P2354 - Determining the Profile of Patients Lost in Follow-Up After the Resection of High-Risk Colonic Polyps

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Andre N. Jove, BS

Baylor College of Medicine
Alpharetta, TX, United States

Andre N. Jove, BS¹, Juan Gomez Cifuentes, MD¹, Scott Berger, MD¹, Kadon N. Caskey, BS¹, Hyunseok Kim, MD¹, Maria J. Gacha, MS², Maria Ellionore Jarbrink-Sehgal, MD, PhD¹, Maria Velez, MD¹, Clark Hair, MD¹, Robert J. Sealock, MD¹, Gyanprakash A. Ketwaroo, MD¹
¹Baylor College of Medicine, Houston, TX; ²University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: Colorectal cancer is the third cause of cancer-related mortality in the United States. Non-pedunculated polyps ≥20 mm have increased risk of recurrence; hence, surveillance colonoscopy is recommended at 6 months. Unfortunately, patient follow up after resection of these high-risk polyps is not perfect. We aim to study the characteristics of patients who were lost in follow up after resection of non-pedunculated polyps ≥20 mm at a safety-net and Veteran’s Affairs (VA) hospitals, with the purpose of developing qualitive improvement interventions targeting these patients.

Methods: Retrospective study of patients who undergone endoscopic mucosal resection of non-pedunculated polyps larger ≥20 mm at a safety-net and VA hospital in Houston, Texas from 2012 to 2019. Patients who had two stage procedures, non-neoplastic histology or evidence of invasive cancer were excluded. Patients were divided by competition of at least 1 surveillance colonoscopy. Demographic data, polyp and resection characteristics were analyzed. Distance to hospital and income was calculated based on zip code. Univariate and multivariate analyzed were performed.

Results: A total of 522 non-pedunculated polyps were included from 468 unique patients. 328 lesions completed at least one surveillance colonoscopy and 194 did not follow up. Patients who did not follow up were more likely to be younger male, uninsured, and had longer driving time and distance to the hospital. Ethnicity, need of English interpreter and average income was comparable between groups. Polyps larger in size, in the right colon, removed by piecemeal resection and with high grade dysplasia were more likely to have at least 1 surveillance colonoscopy (Table 1). After multivariable analysis, male gender (OR 2.88 [1.52-5.47] p=< 0.001) was significantly associated with increased risk of no follow up.

Discussion: Younger males without insurance and with longer driving time and distance to the hospital are more likely to not have surveillance colonoscopy after resection of high-risk colonic polyps. Understanding the patient population who is lost in follow up is key for the implementation of targeted quality improvement interventions.

Factor	Completed at least 1 surveillance Colonoscopy (N=328)	No follow up (N=194)	P-value
Factor	Statistics	Statistics	P-value
Age (± standard error)	65.9 [+/- 0.38]	64.3 [+/- 0.72]	0.040
Gender
Female	69 (21.0%)	27 (13.9%)	0.044
Male	259 (79.0%)	167 (86.1%)	0.044
Ethnicity
White	161 (49.1%)	104 (53.6%)	0.20
African American	110 (33.5%)	48 (24.7%)
Hispanic	50 (15.2%)	38 (19.6%)
Asia	6 (1.83%)	3 (1.55%)
Native American	1 (0.30%)	1 (0.52%)
Hospital
Safety-net Hospital	83 (25.3%)	62 (32.0%)	0.102
Veteran's affairs Hospital	245 (74.7%)	132 (68.0%)	0.102
Insurance
None	10 (3.05%)	17 (8.76%)	0.01
Medicare or Marketplace	42 (12.8%)	19 (9.79%)
Medicaid or county	31 (9.45%)	26 (13.4%)
Veteran's affairs benefits	245 (74.7%)	132 (68.0%)
Average income (dollars)	59,208 [+/- 1234]	57,900 [+/- 1632]	0.52
Driving distance to Hospital (miles)	52.3 [+/- 5.80)	91.3 [+/- 15.1]	0.01
Driving time to Hospital (min)	57.2 [+/- 5.16]	92.5 [+/- 13.7]	0.01
Need of English interpreter	26 (7.93%)	15 (7.73%)	0.936
Boston scale on index colonoscopy	7.73 [+/- 0.09]	7.85 [+/- 0.11]	0.408
Polyp size ≥40 mm	78 (23.8%)	23 (11.9%)	0.001
Polyp location
Right colon	199 (60.7%)	89 (45.9%)	< 0.01
Left colon	129 (39.3%)	105 (54.1%)	< 0.01
Polyp morphology: any depressed component (Paris 0-IIc)	13 (3.96%)	4 (2.06%)	0.245
Lifting age used
Saline and/or methylene blue and/or epinephrine	257 (78.4%)	154 (79.4%)	0.782
Elview or Orise	71 (21.6%)	40 (20.6%)	0.782
Resection type
Piecemeal	252 (76.8%)	100 (51.5%)	< 0.001
Enbloc	76 (23.2%)	94 (48.5%)	< 0.001
Tissue ablation	25 (7.62%)	13 (6.70%)	0.696
Number of clips used for prophylactic defect closure	1.34 (0.099)	1.20 (0.11)	0.376
Intraprocedural bleeding	68 (20.7%)	29 (14.9%)	0.102
Polyp pathology
Tubular adenoma	141 (43.0%)	91 (46.9%)	0.46
Tubulovillous adenoma	165 (50.3%)	86 (44.3%)
Sessile serrated polyps	19 (5.79%)	10 (5.15%)
High grade dysplasia	98 (29.9%)	31 (16.0%)	< 0.001
Positive resection margin	28 (8.53%)	11 (5.67%)	0.232
Delayed post-polypectomy bleeding after index colonoscopy	9 (2.74%)	9 (4.64%)	0.257
Abdominal imaging ordered for post-polypectomy pain	1 (0.30%)	2 (1.93%)	0.318

Table: Table 1: Patient characteristics by type of follow up after index colonoscopy.

Disclosures:

Andre Jove indicated no relevant financial relationships.

Juan Gomez Cifuentes indicated no relevant financial relationships.

Scott Berger indicated no relevant financial relationships.

Kadon Caskey indicated no relevant financial relationships.

Hyunseok Kim indicated no relevant financial relationships.

Maria Gacha indicated no relevant financial relationships.

Maria Ellionore Jarbrink-Sehgal indicated no relevant financial relationships.

Maria Velez indicated no relevant financial relationships.

Clark Hair indicated no relevant financial relationships.

Robert Sealock indicated no relevant financial relationships.

Gyanprakash Ketwaroo indicated no relevant financial relationships.