PWE-032 Advanced neoplasia yield in patients undergoing colonoscopy after screening flexible sigmoidoscopy: are the current referral criteria correct?. (17th June 2017)

• Record Type: Journal Article
• Authors: Rameshshanker, R; Purchiaroni, F; Crudeli, A; Wilson, A; Thomas-Gibson, S; Suzuki, N; Humphries, A; Haycock, A; Saunders, BP
• Is Part Of: Gut. Volume 66(2017)Supplement 2
• Page Start: A140
• Page End: A141
• Publication Date: 2017-06-17
• Subjects: Advanced adenoma -- proximal colon -- sessile serrated polyps; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2017-314472.277
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Currently patients undergoing a "Bowel Scope" (BS)screening are referred for colonoscopy if the following criteria are met: polyps>1 cm, villous histology, high grade dysplasia 3 or more adenomas, >20 hyperplastic polyps and patient related factors causing an incomplete examination ( discomfort or poor access). Objective: To assess the proportion of patients who had a significant polyp (advanced adenoma=adenoma >1 cm, villous or high grade dysplasia on histology) in the proximal colon when referred for a screening colonoscopy after a Bowel Scope examination. Method: A retrospective cross sectional study of 9960 patients who underwent BS screening between July 2013 -July 2016 at our Bowel Cancer Screening Centre was performed. Epidemiology, procedural and polyp data were retrieved from the endoscopy data base. Results: 520 (5.2%) patients had a screening colonoscopy as per the BCS protocol. Median age was 55 years with male: female 2:1. The clear majority of BS examinations reached as far as the descending colon (82%). 351/520 (68%) patients had at least one advanced adenoma (AA) in the distal colon. Overall prevalence of distal AA was 3.2% (351/9960). Caecal intubation was achieved in 98% (510/520) of screening colonoscopies. At least one adenoma or a sessile serrated adenoma/polyp (SSA/P) was detected, proximal to the extent of BS examination in 45% (232/520) of patients, when they had a colonoscopy. Table 1 summarises the prevalence of synchronous proximal colonic pathology. The majority (68%, 351/520) of the colonoscopies were performed due to the presence of AA in the distal colon. Of these 351 patients, 52 (14.8%) had a synchronous proximal colonic AA and 20 had a synchronous SSA/P (5.7%). Only 5 patients had an advanced SSA/P (polyp >1 cm or with dysplasia) in the proximal colon (1.4%). Presence of distal AA was significantly associated with proximal colonic AA (p=0.0006). However, there were no associations between distal AA and proximal SSA/P (p=0.47) or advanced SSA/P (p=NS) Conclusion: Distal colonic AA are a marker of synchronous proximal colonic adenomas and SSA/Ps. When colonoscopies were performed for other indications (non-adenomatous polyp >1 cm, multiple distal HP polyps) the yield in the proximal colon was significantly smaller. These "soft" indications for colonoscopy accounted for a significant additional workload that appears unjustified. Disclosure of Interest: None Declared