Abstract Book UEG Week 2020 - 24
Sunday, October 11, 2020
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for offering population wide CRC screening, however, an optimum strategy would ideally combine the high diagnostic yield of colonoscopy with
the high participation rate of FIT.
Aims & Methods: This was a multicenter randomized health services study
performed within the framework of the Polish Colonoscopy Screening
Program (PCSP) between January 2019 and March 2020. Within the study,
screening-naïve individuals between 55 and 64 years of age were drawn
from the Population Registry. The candidates were randomly assigned
in a 1:1:1 ratio to participate in one of three competing screening invitation strategies: (I. Control, practice as usual) postal invitation to screening
colonoscopy only and a re-invitation to colonoscopy after 6 weeks for initial non-responders; (II. Sequential) postal invitation to primary colonoscopy, and then a postal invitation for screening using FIT (mailed FIT kit)
after 6 weeks for non-responders to initial invitation; or (III. Active choice)
postal invitation offering a choice between FIT (mailed FIT kit) and colonoscopy, and then a re-invitation after 6 weeks for initial non-responders
offering the same choice again. The primary outcome was participation in
CRC screening within 18 weeks after enrollment, defined as completion of
colonoscopy, or completion of FIT (with subsequent colonoscopy in cases
with positive FIT results). Secondary outcome was diagnostic yield for advanced neoplasia (CRC and advanced adenomas). FIT tests were analyzed
in a central laboratory, with 10µg Hb/g feces positivity threshold. Active
call-recall systems after positive FIT test result were established. Colonoscopy was performed as part of usual screening program practice. Study
registration number: NCT03790475.
Results: Out of the 12,298 individuals, 514 (4.18%) were excluded due to
previous diagnosis of CRC, death or unavailable postal address, leaving
11,785 for randomization and invitation to CRC screening. Participation
rate in the control group (16.6%) was significantly lower as compared
with the sequential group (24.8%) and active choice (26.4%) (p< 0.001 for
both comparisons). In the control group, screening colonoscopy yielded
participation comparable to the colonoscopy participation after the first
invitation in sequential group (16.6% and 14.6%, respectively). In the active choice group, the percentage of individuals who chose colonoscopy
was significantly lower (8.5%, p=0.001). FIT positivity rates were 9.3%
and 9.4% in the sequential and active choice groups, respectively, and
the diagnostic work-up colonoscopy rates for positive FITs were 55.5%
and 73.3% respectively, despite active call-recall efforts. In the intention
to screen analysis, advanced neoplasia detection rates per invitee were
comparable between control (1.1%), sequential (1.0%) and active choice
groups (1.1%), respectively.
Conclusion: Offering a combination of FIT and primary colonoscopy as a
sequential or active choice strategy results in increased participation in
CRC screening. Due to suboptimal compliance with diagnostic work-up
colonoscopy after a positive FIT test, increased participation rates did not
translate into higher diagnostic yield.
Disclosure: Nothing to disclose
24
OP030
THE COMPARISON OF COLORECTAL ADENOMAS, INTRAMUCOSAL
CANCERS, AND INVASIVE CANCERS DETECTED BETWEEN DIRECT
SCREENING COLONOSCOPY AND FIT-POSITIVE COLONOSCOPY
Kimura S.1, Fukuda S.2, Nishiya D.1, Ishibasi F.1, Hayamizu S.2,
Arai T.2
1
Aomori Rousai Hospital Division of Gastroenterology,
Gastroenterology and Endoscopy, Hachinohe, Japan,
2
Hirosaki University, Department of Gastroenterology
and Hematology, Hirosaki, Japan
Contact E-Mail Address: saint4road@gmail.com
Introduction: There were few studies regarding the comparison of all
colorectal neoplasms detected between direct screening colonoscopies
and FIT-positive colonoscopies. We tried to compare the prevalences and
the clinicopathological characteristics of colorectal adenomas, intramucosal cancers, and invasive cancers detected between asymptomatic subjects undergoing direct screening colonoscpy and subjects undergoing
colonoscopy for the evaluation of a positive FIT.
Aims & Methods: The study included 1793 patients (mean age 66.4+-11.9
yr, M:F = 1090:703) underwenting colonoscopy for asymptomatic direct
screening (group A), and 2227 (65.4+-11.6 yr, 1306:921) underwenting
colonoscopy for screening as the evaluation of a positive FIT (group B).
The prevalences of colorectal adenomas and intramucosal cancers more
than 5 mm in size detected between group A and B, and clinicopathological characters as to the location, size, configulation, and histology of them
were compared with each other. Subsequently the prevalences of colorectal invasive cancers detected between group A and B, and clinicopathological characters as to the location, size, depth, histology, and lymph node
metastasis of them were compared with each other.
Results: A total of 573 adenomas and/or intramucosal cancers in 338 patients (18.8%) in group A and 1071 in 650 (29.2%) in group B were detected, respectively. The locations of the lesions between group A and B were
47.6%, 37.5% in the right colon, 52.4%, 62.5% in the left colon. The sizes
of the lesions were < 10 mm 64.2%, 64.7% and > 10 mm 35.8%, 35.3%. The
configulations of the lesions were polypoid 85.0%, 88.8%, and non-polypoid 15.0%, 11.2%. The histologies of the lesions were low-grade adenoma
82.4%, 77.6% and high-grade adenoma or cancer 17.6%, 22.4%.
The statistical comparisons disclosed that adenomas and intramucosal
cancers detected in group A were characterized by their right-sided location (p< 0.001), non-polypoid appearance (p< 0.05), and less-advanced
histology (p< 0.05). In contrast the lesions detected in group B were characterized by their left-sided location (p< 0.001), polypoid appearance
(p< 0.05), and more-advanced histology (p< 0.05). A total of 28 invasive
cancers in 28 patients (1.6%) in group A and 115 in 115 (5.2%) in group B
were detected, respectively. The locations of the lesions between group A
and B were 53.6%, 34.8% in the right colon, and 46.4%, 65.2% in the left
colon. The sizes of the lesions were < 30 mm 50.0%, 52.2%, and > 30 mm
50.0%, 47.8%. The depths of the lesions were T1 46.4%, 38.3%, and T2 or
T3 53.6%, 61.7%. The histologies of the lesions were well differentiated
adenocarcinoma 64.3%, 58.3%, and poorly or moderately differentiated
35.7%, 41.7%. The prevalences of lymph node involvements were 21.4%,
26.9%, respectively. There were no statistical differences in clinicopathological factors of detected invasive cancers between group A and B except
the locations of the lesions; Invasive cancers in group A in the right colon
and those in group B in the left colon (p= 0.07).
Conclusion: FIT-positive colonoscopy detected a significantly higher
amount of precancerous lesions when compared with direct screening
colonoscopy. Adenomas and intramucosal cancers detected by FIT were
characterized by their left-sided location, polypoid appearance, and
more-advanced histology. FIT-positive colonoscopy and direct screening
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