B0104 - Clinical Significance of Colonic Wall Thickening on Computed Tomography Scan in Inpatients: Retrospective Study From a Community Hospital

Pratyusha Tirumanisetty, MD¹, Jose W. Sotelo, MD², Tausif Syed, MD³, Eric Then, MD¹, Jamil Shah, MD^1
1The Brooklyn Hospital Center, Brooklyn, NY; ²Texas Tech University Health Sciences Center, El Paso, TX; ³Rochester Regional Health/Unity Hospital, Rochester, NY

Introduction: Colon wall thickening (CWT) is one of the common reasons for GI consults both in inpatient and outpatient settings, owing to the widespread use of computed tomography (CT) scans for assessment of gastrointestinal complaints. Often these patients undergo colonoscopy due to concerns of delaying a potential cancer diagnosis. As of now there are neither guidelines on how to manage these patients nor clear consensus on which factors predict a cancer in a patient with CWT. We aim to evaluate this.

Methods: We identified 116 patients who had CWT on CT scan of the abdomen with intravenous and oral contrast that was performed for various GI complaints, and subsequently underwent colonoscopy for further evaluation between January 2021-2022. Patients with definitive CT evidence of malignancy like colonic mass, metastases were excluded from the study. However, patients in who CT was inconclusive for underlying mass, i.e., possible mass/underlying mass cannot be excluded, are included. Variables listed in table 1 were assessed by univariate and multivariate analysis as appropriate.

Results: Patients with normal colonoscopy or those with diverticulosis, hemorrhoids, adenoma without malignancy irrespective of size and number were grouped as non-significant pathology, and those with malignancy, IBD, ischemic colitis were grouped as significant pathology. Out of 116 patients, 54 (46%) had inpatient colonoscopies; 41 (35%) patients had findings that could potentially explain BWT; 21 (18%) had newly diagnosed cancer, 14 (12%) with IBD of which 3 were newly diagnosed and 6 (5%) patients had ischemic colitis. Of the 21 newly diagnosed colon cancer patients, 5 never had a colonoscopy. The mean duration of last colonoscopy was 8±3 years. Figure 1 depicts the colonoscopy findings in each segment of the colon corresponding to BWT. On multivariate logistic regression weight loss (p< 0.008, OR: 22, 95% CI: 2.2-220) IBD history (p< 0.001) and years passed since last colonoscopy (p< 0.03, OR: 1.3, CI:1.03-1.6) were statistically significant.

Discussion: In our study, bowel wall thickening in majority (65%) of the patients is nonspecific without malignancy or IBD on colonoscopy. Based on our analysis, we conclude that patients with weight loss (OR: 22), rectal bleeding (OR: 28), Hemoglobin< 11g/dL (OR: 19), and more than 5 years since last colonoscopy (OR: 1.3) are more likely to have significant pathology when colonoscopy is performed for colon wall thickening on CT scan. Rest of the patients may be safely monitored.




Disclosures:


Pratyusha Tirumanisetty, MD¹, Jose W. Sotelo, MD², Tausif Syed, MD³, Eric Then, MD¹, Jamil Shah, MD¹. B0104 - Clinical Significance of Colonic Wall Thickening on Computed Tomography Scan in Inpatients: Retrospective Study From a Community Hospital, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.