Prior Colonoscopy Research Articles

Incidental Colonic Ganglioneuroma on Surveillance Colonoscopy.

CASE REPORT A 73-year-old man with a history of diverticulitis after left hemicolectomy and an end-to-end colo-colonic anastomosis underwent a screening colonoscopy with resection of 4, 2-10-mm tubular adenomas. A 10-mm semipedunculated polyp with a normal mucosal pit pattern under narrow-band imaging was found in the splenic flexure (Figure 1). The polyp was resected using a hot snare and submitted for histopathological diagnosis, which demonstrated colonic mucosa with distorted crypt architecture. The lamina propria was expanded by collection of spindle cells within fibrillary matrix, and irregular nests and groups of ganglion cells indicated a ganglioneuroma (GN) (Figure 2). No clinical symptoms were associated with this finding, and a prior colonoscopy revealed no evidence of GN. Surveillance colonoscopy was recommended in 3 years, given the presence of an adenoma of ≥10 mm in size.Figure 1.: (A) A semipedunculated polyp under white-light imaging in the splenic flexure. (B) A semipedunculated polyp with a normal mucosal pit pattern under narrow-band imaging in the splenic flexure.Figure 2.: (A) An (H&E original magnification 20×) image of the colonic polyp consisting of abnormal appearing ganglion cells (single arrow) and spindled Schwann cells (double arrows). (B) An (H&E original magnification 10×) image of the colonic polyp consisting of abnormal appearing ganglion cells and spindled Schwann cells. H&E, hematoxylin & eosin.Ganglioneuromas of the gastrointestinal tract are rare tumors composed of ganglion cells, nerve fibers, and supporting cells. Gastrointestinal GNs are usually confined to the large intestine and are morphologically classified into 3 categories, namely, polypoid GNs, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis.1 Polypoid GNs are mostly solitary and small (measuring <20 mm), with a sessile or pedunculated appearance. Colonic GNs are characterized by a normal colonic pit pattern under narrow-band imaging. These lesions produce no characteristic symptoms and are usually found incidentally during endoscopy. Rarely, they present with abdominal pain, obstruction, ileus, appendicitis, or weight loss depending on their size and anatomical location.2 Ganglioneuromatous polyposis and diffuse ganglioneuromatosis are associated with genetic syndromes, such as neurofibromatosis 1, multiple endocrine neoplasia 2B syndrome, and juvenile polyposis. Solitary GNs are generally not associated with familial syndromes, although they have been reported in cases of Cowden disease, tuberous sclerosis, polyposis coli, and juvenile polyposis.1 Gastrointestinal GNs are usually treated with endoscopic resection. Currently, no guidelines exist on the management of solitary GNs or recommendations for interval surveillance colonoscopy. Repeat colonoscopy is not necessary because of the benign nature of these lesions, which tend not to recur.3 DISCLOSURES Author contributions: S. Agarwal and Y. Wang designed and drafted the article and acquired data. PG Iyer drafted and revised the article for intellectual content. CL Leggett designed and drafted the article , acquired data, revised the article for important intellectual content, and is the article guarantor. Financial disclosure: None to report. Informed patient consent was obtained for this case report.

Low potency of fecal immunological surveillance testing soon after negative colonoscopy or resection of low-risk adenoma in average-risk patients.

Postcolonoscopy surveillance colonoscopy based on positive fecal occult blood testing (FOBT) is often performed, although its long-term efficacy has not been established. The aim of this study was to clarify the low potency of FOBT surveillance at short intervals after colonoscopy. Colonoscopy was performed in 1308 average-risk patients, based on positive results of immunological FOBT [fecal immunological test (FIT)]. Patients were stratified according to the length of time since their last colonoscopy and their colonoscopy results [no adenoma or 1-2 small (<10 mm) adenomas]. Tumor detection rates were determined. The baseline patients characteristics did not differ between the groups. The advanced lesion detection rate (ALDR) among the patients who had never undergone a colonoscopy was 21.9% [95% confidence interval (CI), 19.1-25.0%]. Among the patients who had no adenoma detected in the previous colonoscopy within the past 5 years, the past 5-10 years and over 10 years, the ALDRs were 2.5% (95% CI, 1.0-5.5%), 4.1% (95% CI, 1.5-9.4%) and 9.3% (95% CI, 3.1-22.2%), respectively. Among the patients who had 1-2 small adenomas, the ALDRs were 7.4% (95% CI, 3.4-14.8%), 12.1% (95% CI, 4.2-27.9%) and 27.8% (95% CI, 12.2-51.2%), respectively. Invasive cancer was not observed in any patients within 5 years since the prior colonoscopy. In average-risk patients whose prior colonoscopy detected no adenomas or low-risk adenomas, postcolonoscopy surveillance by FIT has a low positive predictive value within a 5-year interval.

S1767 COVID-19 Infection Masquerading as Inflammatory Bowel Disease

Introduction: Although COVID-19 infection has been associated with GI manifestations like nausea, vomiting, diarrhea, and even transaminitis, there is no known association between this virus and inflammatory bowel disease (IBD). Here we present the case of COVID-19 infection masquerading as IBD. We describe the instance of a COVID-19 patient with hematochezia, found to have histological changes similar to IBD on colon biopsy. Case Description/Methods: A 70 year-old female with PMH of HTN, DM, CAD, COPD, and recently diagnosed poorly differentiated colonic adenocarcinoma with signet ring features (status-post hemicolectomy and chemotherapy), presented to the ED with hypotension in the setting of nausea, vomiting, and diarrhea for 5 days. Patient had been started on chemotherapy two weeks prior and was found to have a blood pressure of 76/53, but was afebrile with no signs of tachycardia or hypoxia. Labs were significant for a white blood cell count of 0.67 (absolute neutrophil count 247), platelets of 115, lactate of 0.9, potassium of 6.2, BUN/creatinine of 88/5.6, and CRP of 20.78. COVID-19 PCR was positive. Abdominal CT identified non-specific ileitis, and GI was consulted due to concern for neutropenic enteritis and ileus. During the hospital stay, she developed hematochezia with a drop in hemoglobin. C. diff and GI PCR were negative. A colonoscopy was performed which showed patchy areas of edema, erythema, and ulceration (Figure 1B). Colon biopsies revealed crypt abscesses, consistent with IBD (Figure 1C). However, prior colonoscopy 4 months ago, which identified colon cancer, did not find any evidence of IBD (Figure 1A). Patient clinically declined, ultimately dying of acute hypoxic respiratory failure. Discussion: Given this patient’s age and the fact that she had previously had a colonoscopy that did not show evidence of crypt abscesses, it is unlikely she developed a new diagnosis of inflammatory bowel disease in the interim. It is more likely that the crypt abscesses noted on colon biopsy were due to COVID-19 infection. One study found that of 651 patients with COVID-19, 11.4% exhibited GI symptoms, most often developing acute gastritis or enteritis. We present this case to raise awareness of an unprecedented phenomenon in COVID-19 infection.Figure 1.: Figure 1a: Ulcerated mass in cecum as seen on initial colonoscopy. Figure 1b: Cecum on repeat colonoscopy one month later with marked improvement in ulcerations.

S298 Management of Colonic Neoplasia During Inpatient Colonoscopy Performed for Suspected Lower Gastrointestinal Bleeding When No Active Bleeding Is Identified

Introduction: Gastrointestinal (GI) bleeding challenges the management of discovered masses and polyps; definitive polypectomy or biopsy may be deferred for many reasons during an acute bleed. When colonoscopy is indicated for GI bleed, but no evidence of bleeding is noted, management of discovered polyps presents an interesting dilemma without strong data supporting clinical decisions. Methods: We conducted a retrospective review at a tertiary medical center spanning 52 months examining adults undergoing colonoscopy indicated for GI bleed (without stigmata of bleed on exam) while excluding patients with known history of gastrointestinal cancer. We observed prior colonoscopy results, current colonoscopy findings and management, and follow-up colonoscopy data. Results: A total of 574 colonoscopies were indicated for lower GI bleed. 443 showed no evidence of active/recent blood loss. 168 of 443 had a polyp or mass discovered on exam with 72.6% undergoing either polyp removal or biopsy. No significant difference was found regarding race, gender, insurance status, PCP status, prior colonoscopy rate, number of polyps, or prep quality between the groups receiving polyp therapy/biopsy and those who did not. Adenocarcinoma was found in 12.3% of patients who underwent polypectomy/biopsy. There was no difference in follow-up colonoscopy rates (19.7% vs 26.1%) and no difference if polyps were seen on follow-up between the groups. More patients in the group not receiving polypectomy/biopsy were instructed to follow-up within a year. However, this was still low at 15.2% vs 5.7%. In the group not receiving polypectomy/biopsy, diverticula were found in 65.2%, hemorrhoids in 17.4%, ischemic colitis in 2.2%, and vascular ectasia in 2.2%. Conclusion: A majority of colonoscopies performed for lower GI bleeding found no evidence of active or recent hemorrhage; however, 37.9 % of these patients were found to have colonic neoplasia and furthermore, a significant number of individuals who underwent biopsy or polypectomy were found to have adenocarcinoma. This data indicates that gastroenterologists generally perceive interventions in the context of no active or recent blood loss as safe, though it is important to note that follow-up colonoscopy rates were low for both groups. This raises the question if polyp management would be safe for these patients during this index exam if prep is adequate vs having these patients return at a later date with potentially low follow-up rates.

S3520 An Unusual Surprise on Routine Colonoscopy

Introduction: Gastrointestinal xanthomas are rare, benign lesions that are incidentally found during endoscopy or colonoscopy. They most frequently occur in the stomach with incidence of gastric xanthomas reported to range between 1-4%. The incidence of colonic xanthoma is unknown but expected to be even lower as it is limited to a few case reports. Here, we present a rare occurrence of a xanthoma incidentally detected in the sigmoid colon. Case Description/Methods: A 77-year-old female presented for a screening colonoscopy. Her past medical history was significant for cirrhosis secondary to autoimmune hepatitis diagnosed 30 years ago and a prior colonoscopy notable for multiple tubular adenomas, tubulovillous adenoma and a transverse colon lipoma. Colonoscopy revealed multiple diverticula in the sigmoid and descending colon, a lipoma in the transverse colon and a polyp in the sigmoid colon. The polyp was 8 mm, semi-pedunculated and removed with a cold snare. Pathology identified the polyp as a xanthoma. Given history of tubulovillious polyp and multiple tubular adenomas, she was instructed to undergo a repeat colonoscopy in 5 years. Discussion: Colonic xanthomas are a rare occurrence with previous cases describing the most common location in the sigmoid colon. The largest case series of 28 colorectal xanthomas described the median age of the patients as 64 years and there were 15 men and 10 women. Macroscopically they generally present as plaques and rarely as polypoid lesions as seen in our patient. Microscopically they contain foamy macrophages that are thought to be lipids derived from damaged cell membranes. Unlike cutaneous xanthomas, gastrointestinal xanthomas do not have a clear association with hyperlipidemia. Our patient did not have history significant for diabetes or hyperlipidemia. Reported associations of colonic xanthomas include adenomas (16%) and adenocarcinomas (4.8%) and hence, should prompt a thorough examination when xanthomas are suspected during a colonoscopy. Although generally asymptomatic, they have a potential of presenting with gastrointestinal obstruction and therefore should be in the differential diagnosis for polypoid lesions found on colonoscopy.Figure 1.: Colonoscopy showing approximately 8mm polypoid lesion in the sigmoid colon.

Video Consent for Colonoscopy Improves Knowledge Retention and Patient Satisfaction: A Randomized Controlled Study.

Informed consent for endoscopy is variable across institutions and remains understudied in gastrointestinal endoscopy. This study aims to standardize informed consent for screening and diagnostic colonoscopies with a supplemental video tool that includes the key components of informed consent. A video tool was developed that incorporated the key components of informed consent for colonoscopy. In addition, a 7-question survey was developed to query patients on core aspects of informed consent and satisfaction with the informed consent process. Patients undergoing elective outpatient colonoscopy with conscious sedation were randomized to traditional consent or consent with the addition of a video tool. A pilot study determined the sample size. Traditional consent was standard of practice before the procedure. Patients in the video tool group watched the video tool in the preprocedure area followed by traditional consent. Both groups had the opportunity to address questions with the attending physician before the procedure. All patients were contacted 1 to 2 days following the colonoscopy to answer the question survey. A total of 110 patients were eligible for participation, and 91 were included in the final data analysis. Subjects in the video tool group demonstrated significantly higher recall of key aspects of informed consent and higher satisfaction with the informed consent process versus the traditional consent group. The history of prior colonoscopy was similar between both groups. Mean endoscopy operation metrics were not negatively impacted by the inclusion of the video tool. Patients undergoing screening and diagnostic colonoscopies who received informed consent supplemented by a video tool had a higher recall of core aspects of informed consent and higher satisfaction with the process, with no impact on procedural times.

Factors Associated With Adherence to Osteoporosis Medications Among Male Veterans.

ABSTRACTRisk factors for nonadherence to osteoporosis medication have been well described for cohorts of women with osteoporosis, but little is known about predictors or mediators of nonadherence in men. We conducted a secondary analysis of a national cohort of male veterans to explore factors associated with nonadherence to osteoporosis medications. We included veterans with a prescription for an oral bisphosphonate or calcitonin between 2000 and 2010. We identified demographic, comorbid, and fracture‐related risk factors by their International Classification of Diseases‐9 (ICD‐9) and Current Procedural Terminology (CPT) codes and used multivariable logistic regression to evaluate their association with adherence. Adherence was measured by medication possession ratio (MPR) over 5 years, starting at the time of their first prescription during the study period and censoring at death or end of study period. Of 135,306 men identified with at least one prescription for an osteoporosis medication during the study period, 90,406 (67%) were nonadherent (MPR < 0.80). The median duration of therapy was 3.2 years (interquartile range [IQR] = 1.7–5.0). In the fully adjusted model, the odds of adherence were lower in those aged <65 years (odds ratio [OR] = 0.87; 95% confidence interval [CI] 0.84–0.89), with no copay (OR = 0.78; 95% CI 0.76–0.80), dementia (OR = 0.87; 95% CI 0.83–0.91), anxiety/depression (OR = 0.92; 95% CI 0.90–0.95), tobacco use (OR = 0.91; 95% CI 0.89–0.94), alcohol abuse (OR = 0.91; 95% CI 0.89–0.94), rheumatoid arthritis (OR = 0.92; 95% CI 0.87–0.97), and on androgen deprivation therapy (OR = 0.89; 95% CI 0.83–0.95). The odds of adherence were higher in whites (OR = 1.14; 95% CI 1.11–1.17), with a prior screening colonoscopy (OR = 1.12; 95% CI 1.09–1.14), on alendronate versus other agents (OR = 1.61; 95% CI 1.55–1.67), with a dual‐energy X‐ray absorptiometry (DXA) (OR = 1.14; 95% CI 1.12–1.17), on glucocorticoids (OR = 1.08; 95% CI 1.02–1.14), and with recent fracture (OR = 1.07; 95% CI 1.04–1.10). In conclusion, adherence to oral bisphosphonates/calcitonin is poor, with particular subgroups at greatest risk. These findings may help tailor approaches for supporting adherence in men prescribed osteoporosis medications. © 2021 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

ID: 3527157 ENDOSCOPY FOR EVALUATION OF ABNORMAL IMAGING; EFFECT OF PRIOR SCREENING COLONOSCOPY

Referrals for endoscopic evaluation of abnormal gastrointestinal imaging findings is a common clinical occurrence. Current guidelines from American Society for Gastrointestinal Endoscopy recommend endoscopic evaluation of abnormal imaging findings if endoscopy "is likely to be clinically significant." To our knowledge, the relationship of prior screening colonoscopies and diagnostic findings has not previously been reported. This study aimed to determine the incidence of prior screening colonoscopies and compare diagnostic findings between those who had prior screening colonoscopy with those who did not.

Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage

PurposeAcute colon perforation is a pediatric surgical emergency. We aimed to analyze the different etiologies and clinical characteristics of acute non-traumatic colon perforation beyond the neonatal period and to identify surgical management and outcomes.MethodsThis retrospective study included 18 patients admitted with acute colon perforation and who received surgical treatment.ResultsAge of patients ranged between 1 month and 15 years. Five patients swallowed foreign objects (two swallowed magnets), two had colon perforation secondary to a malignant tumor (both colorectal adenocarcinoma) and two were iatrogenic (one prior colonoscopy, one air enema for intussusception). There was one perforation due to chemotherapy and Amyand’s hernia respectively. The remaining seven patients had unknown etiologies; five of them were diagnosed with colitis. Fifteen (83.3 %) patients underwent open laparotomy, among which four attempted laparoscopy first. Three (16.7 %) patients underwent laparoscopic surgery. Fourteen (77.8 %) patients received simple suture repairs and four (22.2 %) received colonic resections and anastomosis. Four (22.2 %) patients received a protective diverting colostomy and three (16.7 %) received an ileostomy.ConclusionsThere is a wide range of etiology besides necrotizing enterocolitis and trauma, but a significant portion of children present with unknown etiology. Type of surgery elected should be dependent on the patient’s etiology, disease severity and experience of surgeons.

Perforation and post-polypectomy bleeding complicating colonoscopy in a population-based screening program.

Background and study aims We aimed to estimate the rate of hospital admissions for perforation and for post-polypectomy bleeding, after outpatient colonoscopy following a first positive fecal occult blood test screen through the population-based ColonCancerCheck program in Ontario, Canada. Patients and methods We identified all individuals aged 50 to 74 years with a first positive CCC gFOBT screening result from 2008 to 2017 who underwent outpatient colonoscopy ≤ 6 months later and who did not receive a diagnosis of CRC ≤ 24 months later. We identified inpatient hospital admissions for colonic perforation ≤ 7 days after and for post-polypectomy bleeding ≤ 14 days following colonoscopy. Results Among 121,626 individuals who underwent colonoscopy, the rate of perforation was 0.6 per 1000 from 2008 to 2012 and 0.4 per 1000 from 2013 to 2017. The rate was elevated among those aged 70 to 74 years; those with comorbidities; when colonoscopy was performed by endoscopists other than gastroenterologists or endoscopists with low prior year volume; and when polypectomy was performed during colonoscopy. The rate of bleeding was 4.3 per 1000 and was elevated among those aged 70 to 74 years, those with comorbidity, and with complex polypectomy. Both outcomes were more common among those aged 70 to 74 years, those with a 5-year cumulative Charlson score ≥ 1, those with prior hospitalization for ischemic heart disease, and those with endoscopists whose prior year colonoscopy volume was in the three lower quartiles. Conclusions Colonic perforation and post-polypectomy bleeding, among participants of population-based colorectal screening programs who test positive in the absence of colorectal cancer, are infrequent but serious complications, which increase with participant age and comorbidity, and with endoscopist characteristics.

Are the current colonoscopy recommendations for interval surveillance in patients with polyps enough? Machine learning-augmented propensity score cohort analysis of 1840 patients.

Colonoscopy remains the gold standard for screening and surveillance of colorectal neoplasms, and is associated with a lower risk of colorectal cancer (CRC)-related mortality. The current interval surveillance recommendations in patients with previous adenomas lack sufficient evidence. The prevalence of subsequent adenomas, and especially high-risk adenomas, during surveillance is not well known. The primary outcome of this study was to determine the prevalence of polyps upon surveillance colonoscopy in patients who have a history of adenomas on initial average-risk-screening colonoscopy, but then have a normal initial surveillance (second) colonoscopy between 2003 and 2017. This is the first known retrospective cohort study of adenoma detection rate (ADR) with sub-group analysis of patients with serial surveillance colonoscopies by abnormal and high-risk surveillance findings separately by prior abnormal colonoscopies and correct surveillance strategies based on the recent March 2020 updated guidelines. After ADR calculation, machine learning-augmented propensity score adjusted multivariable regression with augmented inverse-probability weighting propensity (AIPW) score analysis was used to assess the relationship between guideline adherence, as well as abnormal and high-risk surveillance findings. A total of 1840 patients with pathologically confirmed adenomas or cancer on an initial average-risk-screening (first) colonoscopy met study criteria. 837 (45.5%) had confirmed adenomas on second colonoscopy, and 1003 (54.5%) had normal findings. Of 837 patients with polyps on both first and second colonoscopy, 423 (50.5%) had adenomas on third colonoscopy. Of the 1003 patients without polyps on second colonoscopy, 406 (40.5%) had confirmed adenomas on third colonoscopy. Guideline adherence was low at 9.18%, though was associated in propensity score adjusted multivariable regression with increased odds of an abnormal third (but not high-risk) colonoscopy, with comparable AIPW results. This 14-year study demonstrates the ADR to be > 40% on the third colonoscopy for patients with adenomas on initial screening colonoscopy, who then have a normal second colonoscopy. Through advanced machine learning and propensity score analysis, we showed that correct adherence is associated with higher odds of abnormal, but not high-risk abnormal 3rd colonoscopy, with evidence that high-risk surveillance findings are reduced by providers shortening the time between surveillance colonoscopies in contrast to the guidelines for those for whom there is presumed greater clinical suspicion of eventual cancer. Larger prospective trials are needed to guide optimal surveillance for these patients.

Comparison of colonoscopy after colonic diverticulitis and positive fecal immunochemical tests for the detection of colorectal neoplasia.

Background and study aims The relationship between acute colonic diverticulitis and colorectal cancer (CRC) is unclear, but colonoscopy is recommended to exclude malignancy. We compared the detection rates for colorectal neoplasia in patients with colonic diverticulitis and asymptomatic patients who had positive fecal immunochemical tests (FITs). Patients and methods In total, 282 patients with acute colonic diverticulitis were hospitalized in our hospital from February 2011 to December 2019. Of them, 143 patients with diverticulitis and 1819 with positive FITs patients during the same period underwent colonoscopy without a prior colonoscopy within 5 years. We retrospectively compared these patients in terms of the invasive CRC rate, advanced neoplasia detection rate (ANDR), adenoma detection rate (ADR), and polyp detection rate (PDR). Results Compared to the diverticulitis group, the FIT-positive group had a significantly higher CRC rate (0 vs 2.7 %, P = 0.0061), ANDR (5.6 vs. 14.0 %, P = 0.0017), ADR (19.6 vs. 53.2 %, P < .0001), and PDR (44.1 vs. 91.0 %, P < .0001). Using 1:1 propensity score matching based on age and sex, we obtained 276 matched patients in both groups. After matching, no difference was found in the CRC rate (0 vs 0.7 %) or ANDR (5.8 vs 7.3 %) between groups, but the ADR and PDR were significantly higher in the FIT-positive group (20.3 vs 43.5 %, P < .0001; 45.7 % vs 86.2 %, P < .0001). Conclusion Patients with acute diverticulitis had lower ADRs and PDRs than patients with positive FITs.

Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey

BackgroundNER1006 (Plenvu®, Salix Pharmaceuticals, Bridgewater, NJ) is a 1 L polyethylene glycol bowel preparation indicated for colonoscopy in adults. A US online survey assessed real-world ease of use and treatment satisfaction in individuals who received NER1006.MethodsAdults were recruited from 444 US community gastrointestinal practices and provided a kit number for enrollment into an online survey to be completed within 2 weeks. Survey questions evaluated colonoscopy history and prior bowel preparation(s) prescribed, patient experience during NER1006 administration, and patient satisfaction with the bowel preparation process. A 9-point predefined grading scale was used to evaluate ease of NER1006 preparation and consumption (range, 1 “very difficult” to 9 “very easy”); the perceived importance of volume requirement and clear liquid options (range, 1 “not important at all” to 9 “very important”); and patient satisfaction (range, 1 “not satisfied at all” to 9 “very satisfied”).Results1630 patients were enrolled, 1606 underwent colonoscopy, and 1598 completed the survey between September 15, 2018 and February 28, 2019. Among 1606 patients who had a colonoscopy, 62.5% were female, and the mean patient age was 54.4 years (range 18–89 years). Most patients (74.7%) did not report a family history of colon cancer, 62.6% had undergone prior colonoscopy, and 64.8% were undergoing colonoscopy for routine colorectal cancer screening. A majority (76.1%) of patients who completed the survey reported that NER1006 was very easy to prepare and take, and 89.9% were very or moderately satisfied with NER1006 overall. Most (97.6%) patients reported consuming all or most of the bowel preparation. Among 1005 patients with previous bowel preparation use, 84.7% indicated that their experience with NER1006 was much better or better (65.3%) or about the same (19.4%) compared with previously used bowel preparations, while only 15.3% rated NER1006 as worse or much worse.ConclusionsIn this first real-world, US multicenter survey, patient-reported experience with NER1006 as a bowel preparation for colonoscopy was favorable and adherence was high. The majority of patients were very or moderately satisfied with the overall experience and found it much better/better than previously used bowel preparations.Trial registration: Not applicable

A Predictive Model for the Diagnostic and Therapeutic Yield of Colonoscopy Performed for Lower Gastrointestinal Bleeding.

Although colonoscopy is routinely performed for the management of lower gastrointestinal bleeding (LGIB), the quality of evidence supporting its use is poor and its yield for active bleeding or malignancy is low in practice. We conducted a retrospective analysis of all adult patients who underwent colonoscopies for LGIB at our hospital system between January 1, 2015, and December 31, 2019. A statistical model was built on a cohort of 5195 cases using multiple logistic regressions to predict the detection of various colonoscopy findings and the use of different colonoscopy maneuvers. The model was converted into a risk scoring system, named the TYPICAL Index, and was validated against a separate cohort of 914 cases. Active bleeding was only seen in 3.8% of colonoscopies performed for LGIB and endoscopic hemostasis was applied in 43.7% of actively bleeding lesions. Malignant-appearing lesions were detected in 2.5% of LGIB procedures and all cases of proximal colonic mass were identified in subjects age above 60. The TYPICAL Index, derived from age, gender, hemoglobin, creatinine, international normalized ratio, and prior colonoscopy for LGIB has a concordance statistic of 0.71 and a negative predictive value of 93.8% for potential bleeding sources requiring hemostasis, malignant-appearing lesions, or active bleeding on colonoscopy when applied using a threshold of 6. Active bleeding and malignancies are rarely encountered and endoscopic hemostasis is seldom required during colonoscopy performed for LGIB. We developed and validated a risk scoring system to identify cases of low predicted diagnostic and therapeutic yield and to guide clinical decision-making.

Estimating the Backlog of Colonoscopy due to Coronavirus Disease 2019 and Comparing Strategies to Recover in Ontario, Canada

Estimating the Backlog of Colonoscopy due to Coronavirus Disease 2019 and Comparing Strategies to Recover in Ontario, Canada

Abstract PO-246: Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities

Abstract Background Fecal immunochemical tests (FITs) are an acceptable and cost-effective way to identify patients at risk for colorectal cancer (CRC). However, patients who receive an abnormal FIT result must obtain a follow-up colonoscopy. Rates of follow- up colonoscopy are low in most healthcare settings, particularly in federally qualified health centers (FQHCs). Half of patients with an abnormal FIT result fail to complete this essential colonoscopy screening component. Patient navigation can provide much needed support for patients to complete the follow-up colonoscopy. Methods PRECISE is a patient-randomized trial of patient navigation vs usual care for follow-up colonoscopy that will enroll 1,200 patients across 28 community health center clinics in Washington State (anticipated 37% Latinx). For the study, we trained a bilingual (native Spanish speaker) patient navigator (PN) using an intensive 8-week program, based on the New Hampshire Colorectal Cancer Screening Program. As part of the recruitment and data tracking tool used by the PN, open text fields are available for documenting interactions with navigated patients. We present a qualitative content analysis of the open text fields of navigated patients. These findings identify a broad range of supportive interactions engaged in by the PN to assist patients in overcoming barriers to follow-up colonoscopy completion. Results To-date, 124 patients have been randomized to navigation, and 44 of these had open text field documentation. Our content analysis found slightly more than half (N=23) required more intensive navigation assistance for overcoming a variety of barriers such as fear of or misinformation about the colonoscopy; help with scheduling, transportation, and interpreter services; and assistance with obtaining and completing the bowel preparation. Those that needed less navigation (N=21) mostly required assistance with scheduling the colonoscopy and often had protective factors such as prior colonoscopy experience or support from family/friends for completing the procedure. Overall, the top three areas the PN tended to provide support for overcoming barriers included: contacting the gastroenterologist office to problem- solve issues like lack of referral, scheduling delays, or to obtain appointment information (40 instances); assisting the patient with obtaining, understanding, and completing the bowel preparation including diet restrictions, medication interaction, and preparing/consuming the mixture (25 instances); and verifying, coordinating, and offering transportation/escort support before and after the colonoscopy procedure (22 instances). Conclusion The PRECISE trial highlights the importance of targeted patient navigation to improve CRC screening completion. Our open text field findings demonstrate the necessary role of patient navigation for overcoming the multitude of educational and structural challenges facing FQHC patients when attempting to complete a follow-up colonoscopy. Citation Format: Jennifer L. Schneider, Jennifer S. Rivelli, Jamie Thompson, Amanda Petrik, Neha Yadav, Hanna Dinh, Cindy Pulido, Shirley Mendez, DeeDee Torres, Gloria Coronado. Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-246.

Colonoscopy Quality and Adherence to Postpolypectomy Surveillance Guidelines in an Underinsured Clinic System.

Background Delivery of high-quality colonoscopy and adherence to evidence-based surveillance guidelines is essential to a high-quality screening program, especially in safety net systems with limited resources. We sought to assess colonoscopy quality and ensure appropriate surveillance in a network of safety net practices. Methods We identified age-eligible patients ages 50-75 within a Federally Qualified Health Center (FQHC) clinic system with evidence of colonoscopy in preceding 10 years. We performed chart reviews to assess key aspects of colonoscopy quality: bowel preparation quality, evidence of cecal intubation, cecal withdrawal time, and the adenoma detection rate. We then utilized established guidelines to assess and revise surveillance colonoscopy intervals, determine whether appropriate surveillance had taken place, and schedule overdue patients as appropriate. Results Of 26,394 age-eligible patients, a total of 3,970 patients had evidence of prior colonoscopy and 1,709 charts were selected and reviewed. Mean age was 57, 54% identified as women and 51% identified as Hispanic. Of 1709 colonoscopies reviewed, 77% had data on bowel preparation, and of those, 85% had adequate preparation quality. Cecal intubation was documented in 89% of procedures. Adequate cecal withdrawal time was documented in 59% of those with documented cecal intubation. Overall adenoma detection rate was 42%. Initial surveillance interval was clearly stated in 72% (n = 1238) of procedures. Of these, initial recommended intervals were too short in 24.5% (n = 304) and too long in 3.6% (n = 45). A total of 132 patients (10.7%) were overdue for appropriate surveillance and were referred for follow-up colonoscopy. Conclusions Overall, the quality of screening colonoscopy was high, but reporting was incomplete. We found fair adherence to evidence-based surveillance guidelines, with significant opportunities to extend surveillance intervals and improve adherence to best practices.

Cancer Screening During the Coronavirus Disease-2019 Pandemic: A Perspective From the National Cancer Institute’s PROSPR Consortium

Cancer Screening During the Coronavirus Disease-2019 Pandemic: A Perspective From the National Cancer Institute’s PROSPR Consortium

S1661 More Than Just a Polyp? The Diagnosis of TB From a Screening Colonoscopy

INTRODUCTION: TB most commonly affects the lung, but it can affect other anatomic sites including the GI tract. On colonoscopy, colonic TB usually presents as ulcerative lesions, nodular lesions or strictures and less likely to present as a polyp. We present a case of a 66 year old female who was found to have small benign appearing colonic polyps on screening colonoscopy, who was eventually diagnosed with pulmonary TB after pathological examination of the polyp. CASE DESCRIPTION/METHODS: A 66-year Filipino female with past medical history significant for HTN and goiter was referred to the GI clinic for initial colon cancer screening. She had no prior colonoscopies. The patient was born in the Philippines and moved to the United States in 1990. She had no family history of GI malignancies. She denied GI symptoms and her only other complaint being malaise. Physical exam including GI exam did not show significant findings. On colonoscopy, three sessile polyps 2–4 mm in size were identified in the ascending colon, in addition to a 5 mm sessile polyp in the cecum. Histopathological evaluation revealed mucosal granulomas with caseating necrosis in the ascending colon polyps. AFB and fungal stains were negative. CXR was done after receiving the pathology results that showed a right upper lobe lung mass concerning for TB vs malignancy so a chest CT with contrast was done which showed a 10 cm mass in the RUL with nodular pleural thickening, hilar and right internal mammary adenopathy. After further questioning, patient mentioned that she had a cough productive of yellowish sputum of one month duration associated with night sweats but denied any other symptoms. Patient was referred to the pulmonary clinic for further evaluation of the lung mass, sputum AFB stain and sputum culture was positive, and she was treated with anti-tuberculosis drug regimen for 9 months. Patient reported significant improvement in symptoms and follow up chest CT scan showed regression in the lung mass. DISCUSSION: GI TB is not uncommon and the disease remains a significant problem in immune suppressed individuals and those born in other countries. Colonic TB presents with non-specific signs and symptoms as well as non-specific colonic findings which contributes to the delay in diagnosis and management of this condition, so we recommend considering TB in the deferential of colonic polyps in immune suppressed patients and patients with risk factors for TB.Figure 1.: Colonic mucosa with caseating granuloma. Histiocytes and multinucleated giant cells rimming the necrosis.Figure 2.: Sessile polyp identified in ascending colon.Figure 3.: Sessile polyp identified in ascending colon.

S1697 Incidental Finding of Lung Adenocarcinoma During Routine Colonoscopy

INTRODUCTION: Routine colonoscopy in asymptomatic individuals often reveals lesions of varying significance and are performed in an effort to detect colorectal cancer and remove precancerous polyps. About 70% of polyps are adenomas, which have malignant potential. For polyps less than 1 cm in size, there is less than a 1% chance of being cancerous. Even more rarely do these lesions result in diagnosis of a primary malignancy in a distant organ system. CASE DESCRIPTION/METHODS: A 68 year old woman, former smoker, presented to clinic for screening colonoscopy. She had no family or personal history of malignancy and was asymptomatic. Her prior colonoscopy in 2015 showed tubular adenomas in the transverse colon and a prominent fold in ascending colon that pathology revealed as sessile serrated adenoma. She returned for repeat colonoscopy in 2020 that was significant for tubular adenomas and a 4 mm sessile polyp with overlying ulcer in the ascending colon. This polyp resulted as poorly differentiated adenocarcinoma of lung origin. Immunostains demonstrate that the tumor cells are positive for CK7, Cam 5.2, TTF1, Napsin and patchy positive for CK20. This prompted CT which showed a new 2.2 cm spiculated lung nodule, a 1.5 cm stable appearing lung nodule, new mixed sclerotic and lytic lesions of the S1 vertebral body, prominent mediastinal and right hilar lymph nodes. She was diagnosed with metastatic lung adenocarcinoma and referred to oncology. DISCUSSION: Lung cancer is the second most commonly diagnosed cancer in the United States, and the deadliest. Non-small cell lung cancers (NSCLC) make up 85% of lung cancers, and have distant metastases in 39.9% of cases, most commonly to bone (34%), liver (32%), brain (28%), and adrenal glands (17%). Metastasis to the colon is rarely reported, and usually discovered due to symptoms of bleeding or obstruction. This case reports detection of primary lung neoplasia found in an incidental polyp during screening colonoscopy in an asymptomatic patient. It is difficult to determine the incidence of metastasis to the colon, but one study found a single patient in 1,542 with NSCLC. Multiple studies have shown that the site of metastasis is correlated with prognosis, but there is no data on the prognostic indications of intestinal metastasis. This case demonstrates the importance of pathological evaluation of polyps seen on colonoscopy. Once diagnosed with cancer of pulmonary origin, these patients should be evaluated for other sites of metastasis.