P0161 - Variability in Follow-up Recommendations After a Diagnostic Colonoscopy Performed for a Positive Multitarget Stool DNA Test

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Samuel Cheong, MD

University of Arizona-Banner Health Tucson
Tucson, AZ

Mahak Chauhan, MD¹, Samuel Cheong, MD², Amar Vedamurthy, MD³, Joshua Melson, MD², Avin Aggarwal, MD²
¹University of Arizona-Tucson College of Medicine, Tucson, AZ; ²University of Arizona-Banner Health Tucson, Tucson, AZ; ³Banner Health, Tucson, AZ

Introduction: There is a rise in multi-target stool DNA (mts-DNA) testing for colorectal cancer (CRC) screening. Data suggests that the colonoscopies performed after a positive stool DNA test have a significantly higher neoplastic burden with high ADRs and a higher rate of advanced neoplasia1. Following an index diagnostic colonoscopy for a positive mts-DNA test, physicians are inclined to choose a shorter interval due to apprehension about missed lesions. We aimed to study physicians' behavior in determining follow-up intervals in this subset of patients.

Methods: We identified patients who underwent index diagnostic colonoscopy for a positive mts-DNA, had a high-quality exam with cecal intubation, and adequate bowel preparation. A chart review was performed to identify the number of polyps, and a pathology report to confirm neoplasia detection.

Results: 316 patients were identified; 273 met the criteria and 43 did not have a follow-up recommendation due to age or other comorbidities. Among patients with no polyps, the median time for subsequent screening exam was 10 years, (IQR; 3-10 years) despite adequate preparation for colonoscopy. However, patients with 1-2 tubular adenomas (TA) were given a median follow-up of 5 years, two years before the USPSTF recommendation. Similarly, those with 3-4 TA had a median follow-up of 3 years, which was the lower limit of recommended interval. In patients with advanced adenomas, the recommended interval was again variable but tended to be earlier than the guidelines. Those with villous features with a size < 10 mm, had a median follow-up of 3 years. Those with 1-2 SSPs (< 10mm) had a median follow-up for 3 years (IQR; 3-5 years); significantly shorter than the standard guidelines.

Discussion: Our study shows variability in recommendations for subsequent screening or surveillance colonoscopy following a diagnostic examination for a positive stool mts-DNA test. The recommended interval tends to be shorter when no polyps are identified. A similar trend was seen in those with advanced adenoma with follow-up at the lower limit of the recommended guidelines. Further studies should be conducted to determine whether closer monitoring impacts long-term outcomes in these patients.

Reference:

Dominitz, Jason A et al. “Screening With FIT-DNA: Impact on Colonoscopy Withdrawal Time, Adenoma Detection and Endoscopist’s Recommendation for Follow-Up. The American Journal of Gastroenterology 117(10S):p e177-e178, October 2022. |

Type of Polyp	Number of patients	Median (y)	Mean (y)	Range	IQR	USPSTF Guidelines
No polyp	68	10	7.3	1-10 years	3-10 years	10
1-2 TA	46	5	4.2	1month-10 years	3-7 years	7-10
3-4 TA	20	3	2.7	1month-5 years	3months-5 years	3-5
5-10 TA < 10mm	14	3	2.2	1month-5 years	6months-3 years	3
Adenoma >10mm	35	1	1.9	1month-7 years	1month-5 years	3
Villous features	39	3	1.9	1month-5 years	3months-3 years	3
1-2 SSP < 10 mm	22	3	3.3	1month-7 years	3-5 years	5-10
< 20 HP < 10 mm	22	10	7.1	3-10 years	5-10 years	10
Insufficient data for >10 adenomas, HGD (High grade dysplasia). HP = Hyperplastic Polyp, IQR= Interquartile range, SSP= Serrated Sessile Polyp, TA= Tubular Adenoma.

Table: Table 1: Follow-up recommendations after colonoscopy and polypectomy in patients with positive mts-DNA.

Disclosures:

Mahak Chauhan indicated no relevant financial relationships.

Samuel Cheong indicated no relevant financial relationships.

Amar Vedamurthy indicated no relevant financial relationships.

Joshua Melson indicated no relevant financial relationships.

Avin Aggarwal indicated no relevant financial relationships.

Mahak Chauhan, MD¹, Samuel Cheong, MD², Amar Vedamurthy, MD³, Joshua Melson, MD², Avin Aggarwal, MD². P0161 - Variability in Follow-up Recommendations After a Diagnostic Colonoscopy Performed for a Positive Multitarget Stool DNA Test, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.