C0183 - Screening With FIT-DNA: Impact on Colonoscopy Withdrawal Time, Adenoma Detection and Endoscopist’s Recommendation for Follow-Up

Award: Presidential Poster Award

Jason A. Dominitz, MD, MHS¹, Jennifer Holub, MPH², Rachel Issaka, MD, MAS³, Cynthia Ko, MD, MS⁴, Uri Ladabaum, MD⁵, Douglas Robertson, MD, MPH^6
1Veterans Health Administration, Bellevue, WA; ²GI Quality Improvement Consortium, Ltd., Bethesda, MD; ³University of Washington School of Medicine, Seattle, WA; ⁴University of Washington, Seattle, WA; ⁵Stanford University, Palo Alto, CA; ⁶White River Junction VA and the Geisel School of Medicine at Dartmouth, White River Junction, VT

Introduction: Limited data exist on colonoscopy after abnormal fecal immunochemical test (FIT)-DNA (a.k.a. multitarget stool DNA test). We hypothesized that endoscopists perform a more careful exam (e.g., longer withdrawal time (WT)) and recommend early re-screening after FIT-DNA+/negative colonoscopy due to expectations about test performance. We aimed to A) determine adenoma detection rate (ADR) and other lesion detection rates and B) assess endoscopist behavior regarding WT and recommendations after negative colonoscopy for 3 indications: 1) FIT-DNA+, 2) average-risk screening (SCR) and 3) abnormal fecal occult blood test (FOBT+, guaiac or FIT).

Methods: Using GIQuIC data (2019-2022) from 727 endoscopy units, we identified patients aged 50-75 years undergoing colonoscopy for FIT-DNA+, SCR or FOBT+. We excluded colonoscopy with any other indications (e.g., family history), inadequate bowel preparation or incomplete exam. If pathology was obtained but results were not available, the record was excluded from pathology-related outcomes. Generalized estimating equations clustered by endoscopist were used to assess the association between indication and outcomes while adjusting for patient characteristics and endoscopist's screening ADR.

Results: >1.8 million colonoscopies were included; demographics varied by indication (Table). FIT-DNA+ was associated with higher ADR (59.6%) than SCR (39.3%, p< 0.0001) and FOBT+ (53.8%, p< .0001) and greater detection of advanced neoplasia and sessile serrated lesions (Table). Among those with no pathology obtained on colonoscopy, WT was longer for FIT-DNA+ than for SCR and FOBT+. Among patients aged 50-65 years with no pathology and ASA < IV, a 10-year colonoscopy was recommended in only 80.1% of FIT-DNA+ patients vs. 87.2% of SCR and 86.5% of FOBT+. In multivariable models, compared to FIT-DNA+, SCR and FOBT+ are associated with shorter WT (p< 0.0001 for both), and lower odds of adenoma detection (OR 0.48 (95% CI 0.47-0.50) and 0.71 (0.68-0.74), respectively) and recommendations for re-screening in < 10 years (OR 0.64 (0.57-0.72) and 0.84 (0.74-0.96), respectively).

Discussion: FIT-DNA+ is associated with greater neoplasia detection than FOBT+ and SCR, but also with longer WT and more recommendations for early re-screening after a negative colonoscopy. Despite lower specificity of FIT-DNA vs. FOBT, endoscopists seem to have greater concern for missed pathology in FIT-DNA+/negative colonoscopies, leading to downstream impacts on healthcare utilization.



Disclosures:


Jason A. Dominitz, MD, MHS¹, Jennifer Holub, MPH², Rachel Issaka, MD, MAS³, Cynthia Ko, MD, MS⁴, Uri Ladabaum, MD⁵, Douglas Robertson, MD, MPH⁶. C0183 - Screening With FIT-DNA: Impact on Colonoscopy Withdrawal Time, Adenoma Detection and Endoscopist’s Recommendation for Follow-Up, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.