P1767 - A Majority of Patients With Positive Multitarget-Stool DNA (mt-sDNA) Test Results Do Not Complete Follow-Up Colonoscopy: Results From a Large Urban Health System

Shabari M. Shenoy, MBBS¹, Michael S.. Smith, MD, MBA², Lina Jandorf, MA^2
1Mount Sinai Morningside and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY; ²Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Stool-based tests are widely used for colorectal cancer (CRC) screening. Sensitivities of multitarget-stool DNA (mt-sDNA) testing to detect CRC and advanced adenomas are as high as 92.3% and 42.4%, respectively. This screening approach involves a two-step process, where a positive stool test requires a diagnostic colonoscopy. Completed colonoscopy after positive mt-sDNA testing can avert an estimated fourfold more CRC cases and twofold more CRC deaths than standard screening colonoscopy. The aim of this study was to assess factors affecting referral for and completion of follow-up colonoscopy in patients with positive mt-sDNA tests.

Methods: Retrospective chart review was performed on all patients aged 45 years and older with a positive mt-sDNA test between 4/2019 and 9/2022 in a single urban healthcare system. Demographic data, colonoscopy completion rates and histologic findings were collected. Descriptive and co-variate analysis was performed to examine potential predictors of completed colonoscopy.

Results: A total of 342 patients had a positive mt-sDNA test (Table 1). Within this cohort, 269 patients (78.6%) were referred for follow-up colonoscopy and 148 (43.2%) were completed. Patients identified as Hispanic had a higher referral rate for follow-up colonoscopy (94% vs 78% vs 69.9%, p < 0.005). However, there was no difference in completed colonoscopy rate. Patient age and Charlson Comorbidity Index (CCI) did not affect referral rate. Similarly, there were no differences in follow-up colonoscopy completion rates based on age, sex, ethnicity or CCI. Follow-up colonoscopy found no adenomas in 46 patients (31%), non-advanced adenomas in 69 patients (47%), advanced adenomas in 31 patients (21%) and CRC in 2 patients (1.4%) (Table 2). No differences in colonoscopy findings were observed based on patient age, sex, ethnicity or CCI.

Discussion: In this study, less than half of patients found to have a positive mt-sDNA testing completed a colonoscopy as part of the 2-step process. Patients identified as Hispanic had higher colonoscopy referral rates but similar completion rates to the rest of the cohort. Adenomas or neoplasia were found in nearly 70% of completed colonoscopies, confirming the importance of the second step in the screening process. These data underscore the need to focus on barriers both to appropriate referral for colonoscopy as well as completion of the procedure in populations where mt-sDNA is used for CRC screening.


Disclosures:


Shabari M. Shenoy, MBBS¹, Michael S.. Smith, MD, MBA², Lina Jandorf, MA². P1767 - A Majority of Patients With Positive Multitarget-Stool DNA (mt-sDNA) Test Results Do Not Complete Follow-Up Colonoscopy: Results From a Large Urban Health System, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.