P1762 - Metachronous Colorectal Neoplasia Risk in Adults Younger Than Age 45 with Advanced Neoplasia at Baseline

Raj Jessica Thomas, DO¹, Jacquelyn Bolwell, MD², Robert S. Butler, MS², Carol A. Burke, MD, FACG², Carole Macaron, MD^3
1Cleveland Clinic Akron General, Akron, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH

Introduction: The risk of metachronous colorectal neoplasia in adults younger than 45 years with advanced lesions at baseline colonoscopy is not well defined. Identifying non-endoscopic factors associated with the risk of neoplasia on surveillance colonoscopy may help advise patients on risk mitigation strategies. The aims of the study are: 1) To examine risk for metachronous neoplasia in adults < 45 years of age who had advanced neoplasia (AN) at baseline colonoscopy, 2) To determine factors associated with metachronous neoplasia in these patients.

Methods: Individuals 18-44 years of age with ≥ 1 AN [tubular adenoma (TA) >10 mm or with villous features or high-grade dysplasia (HGD), sessile serrated lesion (SSL) >10 mm or with dysplasia, traditional serrated adenoma (TSA) or invasive adenocarcinoma] who had colonoscopy > 6 months after their baseline colonoscopy were included. Patients with inflammatory bowel disease or inherited CRC syndromes were excluded. Age, gender, race, ethnicity, BMI, alcohol and tobacco use, diabetes (ICD codes, or Hba1c >6.4%), hyperlipidemia (ICD codes or LDL > 130 mg/dl), vitamin D level, family history of CRC, and colonoscopy indications were obtained. Individuals were divided into 3 groups based on metachronous colonoscopy findings: 1) normal (no polyps or hyperplastic polyps), 2) non advanced neoplasia (NAN) [TA < 10mm, SSL < 10 mm without dysplasia] and 3) AN. Multivariable logistic regression model were performed.

Results: Of 651 patients included, 331 (50.8%) had ≥ 1 follow up colonoscopies during a mean follow up of 43 months. Follow up findings were normal in 194 (58.6%), NAN in 109 (32.9%) and AN in 28 (8.4%). No adenocarcinoma was diagnosed on follow up. Patients with metachronous NAN and AN had longer follow-up time (50.3 vs 45.3 vs 38.7 months respectively, p< 0.001) and more surveillance colonoscopies (1.1 vs 1.7 vs 1.6 respectively, p< 0.001) compared to patients with a normal colonoscopy. In the multivariable model comparing predictors of a composite endpoint (AN and NAN), only BMI was found to be statistically significant OR 1.072 (p=0.016) (Table 1b).

Discussion: In our cohort, we observed AN in < 10% of adults < 45 years of age during a follow up approximating 4 years. Except for BMI, no clinical or pathological factors were associated with metachronous neoplasia. Personalized surveillance colonoscopy and providing weight management in young patients with high BMI may help reduce risk in these young patients.


Disclosures:


Raj Jessica Thomas, DO¹, Jacquelyn Bolwell, MD², Robert S. Butler, MS², Carol A. Burke, MD, FACG², Carole Macaron, MD³. P1762 - Metachronous Colorectal Neoplasia Risk in Adults Younger Than Age 45 with Advanced Neoplasia at Baseline, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.