those with no laxatives use. We detected a high adherence to CRC screening, but also a substantial proportion of pwCF who were not informed about screening recommendations, calling for greater awareness among clinicians. Although lower than previously described, our study revealed high numbers of precancerous polyps and CRC compared with the general population, underlining the need for screening. BP quality remained high, despite frequent use of standard regimens, implicating the need for more individualized regimens before undergoing colonoscopy.

Unusual gastrointestinal bleeding - Small intestinal venous ectasias.

A 34-year-old man presented to our emergency department with a 6-day history of bloody stools. He had no complaints of alteration in bowel habits in the stool. He did not consume alcohol and was a non-smoker. The patient had no any previous notable medical history or family history of similar complaints. Physical examination was unremarkable. In the local hospital, laboratory studies showed a hemoglobin level of 6.0g per deciliter (normal range, 11.5 to 15.5). After blood transfusion, an upper gastrointestinal endoscopy and complete colonoscopy did not reveal any bleeding lesion. In our hospital, the patient underwent abdominal contrast-enhanced CT, small intestinal venous ectasias were detected. The selective angiography was performed, but no aneurysm or arteriovenous fistula was found. The gastrointestinal tract bleeding still occurred for an unknown reason. Subsequently, single-balloon enteroscopy was carried out. By oral approach enteroscopy, obvious jejunum venous ectasias were detected.

S488 Bowel Preparation Hesitancy Identified as Biggest Barrier to Screening Colonoscopy: Results from a Large Online Survey of Patients Who Complete Colonoscopy

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