P0326 - Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

Award: Presidential Poster Award

Fouad Jaber, MD¹, Mouhand Mohamed, MD², Natalie Wilson, MD³, Abubaker Abdalla, MD⁴, Abdelrahman Mohamed Mahmoud, MS⁵, Saqr Alsakarneh, MD¹, Azizullah Beran, MD⁶, Khalid K. Ahmed, MD⁷, Aasma Shaukat, MD⁸, Mohammad Bilal, MD^9
1University of Missouri-Kansas City, Kansas City, MO; ²Brown University, Providence, RI; ³University of Minnesota, Minneapolis, MN; ⁴Emory University, Atlanta, GA; ⁵Menoufia University, Menoufia, Al Minufiyah, Egypt; ⁶Indiana University, Indianapolis, IN; ⁷The Wright Center for GME, Scranton, PA; ⁸NYU Langone Health, New York, NY; ⁹Minneapolis VA Medical Center, Minneapolis, MN

Introduction: Fecal immunochemical test (FIT) is a stool-based test recommended by the United States Preventative Services Taskforce (USPSTF) for screening for colorectal cancer (CRC) in average risk individuals. While studies have reported adenoma detection rates in FIT-positive individuals, there is a lack of data on the performance of FIT in detecting sessile serrated lesions (SSLs). We conducted a systematic review and meta-analysis to evaluate the SSL detection rate in individuals with a positive FIT undergoing colonoscopy.

Methods: We conducted a comprehensive search of PubMed, Scopus, and Embase databases up to May 2023 to identify studies reporting SSLs in FIT-positive individuals undergoing colonoscopy for average-risk CRC screening. The primary outcome was the overall SSL detection rate, and secondary outcomes included the prevalence of proximal and distal SSLs. A proportion meta-analysis, utilizing the random effects model, was used to generate the pooled rates with their corresponding 95% confidence intervals (CI). I2 adjudicated the heterogeneity. CMA software was used for statistical analysis.

Results: Six studies met the inclusion criteria, involving 252,455 FIT-positive individuals undergoing colonoscopy. Average age of patients ranged between 59-62 years, with 45.5% being female. Four of six studies were from North America (US and Canada). Two studies used a FIT positivity threshold of 20 mcg /g feces, while the remaining studies used a threshold of 10 mcg /g feces. A total of 14,026 individuals were found to have at least 1 SSL from a total of 252,455 patients across six studies, for a pooled SSL detection rate of 5.56%. Using random-effects models, the overall SSL detection rate was estimated to be 4.91% (CI: 3.14% - 7.60%; I²: 99%) (Figure 1-A). For proximal SSLs, the detection rate was 3.49% (CI: 0.77% - 14.37%; I²: 99%), based on three studies (Figure 1-B). For distal SSLs detection, the pooled rate from three studies was 2.05% (CI: 1.17% - 3.57%; I²: 99%) (Figure 1-C).

Discussion: Our meta-analysis highlights sessile serrated lesion (SSL) detection rates in FIT-positive individuals undergoing colonoscopy. The findings reveal a significant and variable prevalence of SSLs in this population, with rates differing based on polyp location. Our analysis provides valuable information regarding SSL detection rates in FIT-positive individuals which can be used as a quality benchmark in FIT based population screening programs.



Disclosures:


Fouad Jaber, MD¹, Mouhand Mohamed, MD², Natalie Wilson, MD³, Abubaker Abdalla, MD⁴, Abdelrahman Mohamed Mahmoud, MS⁵, Saqr Alsakarneh, MD¹, Azizullah Beran, MD⁶, Khalid K. Ahmed, MD⁷, Aasma Shaukat, MD⁸, Mohammad Bilal, MD⁹. P0326 - Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.