Nicholas Talabiska, BS, Marika Bergenstock, DO, Claire Pedroso, MD, David Talabiska, DO, Joshua Shellenberger, DO; Geisinger Medical Center, Danville, PA
Introduction: Patients are reluctant to undergo colonoscopy for colorectal cancer (CRC) screening despite proven benefits. A non-invasive multi-target stool DNA test (cologuard) is an approved CRC screening tool for average risk adults. A subset of the population with a positive cologuard has a negative colonoscopy and currently there are no consistent recommendations for post-colonoscopy follow-up. Our study aims to identify patients with a negative, good quality colonoscopy for a positive cologuard and to evaluate their indication, characteristics, and follow-up recommendations. Methods: We performed a retrospective review of all patients from 2015 to 2019 undergoing colonoscopy for a positive cologuard at our tertiary referral center. Demographics, medical/family history, indications for test, prep quality, colonoscopy findings, and follow-up recommendations were collected. Results: A total of 158 patients underwent a colonoscopy for a positive cologuard over a 4 year period and of these, 85% (135/158) had a complete, good quality bowel prep (Figure 1).
A total of 24% (32/135) had no identifiable polyps (negative colonoscopy), a median age of 60 years, 7 M and 25 F. A total of 50% (16/32) of negative colonoscopies had no documented findings and 50% reported a combination of hemorrhoids, diverticulosis, ulcer, AVM. Post colonoscopy follow-up included colonoscopy at 5 y (38%, 12/32), 5-10 y (3%, 1/32), 10 y (40%, 13/32), repeat cologuard 1 y (3%, 1/32), and no follow-up (16%, 5/32). Cologuard was not indicated in 9% (3/32) due to history of IBD and past adenomas.
A total of 76% (103/135) had identifiable polyps (positive colonoscopy), a median age of 66 years, 53 M and 50 F. Based on the most clinically significant lesions from each procedure, findings included adenocarcinoma (6%, 6/103), tubulo-villous adenoma (26%, 27/103), adenoma > 1 cm (10%, 10/103), sessile serrated (3%, 3/103), adenoma < 1 cm (47%, 48/103), inflammatory polyp (2%, 2/103), and hyperplastic polyp alone (8%, 7/103). Cologuard was not indicated in 11% (11/103) due to history of IBD, past adenomas, and CRC. Discussion: In summary, 24% of patients who underwent CRC with cologuard had a negative colonoscopy with no consensus on follow-up colonoscopy recommendations. A positive cologuard was likely to be associated with adenoma on colonoscopy, however, it was not indicated in 10% of patients. Provider education on patient selection and consensus in post-colonoscopy follow-up is paramount in CRC screening with cologuard.
Figure 1: Study outcomes.
Disclosures: Nicholas Talabiska indicated no relevant financial relationships. Marika Bergenstock indicated no relevant financial relationships. Claire Pedroso indicated no relevant financial relationships. David Talabiska indicated no relevant financial relationships. Joshua Shellenberger indicated no relevant financial relationships.