Session: Plenary Session 3B - General Endoscopy / Practice Management / Colorectal Cancer Prevention
49 - Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database
Natalie Wilson, MD1, Anders Westanmo, PharmD2, Amy Gravely, 3, Mohammad Bilal, MD2, Aasma Shaukat, MD4 1University of Minnesota, Minneapolis, MN; 2Minneapolis VA Medical Center, Minneapolis, MN; 3Minneapolis Veterans Affairs Medical Center, Minneapolis, MN; 4NYU Langone Health, New York, NY
Introduction: Sessile serrated lesions (SSLs) are increasingly being recognized as precursors to colorectal cancer (CRC). Fecal immunochemical test (FIT) is recommended by the United States Preventative Services Taskforce for screening for colorectal cancer (CRC) in average risk individuals. However, SSLs are not considered in the diagnostic yield of FIT testing, and the prevalence of SSLs in FIT positive individuals is not well studied. Therefore, we aimed to evaluate the SSL detection rate (SDR) in individuals with a positive FIT undergoing colonoscopy using an integrated nationwide database of United States veterans.
Methods: Data was obtained from the Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) using Structured Query Language (SQL). The CDW contains extracts from VHA clinical and administrative systems that contain complete clinical data from October 1999. SQL Natural Language Processing was utilized to identify individuals who underwent their index colonoscopy within 12 months of a positive FIT test between January 1, 2015 to April 30, 2023. Primary outcome was SDR in individuals with positive a FIT test. SDR calculation included finding of at least one SSL (sessile serrated adenoma / polyp and/or traditional serrated adenoma) during colonoscopy. Secondary outcome was predictors of having SSLs in those with a positive FIT test. Logistic regression was utilized to examine the univariate and multivariate relationships between each independent variable of interest and finding a SSL.
Results: A total of 51,526 individuals with a positive FIT who underwent a subsequent colonoscopy were included. Mean age was 62.5 years and 93.5% were male. Average number of days between a positive FIT and colonoscopy were 85 days [Table 1]. The overall SSL detection rate was 6.1% [males: 6.5%, females: 5.3%]. On multivariate analysis, predictors for SSLs included age 70-79 years, body mass index > 25 kg/m2 and smoking status. Protective factors for SSL were Black race and Aspirin use [Figure 1].
Discussion: We found a sessile serrated lesion detection rate of 6.1% in individuals who underwent colonoscopy after a positive FIT. Factors associated with detection of SSLs included age 70-79 years, obesity and smoking. Our results were comparable to those reported in prior reports from Europe. These findings can be used to determine quality benchmarks for SSL detection rates in FIT based population screening programs.
Figure: Figure 1. Multivariate analysis for predictors of sessile serrated lesion in FIT positive individuals
Table: Table 1. Demographics and procedural data Table values are n (%) unless otherwise specified Abbreviations: SD: standard deviation; BMI: body mass index; FIT: fecal immunohistochemical test; SDR: serrated lesion detection rate
Disclosures:
Natalie Wilson indicated no relevant financial relationships.
Anders Westanmo indicated no relevant financial relationships.
Amy Gravely indicated no relevant financial relationships.
Mohammad Bilal: Boston Scientific – Consultant.
Aasma Shaukat indicated no relevant financial relationships.
Natalie Wilson, MD1, Anders Westanmo, PharmD2, Amy Gravely, 3, Mohammad Bilal, MD2, Aasma Shaukat, MD4, 49, Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
