(235) Prevalence of Colorectal Neoplasia Among Adults with Cystic Fibrosis: A Single Center Experience

Background: Individuals with cystic fibrosis (CF) are living longer and developing adult-onset conditions. Colorectal neoplasia is more prevalent in individuals with CF than in the general population, leading to unique screening and surveillance recommendations which were published in 2018. We performed a retrospective chart review to characterize colorectal neoplasia in adult CF patients and to evaluate our institution’s adherence to society recommendations.

Methods: We performed a single-center retrospective review to measure the prevalence of colorectal neoplasia among adults with CF. We searched medical records for all patients with CF who underwent colonoscopy between 10/2001 and 10/2021. Patient characteristics and colonoscopy findings were recorded and analyzed with descriptive statistics. Fisher exact tests were used to compare categorical variables; Mann Whitney U tests were used to compare continuous variables.

Results: A total of 34 subjects (17 males) with CF underwent at least one colonoscopy (median 2, range 1-8). A total of 73 colonoscopies were performed, including screening (n=24), surveillance (n=27), and diagnostic (n=22) procedures. The most common genotype was F508del/F508del (35%). Thirty subjects (88%) were pancreas insufficient and 14 subjects (41%) had a prior lung transplant.

The median age among subjects undergoing screening examinations was 43.5 (range 32-61). Bowel preparation quality was recorded in 69 procedures, among which 47 (68.1%) were adequate. Of those with available data regarding bowel preparation medication (n=54), a two-day preparation was prescribed for 3 (6%) patients. Inappropriately long re-screening intervals ( >5 years or >3 years after solid organ transplant) were recommended after 16 (26%) procedures.

Overall, 14/34 (41%) subjects had at least one adenoma, 5/34 (15%) had at least one advanced adenoma, 1/34 (3%) had at least one sessile serrated adenoma, and 2/34 (6%) had colorectal cancer. Among subjects undergoing screening colonoscopy, 8/24 (33%) had at least one adenoma and 2/24 (8%) had at least one advanced adenoma, but no sessile serrated adenoma or colorectal cancer was identified. Subjects with adenomas found during screening colonoscopy were similar in age (median 44.5 vs 43.5 years, p=0.83) and sex distribution (75% vs 50% male, p=0.39) to those without adenomas on screening colonoscopy. When grouped by transplant status, 2/8 (25%) subjects with a solid organ transplant and 6/16 (38%) subjects without a transplant had at least one adenoma on their screening colonoscopy (p=0.66). Adenomas detected on surveillance colonoscopies are depicted in Figure 1. Two colon cancers were identified in 50-year old subjects, one from the surveillance cohort (prior poor preparations) and one from the diagnostic cohort (no prior colonoscopy).

Conclusions: Our experience shows that bowel preparation quality and surveillance intervals have not been optimized in CF. Publication and dissemination of society guidelines for colon cancer screening in adults with CF is an important first step in improving outcomes, but will require quality improvement efforts to improve adherence to these guidelines. This represents an unmet need to improve the gastrointestinal care of adults with CF, particularly given the high incidence of adenomas in this population.

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