P139 Development of a CF bowel screening programme. (19th June 2022)

• Record Type: Journal Article
• Authors: Archer, Thomas; McNally, Mairéad; Edenborough, Frank; Thoufeeq, Mo
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A109
• Page End: A109
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.195
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Cystic fibrosis (CF) is a common, multisystem genetic disorder, affecting over 10, 000 people in the UK. The risk of colorectal cancer (CRC) is 5-10 times greater than the general population, and 25 times greater in those with a transplant. The life expectancy from lung related disease has significantly improved over recent years, necessitating recommendations for screening for CRC in this high-risk cohort. Bowel preparation (BP) for colonoscopy is often poor in patients with cystic fibrosis (PWCF). Matson et al. demonstrated that a more intensive regime than for standard colonoscopies can lead to better bowel clearance for PWCF. We describe the development of a screening service at a tertiary centre with a dedicated CF bowel preparation regime. Methods: This service was developed at Sheffield Teaching Hospital NHS Foundation Trust using a Plan-Do-Study-Act (PDSA) approach. Firstly, a review of the cohort of PWCF was undertaken to calculate the number of patients eligible for screening. Fit patients over 40 years and post-transplant patients were deemed eligible. Prior screening investigations in this cohort were reviewed. A steering committee was established with a team of medical endoscopists and specialist CF doctor and nurse. Dieticians, patients, the clerical staff, endoscopy nurses, and colorectal cancer screening team were consulted in the development of the service and the BP regime. Tolerance of BP was recorded using a modified Mayo Clinic bowel prep tolerability questionnaire. BP quality was recorded using a categorical scale. Results: 210 patients were under the care of STH with CF. There were 48 eligible for screening (41 over the age of 40; 7 had had a transplant). of the screening cohort 20/48 (42%) were female with a mean age 50 (2SD = 16.8). A dedicated CF nurse specialist was assigned the role of educating patients on the regime. 5 (10%) of the eligible cohort have attended the dedicated clinic and completed colonoscopy. A weekly CF endoscopy slot was secured in the department, which improved service provision, planning of appointments and provision of augmented BP. Feedback through PDSA from administrative staff highlighted the potential for duplicate BP planning of endoscopy for CF patients. Therefore, an administrative lead with responsibility for booking all CF colonoscopies was appointed. Patients provided feedback on the regime which consisting of 5 litres of Moviprep©, Laxido ©, Bisacodyl and a low residue. Tolerance was reported as good globally. Good/excellent preparation was recorded in 4/5 colonoscopies. One patient had inadequate views for polyp assessment but had only completed two-thirds of her preparation due to a clerking error while an inpatient. Conclusions: CRC is an emerging concern within PWCF. Dedicated surveillance programmes may help to optimise care and minimise unsuccessful colonoscopies due to poor BP. We demonstrated the development a CF screening pathway at our trust using a PDSA approach. The patient-centred pathway records colonoscopy outcomes and prioritises PROMs regarding BP and procedure tolerance. It provides an opportunity to optimise the delivery of this service by tailoring the BP regime to improve tolerability and outcomes, in this difficult to prepare cohort.