Complete Colonoscopy Research Articles

AI virtual patient navigation to promote re-engagement of U.S. inner city patients nonadherent with colonoscopy appointments: A quality improvement initiative.

100 Background: Colorectal cancer disparities loom large for underserved communities of color in the US where barriers to screening uptake can contribute to late-stage diagnosis and poor outcomes. Despite active outreach by skilled patient navigators (PN) at a NYC cancer center serving an ethnically minoritized and disadvantaged population, 59% (1,925/3,276) of patients either cancelled or did not show for their colonoscopy appointments in 2022. While PN re-engagement efforts led to 410 (21%) completing colonoscopy, 1,500 patients did not undergo potentially life-saving colon cancer screening that year. With the advent of conversational Artificial Intelligence (AI)-driven applications within health care offering a potential extension to a stretched workforce, our cancer center examined the use of an AI-based virtual patient navigator, MyEleanor, as part of a colorectal cancer screening quality improvement (QI) project. Methods: This QI project employed MyEleanor between Apr-Dec 2023 to target re-engagement of 2,400 patients nonadherent with colonoscopy appointments in 2022-2023. In place of human PNs, MyEleanor (a) called patients to discuss rescheduling, (b) assessed barriers to uptake, c) offered live transfers to clinical staff to reschedule, and d) provided procedure prep reminder calls. Evaluable outcomes included: (a) engagement with MyEleanor via identity confirmation, (b) live transfers accepted (actionable), (c) colonoscopy completion rate, and (d) patient volume, with (d) barriers to care, and (e) predictors of actionable engagement examined. Results: Over 8 months, 57% (1,368/2,400) of patients engaged with MyEleanor, with 58% (789) of this group, or 33% overall, accepting the live transfer. The completion rate for patients who did not show for initial appointment nearly doubled from 10% to 19% from 2022 to 2023 (pre to post-MyEleanor). Overall patient volume increased by 36%. Patients who engaged were a Mean age of 56.66 (41-79 yrs), female (66%), Hispanic (41%), Black (33%), English (73%) or Spanish (25%) speaking, and partnered (37%). Nearly one third reported at least two barriers to screening; top barriers included lack of perceived need (19%), time (18%), and MD encouragement (16%), medical mistrust (14%), and concerns about findings (13%) and cost (12%). Greater number of barriers predicted actionable engagement, (F(1366) = 354, p < 0.001), with Spanish-dominant patients and those declining to identify their race reporting nearly twice the number of barriers, F(1366) = 138.98 and F(1366) = 5.17, p < 0.001, respectively). Conclusions: This project demonstrates high potential of an AI patient navigator in helping to overcome patient attrition that can lead to colon cancer disparities while improving patient volume. Next phase of the project will examine impact on patient prep adherence, staff burden, and revenue.

Disparities in diagnosis and access to care in patients with young-onset rectal cancers in northeast Ohio.

e15521 Background: The rising incidence of young-onset colorectal cancers (YO-CRC) in individuals < 50 years old is alarming. Despite the updated USPSTF recommended age for CRC screening ( < 45) in 2021, disparities in receiving proper care for YO-CRC remained largely under addressed. We sought to identify modifiable disparities to be addressed with future interventions for patients with YO-rectal cancer (YO-RC). Methods: We analyzed a cohort of patients with newly diagnosed YO-RC from 2001 to 2023 at a large academic center in Northeast Ohio. Demographic data included sex, race, age, smoking status, and poverty index. A retrospective chart review was completed to assess diagnosis date and time from symptom onset to diagnosis. Access to guideline-concordant care was assessed via clinic visits with specialty providers in medical oncology, radiation oncology, colorectal surgery, genetics, and onco-fertility. Chi-square testing and Cox regression modeling was used for statistical analyses. Results: We identified 83 patients with YO-RC, 52% female (n = 43) and 48% male (n = 40), of which 76% were White (n = 63), 21% Black (n = 17), 2% Hispanic (n = 2), and 1% Asian (n = 1). Median age at diagnosis was 44 years (IQR[39-49]). Non-White (NW) patients had a greater delay from symptom onset to diagnosis compared to White (W) patients, with an average time of 6.9mo vs 1.3mo (p < 0.00001). Colonoscopy completion rates after symptom onset for NW and W patients at 2-months was 11% vs 81% and 33% vs 98% at 4-months (p < 0.0001, respectively). Rate of access to specialty care once diagnosed was not statistically significant for either groups, but there is a lower percentage of all YO-RC patients who accessed onco-fertility (13%, n = 11) or genetics services (46%, n = 38). The median 1-year overall survival was 50% for NW patients vs 85.7% for W patients, which was statically significant on univariate analysis (p = 0.04), but not on multivariate analysis. Conclusions: We found significant disparities for YO-RC from symptom onset to diagnosis with longer delays noted in NW patients. Such delays in diagnosis may lead to higher staging upon presentation and impact survival. Once a diagnosis was made, access to specialty oncology care rates was similar across groups. This study encourages further evaluation and consideration of socioeconomic factors and care access patterns to address disparities in diagnosis, access, and treatment of YO-CRC. [Table: see text]

Adenoma detection rate of screening colonoscopy among age 40–75 years: Implications for lowering the age for colorectal cancer screening

AbstractIncidence of early‐onset colorectal cancer is on the rise, prompting updated international guidelines recommending screening for average‐risk individuals starting at age 45. Adenoma detection rate (ADR) serves as a crucial quality indicator for colonoscopy (CFS), with a current benchmark of 25% for screening CFS starting at age 50. However, the impact of lowering the screening age on ADR remains uncertain. This study aimed to assess the ADR in average‐risk individuals who undergo screening colonoscopy at an age older than 40. Participants who underwent a complete colonoscopy for health examination at a medical center between January 2014 and February 2020 were enrolled in this study. We excluded colonoscopies performed on individuals younger than 40 years of age or older than 75 years of age, as well as those conducted for surveillance purposes. ADR was defined as the percentage of colonoscopies with at least one colorectal adenoma detected. We calculated the ADR for different age groups, including 40–44, 45–49, 50–54, and 55–75, to understand the age‐specific ADR of screening colonoscopy. Additionally, we evaluated the ADR among participants who started screening colonoscopy at ages ≥40, ≥45, and ≥50 to understand the impact of starting age on ADR. A p value <.05, determined by the chi‐square test, was considered significant. Among the 33 073 CFS completed during the study period, 5852 CFS examined in patients aged younger than 40 years, 344 CFS examined in patients aged older than 75, and 6881 CFS with surveillance indication were excluded, leaving 19 996 CFS enrolled for analysis. The mean age of the participants was 53, with 57% being male and 43% being female. The ADR for the age groups of 40–44, 45–49, 50–54, and 55–75 were 28.0% (1058/3778), 31.8% (1191/3741), 35.6% (1387/3891), and 44.2% (3794/8586), respectively, with a statistically significant difference (p < .01). The ADR for age ≥40, ≥45, and ≥50 were 37.2% (7430/19996), 40.1% (6372/15874), and 41.5% (5181/12477), respectively, with a statistically significant difference (p < .01). The findings of our study indicate that there are notable differences in ADR among various age groups. Lowering the screening age might result in a decrease in the overall ADR. However, our results suggest that even if CRC screening begins at age 40 or 45, the current benchmark of 25% ADR for screening colonoscopy may still be maintained. These findings provide valuable insights into the age‐ and gender‐specific prevalence of adenomas in colonoscopy screening and can be used to inform future screening guidelines and recommendations.

Patterns of Care Following a Positive Fecal Blood Test for Colorectal Cancer: A Mixed Methods Study.

Multilevel barriers to colonoscopy after a positive fecal blood test for colorectal cancer (CRC) are well-documented. A less-explored barrier to appropriate follow-up is repeat fecal testing after a positive test. We investigated this phenomenon using mixed methods. This sequential mixed methods study included quantitative data from a large cohort of patients 50-89years from four healthcare systems with a positive fecal test 2010-2018 and qualitative data from interviews with physicians and patients. Logistic regression was used to evaluate whether repeat testing was associated with failure to complete subsequent colonoscopy and to identify factors associated with repeat testing. Interviews were coded and analyzed to explore reasons for repeat testing. A total of 316,443 patients had a positive fecal test. Within 1year, 76.3% received a colonoscopy without repeat fecal testing, 3% repeated testing and then received a colonoscopy, 4.4% repeated testing without colonoscopy, and 16.3% did nothing. Among repeat testers (7.4% of total cohort, N = 23,312), 59% did not receive a colonoscopy within 1year. In adjusted models, those with an initial positive test followed by a negative second test were significantly less likely to receive colonoscopy than those with two successive positive tests (OR 0.37, 95% CI 0.35-0.40). Older age (65-75 vs. 50-64years: OR 1.37, 95% CI 1.33-1.41) and higher comorbidity score (≥ 4 vs. 0: OR 1.75, 95% CI 1.67-1.83) were significantly associated with repeat testing compared to those who received colonoscopy without repeat tests. Qualitative interview data revealed reasons underlying repeat testing, including colonoscopy avoidance, bargaining, and disbelief of positive results. Among patients in this cohort, 7.4% repeated fecal testing after an initial positive test. Of those, over half did not go on to receive a colonoscopy within 1year. Efforts to improve CRC screening must address repeat fecal testing after a positive test as a barrier to completing colonoscopy.

Duration of risk reduction in colorectal cancer incidence and mortality after a complete colonoscopy in Ontario, Canada: a population-based cohort study

Colorectal cancer guidelines recommend screening colonoscopy every 10 years after a negative procedure. If risk reduction extends past 10 years, the recommended interval could be extended, reducing the burden on the individual and health-care system. We aimed to estimate the duration that patients remain at reduced risk of colorectal cancer incidence and mortality after a complete colonoscopy. We did a population-based cohort study of individuals aged 50-65 years between Jan 1, 1994, to Dec 31, 2017. We excluded individuals with previous exposure to colonoscopy or colorectal surgery, those previously diagnosed with colorectal cancer, or a history of hereditary or other bowel disorders. We followed up participants until Dec 31, 2018, and identified all colonoscopies performed in this time period. We used a 9-level time-varying measure of exposure, capturing time since last complete colonoscopy (no complete colonoscopy, ≤5 years, >5-10 years, >10-15 years, and >15 years) and whether an intervention was performed (biopsy or polypectomy). A Cox proportional hazards regression model adjusting for age, sex, comorbidity, residential income quintile, and immigration status was used to estimate the association between exposure to a complete colonoscopy and colorectal cancer incidence and mortality. 5 298 033 individuals (2 609 060 [49·2%] female and 2 688 973 [50·8%] male; no data on ethnicity were available) were included in the cohort, with a median follow-up of 12·56 years (IQR 6·26-20·13). 90 532 (1·7%) individuals were diagnosed with colorectal cancer and 44 088 (0·8%) died from colorectal cancer. Compared with those who did not have a colonoscopy, the risk of colorectal cancer in those who had a complete negative colonoscopy was reduced at all timepoints, including when the procedure occurred more than 15 years earlier (hazard ratio [HR] 0·62 [95% CI 0·51-0·77] for female individuals and 0·57 [0·46-0·70] for male individuals. A similar finding was observed for colorectal cancer mortality, with lower risk at all timepoints, including when the procedure occurred more than 15 years earlier (HR 0·64 [95% CI 0·49-0·83] for female participants and 0·65 [0·50-0·83] for male participants). Those who had a colonoscopy with intervention had a significantly lower colorectal cancer incidence than those who did not undergo colonoscopy if the procedure occurred within 10 years for females (HR 0·70 [95% CI 0·63-0·77]) and up to 15 years for males (0·62 [(0·53-0·72]). Compared with those who do not receive colonoscopy, individuals who have a negative colonoscopy result remain at lower risk for colorectal cancer incidence and mortality more than 15 years after the procedure. The current recommendation of repeat screening at 10 years in these individuals should be reassessed. Canadian Institutes of Health Research.

Timely Completion of Direct Access Colonoscopy Is Noninferior to Office Scheduled for Screening and Surveillance.

We aimed to evaluate whether direct access colonoscopy (DAC) is noninferior to office-scheduled colonoscopy (OSC) for achieving successful colonoscopy. DAC may improve access to colonoscopy. We developed an algorithm assessing eligibility, risk for inadequate preparation, and need for nursing/navigator assistance. This was a retrospective, single-center study of DAC and OSC patients from June 5, 2018, to July 31, 2019. Patients were 45 to 75 years old with an indication of screening or surveillance. A successful colonoscopy met 3 criteria: complete colonoscopy (cecum, anastomosis, or ileum), adequate preparation (Boston Score ≥2/segment), and performed <90 days from initial patient contact. Unsuccessful colonoscopy did not meet ≥1 criteria. Secondary end points included days to successful colonoscopy, preparation quality, polyp detection, and 10-year recall rate. Noninferiority against risk ratio value of 0.85 was tested using 1-sided alpha of 0.05. A total of 1823 DAC and 828 OSC patients were eligible. DAC patients were younger, with a greater proportion of black patients and screening indications. For the outcome of successful colonoscopy, DAC was noninferior to OSC (DAC vs. OSC: 62.7% vs. 57.1%, RR 1.16, 95% LCL 1.09, P=0.001). For DAC, days to colonoscopy were fewer, and likelihood of 10-year recall after negative screening greater. Boston Score and polyp detection were similar for groups. Black patients were less likely to achieve successful colonoscopy; otherwise, groups were similar. For unsuccessful colonoscopies, proportionally more DAC patients canceled or no-showed while more OSC patients scheduled >90 days. DAC remained noninferior to OSC at 180 days. DAC was noninferior to OSC for achieving successful colonoscopy, comparing similarly in quality and efficiency outcomes.

Colonoscopy Outreach for Rural Communities (CORC): A study protocol of a pragmatic randomized controlled trial of a patient navigation program to improve colonoscopy completion for colorectal cancer screening

BackgroundColonoscopy is one of the primary methods of screening for colorectal cancer (CRC), a leading cause of cancer mortality in the United States. However, up to half of patients referred to colonoscopy fail to complete the procedure, and rates of adherence are lower in rural areas. ObjectivesColonoscopy Outreach for Rural Communities (CORC) is a randomized controlled trial to test the effectiveness of a centralized patient navigation program provided remotely by a community-based organization to six geographically distant primary care organizations serving rural patients, to improve colonoscopy completion for CRC. MethodsCORC is a type 1 hybrid implementation-effectiveness trial. Participants aged 45–76 from six primary care organizations serving rural populations in the northwestern United States are randomized 1:1 to patient navigation or standard of care control. The patient navigation is delivered remotely by a trained lay-person from a community-based organization. The primary effectiveness outcome is completion of colonoscopy within one year of referral to colonoscopy. Secondary outcomes are colonoscopy completion within 6 and 9 months, time to completion, adequacy of patient bowel preparation, and achievement of cecal intubation. Analyses will be stratified by primary care organization. DiscussionTrial results will add to our understanding about the effectiveness of patient navigation programs to improve colonoscopy for CRC in rural communities. The protocol includes pragmatic adaptations to meet the needs of rural communities and findings may inform approaches for future studies and programs. Trial registration: National Clinical Trial Identifier: NCT05453630.Trial registration: ClinicalTrials.gov. Identifier: NCT05453630. Registered July 6, 2022.

Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program.

Colorectal cancer (CRC) screening can significantly reduce incidence and mortality; however, screening rates are suboptimal. The lowest rates are among those with no usual source of care and the uninsured. We describe the implementation and evaluation of a community-based CRC screening program from 2012 to 2015 designed to increase screening within a predominantly Hispanic US-Mexico border population. The multicomponent, evidence-based program provided in-person, bilingual, culturally tailored health education facilitated by community health workers, no-cost primarily stool-based testing and diagnostic colonoscopy, and navigation. We recruited uninsured individuals due for CRC screening from clinics and community sites. An extensive qualitative and quantitative program process and outcome evaluation was conducted. In total, 20 118 individuals were approached, 8361 were eligible for screening; 74.8% completed screening and 74.6% completed diagnostic testing; 14 cancers were diagnosed. The mean age of participants was 56.8 years, and the majority were Hispanic, female, and of low socioeconomic status. The process evaluation gathered information that enabled effective program implementation and demonstrated effective staff training, compliance with processes, and high patient satisfaction. This program used a population-based approach focusing on uninsured individuals and proved successful at achieving high fecal immunochemical test kit return rates and colonoscopy completion rates. Key factors related to its success included tailoring the intervention to our priority population, strong partnerships with community-based sites and clinics, expertise in clinical CRC screening, and an active community advisory board. This program can serve as a model for similar populations along the border to increase CRC screening rates among the underserved.

High-risk smoking in the United States: Nicotine staining predicts increased colonic adenomas and advanced adenomas on colonoscopy

BackgroundSmoking is linked with numerous adverse health effects. Nicotine staining on fingers or teeth is thought to suggest active or heavy smoking. The significance of nicotine staining within gastroenterology remains unclear. AimWe set out to establish the predictive value of nicotine staining for adenomas and advanced adenomas. MethodsThis was a cross-section study of patients who underwent colonoscopy at the Oklahoma City Veterans Affairs Medical Center from November 2019 to November 2020. Pre-procedure patient survey ascertained current smoking status. Endoscopist performed a nicotine staining survey upon completion of the respective colonoscopy. Chart review allowed determination of patient demographics, comorbidities, and colonoscopy findings. Patients without smoking history were assigned to a control cohort. We applied one-way analysis of variance when comparing the mean of continuous variables and the Chi-square test when comparing categorical variables. Lastly, we used stepwise logistic regression to estimate adjusted odds ratio. A p-value <0.05 was considered statistically significant. ResultsCompared to those without smoking history or evidence of nicotine staining, patients with positive nicotine staining were older (P = 0.03), leaner (P < 0.0001), and more likely to have chronic obstructive pulmonary disease (P < 0.0001) or history of alcohol abuse (P < 0.0001). Furthermore, presence of nicotine staining independently predicted increased likelihood of multiple adenomas (OR 1.5, 95% CI [1.2–1.9]) and advanced adenomas (OR 1.6, 95% CI [1.2–2.2]). ConclusionThis marks the first investigation of nicotine staining within gastroenterology. We have demonstrated that the presence of nicotine staining independently predicts numerous adenomas and advanced adenomas.

Electronic Coding for Abnormal Fecal Immunochemical Test Is Associated With Increased Colonoscopy Completion.

We examined the utility of the International Classification of Disease, Tenth Revision (ICD-10) code, R19.5, for a positive or abnormal fecal immunochemical test (FIT) and its association with colonoscopy completion. We identified all patients in a safety-net health system who underwent FITs from January 1, 2020, to August 31, 2021, and extracted the FIT date, FIT result, and ICD-10 code (R19.5) and colonoscopy procedures for each patient. FIT-positive patients who had an R19.5 designation within 90 days (n = 383) were significantly more likely than all other FIT-positive patients (n = 273) to complete a colonoscopy within 6 months (40.9% vs 16.8%, P <0.001). We found that less than two-thirds of patients had an ICD-10 code designated in their chart within 30 days of an abnormal FIT. When coding occurred in a timely manner, patients were more likely to complete their colonoscopy within 6 months.

Prevalence and risk factors of colorectal neoplasia in individuals aged 40-49years: Findings from screening program in China.

The incidence of colorectal cancer (CRC) in individuals under 50 is increasing worldwide. We conducted an analysis of colonoscopy findings in high-risk individuals under 50 in the CRC screening program in Tianjin, China, to determine the detection rate and risk factors of advanced adenomas (AA), advanced colorectal neoplasia (ACN), colorectal neoplasia (CN). Our study investigated individuals aged 40-49 who underwent CRC screening and completed colonoscopy, 2012-2020, while the 50-54 age group served as a control. We compared the detection rates of AA, ACN, and CN among three age groups using univariate and multivariable logistic regression analyses, and investigated the risk factors associated with AA, ACN, and CN among individuals aged 40-49. We found a gradual increase in the detection rate of AA, ACN, and CN among individuals aged 40-54. The detection rates for AA (OR 0.58; 95% CI 0.41-0.81), ACN (OR 0.58; 95% CI 0.43-0.77), and CN (OR 0.64; 95% CI 0.56-0.74) were lower in individuals aged 40-44 compared to 45-49. The detection rates of AA (OR 1.08; 95% CI 0.87-1.34) and ACN (OR 1.12; 95% CI 0.93-1.35) in individuals aged 45-49 were comparable with 50-54. Besides, lifestyle factors, BMI, and FIT are not associated with the detection rates of AA, ACN, and CN among individuals aged 40-49. Our study reveals screening data in individuals under 50, indicating comparable detection rates of AA and ACN in individuals aged 45-49 and 50-54. These findings provide valuable data support for optimizing the optimal age to initiate screening.

Abnormal Colorectal Cancer Test Follow-Up: A Quality Improvement Initiative at a Federally Qualified Health Center.

Colonoscopy completion rates after an abnormal fecal immunochemical test (FIT) are suboptimal, resulting in missed opportunities for early detection and prevention of colorectal cancer. Patient navigation and structured follow-up may improve colonoscopy completion, but implementation of these strategies is not widespread. We conducted a quality improvement study using a Plan-Do-Study-Act (PDSA) Model to increase colonoscopy completion after abnormal FIT in a large federally qualified health center serving a diverse and low-income population. Intervention components included patient navigation, and a checklist to promote completion of key steps required for abnormal FIT follow-up. Primary outcome was proportion of patients achieving colonoscopy completion within 6 months of abnormal FIT, assessed at baseline for 156 patients pre-intervention, and compared to 208 patients during the intervention period from April 2017 to December 2019. Drop offs at each step in the follow-up process were assessed. Colonoscopy completion improved from 21% among 156 patients with abnormal FIT pre-intervention, to 38% among 208 patients with abnormal FIT during the intervention (P < .001; absolute increase: 17%, 95% CI: 6.9%-25.2%). Among the 130 non-completers during the intervention period, lack of completion was attributable to absence of colonoscopy referral for 7.7%; inability to schedule a pre-colonoscopy specialist visit for 71.5%; failure to complete a pre-colonoscopy visit for 2.3%; the absence of colonoscopy scheduling for 9.2%; failure to show for a scheduled colonoscopy for 9.2%. Patient navigation and structured follow-up appear to improve colonoscopy completion after abnormal FIT. Additional strategies are needed to achieve optimal rates of completion.

Effect of Abdominal Corset on Completion of Colonoscopy and Cecal and Ileocecal Intubation Time in Patients with Central Obesity: A Prospective Randomized Controlled Trial.

This work investigated the effect of an abdominal corset on the colonoscopy completion rate, as well as cecum and ileum intubation time, total colonoscopy time, and pain score in centrally obese patients. Patients were randomized into two groups, with 50 patients in each group. A colonoscopy was performed using the abdominal corset in Group 1 and the standard method in Group 2. The comparison between the groups evaluated demographic data, procedure details, circulatory dynamics, anesthesia data, and visual analogue scale (VAS). Of the patients included in the study, 60 were female, and 40 were male, with a mean age of 57.3 ± 13.6 years. Cecal intubation time (Z: -2.66 p: 0.008), total colonoscopy time (Z: -2.180 p: 0.029), number of maneuvers (χ2: 8.391 p: 0.039), and VAS (Z: -3.087 p: 0.002) were significantly lower in the abdominal corset group. An abdominal corset that applies external abdominal compression reduces the cecal intubation time, the total colonoscopy time, the number of maneuvers, and the pain level. NCT03128645 (https://clinicaltrials.gov/study/NCT03128645?tab=results).

Extensive colitis associated with ixekizumab.

We present the clinical case of a 56-year-old former smoker female, with a family history of maternal ulcerative colitis and personal history of ankylosing spondylitis treated with Ixekizumab for 3 months, who was admitted for fever, left iliac fossa pain and diarrhea without pathological products of 2 weeks of evolution. Abdominopelvic computed tomography scan identified pancolitis. Complete colonoscopy revealed continuous involvement of the proximal colon (right and transverse colon presented deep ulcerations and mucosal friability) with preservation of the terminal ileum. After many complementary tests and according to the clinical context, the diagnosis of extensive colitis associated with IL-17 inhibitor was established.

Adapting a Remotely Delivered Patient Navigation Program for Colorectal Cancer Screening in Primary Care: Important Considerations for Rural Contexts.

Colonoscopy is a critical component of colorectal cancer (CRC) screening and patient navigation (PN) improves colonoscopy completion. A lay navigator remotely providing navigation across rural primary care organizations (PCOs) could increase PN access. In preparation for the Colonoscopy Outreach for Rural Communities (CORC) study, we examined partners' perspectives on contextual factors that could influence CORC program implementation, and adaptations to mitigate potential barriers. We interviewed 29 individuals from 6 partner PCOs and the community-based organization (CBO) delivering the PN program. An analysis approach informed by Miles, Huberman, and Saldana identified critical themes. Results are reported using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). Potential barriers included that rural patients are hard to reach remotely and might mistrust the navigator, and the CBO is unfamiliar with the patient communities and does not have patient care experience or pre-existing communication pathways with the PCOs. Program content and navigator training was adapted to mitigate these challenges. Our study highlights contextual factors to account for before implementing a remote, centralized patient navigation program serving rural communities. Gathering partner perspectives led to intervention adaptations intended to address potential barriers while leaving the core components of the evidence-based intervention intact.

Prevalence and Property of Colonic polyp and Adenoma among Iraqi Patients

Background: Colorectal cancer (CRC) is the third common diagnosed. ‎cancer in the world, so that colonic polyp detection is important because colonic polyp is a precursor to CRC. Objective: To detect the prevalence of polyp and adenoma. Patients and Methods: A retrospective study was done using reports of endoscopic examination done previously for patients seen at gasteroenterology and hepatology hospital in Baghdad. Results: The study included 924 examination of colon, mean age of patients was 48.1 years. Polyps was detected in 128 colonoscopies. (PDR) was 16.7 %. The PDR was higher in patients ≥ 60 years old (25 %), while polyp detection rate was ( 17.7 % ) in those 50 – 59 years age group. Adenoma was found in 7.9 % of those with completed colonoscopies. It was higher in male patients (9.2 % ) than female patients (6.2%). It was highest in age group ≥ 60 years old (15.9%), while adenoma was found in (8.2 %) of those with age group of 50 – 59 years old. Conclusion: This study highlight on the prevalence of polyp (16.7%) and adenomas (7.9%) in patients underwent endoscopy for different indications, and give us an idea about screening for CRC in Iraq and at which age it should be started. Keywords: CRC, PRD, ADR

Prevalence and Property of Colonic polyp and Adenoma among Iraqi Patients

Background: Colorectal cancer (CRC) is the third common diagnosed. ‎cancer in the world, so that colonic polyp detection is important because colonic polyp is a precursor to CRC.&#x0D; Objective: To detect the prevalence of polyp and adenoma.&#x0D; Patients and Methods: A retrospective study was done using reports of endoscopic examination done previously for patients seen at gasteroenterology and hepatology hospital in Baghdad.&#x0D; Results: The study included 924 examination of colon, mean age of patients was 48.1 years. Polyps was detected in 128 colonoscopies. (PDR) was 16.7 %. The PDR was higher in patients ≥ 60 years old (25 %), while polyp detection rate was ( 17.7 % ) in those 50 – 59 years age group. Adenoma was found in 7.9 % of those with completed colonoscopies. It was higher in male patients (9.2 % ) than female patients (6.2%). It was highest in age group ≥ 60 years old (15.9%), while adenoma was found in (8.2 %) of those with age group of 50 – 59 years old.&#x0D; Conclusion: This study highlight on the prevalence of polyp (16.7%) and adenomas (7.9%) in patients underwent endoscopy for different indications, and give us an idea about screening for CRC in Iraq and at which age it should be started.

Application of the ‘online assessment + FOBT at home’ to improve participation and the efficacy of opportunistic screening for colorectal cancer: a retrospective cohort study

BackgroundColorectal cancer (CRC) screening faces two major challenges: insufficient screening coverage and poor adherence. A smartphone applet named “Early Screening Assistant (ESA)” was developed to create an online risk-assessment and fecal occult blood test (FOBT) at home. This retrospective study was designed to evaluate whether the new CRC screening strategy can improve the colonoscopy participation rate (PR) and lesion detection rate (DR).MethodsIn total, 6194 individuals who accepted normal health examinations and CRC screening based on the ESA from June 2020 to May 2022 were assigned to the ESA group. Accordingly, 7923 inhabitants who only accepted normal health examinations were assigned to the control group. The colonoscopy PR and neoplastic lesion DR were then compared between the two groups.ResultsOverall, a higher proportion of subjects in the ESA group (285 of 6194 [4.6%]) completed colonoscopy than in the control group (126 of 7923, [1.6%]), p < 0.01). The neoplastic lesion DR also significantly increased in the ESA group (76 of 6194 [1.22%]) compared with the control group (15 of 7923 [0.19%]) (p < 0.01). The adjusted diagnostic sensitivity and specificity of the “Online assessment + FOBT at home” were 41.5% and 62.6% for neoplastic lesions, respectively.ConclusionsThis retrospective cohort study confirmed that the new CRC screening strategy based on the “Online assessment + FOBT at home” can improve colonoscopy participation and the neoplastic lesion detection rate and may represent a promising screening strategy for CRC.Trial registrationThis study was registered in China Clinical Trial Registry (https://www.chictr.org.cn) on 29/09/2022. Registration number: ChiCTR2200064186.

Development and validation of a three-dimensional deep learning-based system for assessing bowel preparation on colonoscopy video.

The performance of existing image-based training models in evaluating bowel preparation on colonoscopy videos was relatively low, and only a few models used external data to prove their generalization. Therefore, this study attempted to develop a more precise and stable AI system for assessing bowel preparation of colonoscopy video. We proposed a system named ViENDO to assess the bowel preparation quality, including two CNNs. First, Information-Net was used to identify and filter out colonoscopy video frames unsuitable for Boston bowel preparation scale (BBPS) scoring. Second, BBPS-Net was trained and tested with 5,566 suitable short video clips through three-dimensional (3D) convolutional neural network (CNN) technology to detect BBPS-based insufficient bowel preparation. Then, ViENDO was applied to complete withdrawal colonoscopy videos from multiple centers to predict BBPS segment scores in clinical settings. We also conducted a human-machine contest to compare its performance with endoscopists. In video clips, BBPS-Net for determining inadequate bowel preparation generated an area under the curve of up to 0.98 and accuracy of 95.2%. When applied to full-length withdrawal colonoscopy videos, ViENDO assessed bowel cleanliness with an accuracy of 93.8% in the internal test set and 91.7% in the external dataset. The human-machine contest demonstrated that the accuracy of ViENDO was slightly superior compared to most endoscopists, though no statistical significance was found. The 3D-CNN-based AI model showed good performance in evaluating full-length bowel preparation on colonoscopy video. It has the potential as a substitute for endoscopists to provide BBPS-based assessments during daily clinical practice.

Abstract A138: Impact of racial disparities in follow-up colonoscopy for abnormal stool-screening test results on colorectal cancer incidence and mortality: A simulation modeling analysis

Abstract Introduction: The benefits of colorectal cancer (CRC) screening programs for average-risk adults rely on completion of follow-up colonoscopy (FU-Col) after a positive result from either the stool-based fecal immunochemical test (FIT) or multi-target stool DNA (mt-sDNA) test. Existing data demonstrate significantly lower rates of FU-Col for Black Americans than White Americans. However, the contribution of differential FU-Col rates on disparate CRC outcomes among Black and White Americans has not been rigorously evaluated. Methods: We used the CRC-Adenoma Incidence and Mortality (CRC-AIM) model as our analysis platform, with inputs from published literature that report Black adults are approximately 15% less likely to complete FU-Col compared to White adults. CRC-AIM was validated against United Kingdom Flexible Sigmoidoscopy Screening Trial and three National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET) CRC models. We simulated screening with annual FIT and triennial mt-sDNA between ages 45 and 75 versus no screening. We considered two scenarios that assumed perfect adherence to FIT/mt-sDNA screening: 1) FU-Col rates for Black adults are 15% lower than those for White adults; 2) Black adults have the same FU-Col rates as White adults. In a secondary analysis, we considered real-world adherence to FIT (43%) and mt-sDNA (66%) and reran these two scenarios. Lifetime outcomes per 1,000 individuals were reported. Results: Assuming perfect adherence to FIT/mt-sDNA screening and 15% lower FU-Col rates, estimated life-year gains (LYG) from annual FIT and triennial mt-sDNA screening strategies compared to no screening was 227 and 239 per 1,000 individuals, respectively. If Black adults had the same FU-Col rates as White adults, the LYG would increase to 243 and 256 for FIT and mt-sDNA screening, respectively, which corresponds to a 7% improvement in LYG. Furthermore, elimination of racial disparities in FU-Col rates would reduce CRC incidence by 8% and 9% for FIT and mt-sDNA screening, respectively and reduce CRC mortality by 10% for both FIT and mt-sDNA screening. Secondary analysis shows that eliminating disparities in FU-Col would lead to 9-11% improvement in LYGs, 5-9% improvement in CRC incidence, and 7-11% improvement in CRC mortality for Black adults considering the real-world adherence to FIT/mt-sDNA screening. Conclusions: Data from this novel simulation modeling study that accounts for differences in FU-Col rates between Black and White Americans suggest that focused efforts to eliminate this gap would improve the anticipated LYG, CRC incidence, and CRC mortality benefits associated with stool-based CRC screening by over 7%, 8%, and 10%, respectively. Further investigation of this under-appreciated contributor to established racial disparities in CRC control may lead to innovative solutions for improving health equity. Citation Format: Oguz Alagoz, A. Mark Fendrick, Vahab Vahdat, Chris Estes, A. Burak Ozbay, Travelle Ellis, Paul J. Limburg, Durado Brooks. Impact of racial disparities in follow-up colonoscopy for abnormal stool-screening test results on colorectal cancer incidence and mortality: A simulation modeling analysis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A138.