Comparison of Comorbidities between Adults and Children with Glycogen Storage Disease Type Ia (GSDIA)

Objectives: Glycogen Storage Disease Type Ia (GSDIa) is a rare inherited disorder resulting in acute hypoglycemia due to impaired release of glucose from glycogen. Despite dietary management practices to prevent hypoglycemia in patients with GSDIa, complications still occur in children and throughout adulthood. This retrospective cohort study compared the prevalence of complications in adults and children with GSDIa. Method(s): Using ICD-10 diagnosis codes, the IQVIA Pharmetrics Plus database was searched for patients with >=2 GSDI claims (E74.01) from January 2016 through February 2020, with >=12 months continuous enrollment beginning prior to March 2019 (for one year of follow-up before COVID-19), and no inflammatory bowel disease diagnoses (indicative of GSDIb). Complication prevalence in adults and children with GSDIa was summarized descriptively. Result(s): In total, 557 patients with GSDIa were identified (adults, 67%;male, 63%), including 372 adults (median age, 41 years) and 185 children (median age, 7 years). Complications occurring only in adults were atherosclerotic heart disease (8.6%), pulmonary hypertension (3.0%), primary liver cancer (1.9%), dialysis (0.8%), and focal segmental glomerulosclerosis (0.3%). Other complications with the greatest prevalence in adults/children included gout (11.8%/0.5%), insomnia (10.0%/1.1%), osteoarthritis (22.0%/2.7%), severe chronic kidney disease (4.3%/0.5%), malignant neoplasm (10.8%/1.6%), hypertension (49.7%/8.7%), acute kidney failure (15.3%/2.7%), pancreatitis (3.0%/0.5%), gallstones (7.8%/1.6%), benign neoplasm (37.4%/8.1%), hepatocellular adenoma (7.0%/1.6%), neoplasm (41.1%/9.7%), and hyperlipidemia (45.2%/10.8%). Complications with the greatest prevalence in children/adults included poor growth (22.2%/1.9%), gastrostomy (29.7%/3.2%), kidney hypertrophy (2.7%/0.8%), seizure (1.6%/0.5%), hypoglycemia (27.0%/11.3%), hepatomegaly (28.7%/15.9%), kidney transplant (1.6%/1.1%), diarrhea (26.5%/18.6%), nausea and/or vomiting (43.8%/35.8%), acidosis (20.0%/17.2%), and anemia due to enzyme disorders (43.8%/40.6%). Conclusion(s): GSDIa is associated with numerous, potentially serious complications. Compared with children, adults with GSDIa had a greater prevalence of chronic complications, potentially indicating the progressive nature of disease. Children with GSDIa had more acute complications related to suboptimal metabolic control.Copyright © 2023

IDDF2023-ABS-0156 Poor tolerance of bowel preparation for index colonoscopy decreases surveillance rate in high-risk adenoma removal patients

IDDF-2023-ABS-0156 Table 1Association between Tolerance of BP for index colonoscopy and surveillance rateTolerance of BP for index colonoscopy Surveillance rate% (n/N) Total 67% (127/186) 1. Very intolerable 47% (9/19) 2. Intolerable 48% (10/21) 3. Neither tolerable nor intolerable 76% (55/72) 4. Tolerable 71% (22/31) 5. Very tolerable 72% (31/43) P for trend test 0.04 IDDF2023-ABS-0156 Table 2Risk factors of non-compliance of surveillance colonoscopy by multivariate regression analysis Multivariate OR (95%CI) p value Age,/1-year increase 1.04 (1.03-1.05) 0.001 Male sex 1.13 (0.85-1.52) 0.40 BMI,/1-kg/m2 increase 1.05 (0.96-1.15) 0.28 Family history of CRC 0.93 (0.16-5.25) 0.92 Low education 0.92 (0.39-2.15) 0.90 Comorbidities 1.05 (0.51-2.13) 0.90 Low tolerance of BP for colonoscopy 2.45 (1.11-5.41) 0.006 Absence of primary care physician 4.63 (1.60-13.4) 0.001 BMI: body mass index, CRC: colorectal cancer, BP: bowel preparation IDDF2023-ABS-0156 Table 3The reasons of non-compliance surveillance colonoscopyReasons of non-compliance surveillance colonoscopy n, (%) Total 62 (100%) Not knowing about follow-up intervals 4 (6%) Having no symptoms 15 (24%) Fear of examination Pain during colonoscopy 1 (2%) Embarrassment during colonoscopy 0 (0%) Bowel preparation for colonoscopy 17 (28%) Over sedation during colonoscopy 2 (3%) Old age/severe illness for surveillance 10 (16%) Having no time 10 (16%) Having no money 1 (2%) Fear of Covid-19 infection 2 (3%) IDDF2023-ABS-0156 Figure 1ConclusionsOur findings highlight the need for improvement of the surveillance colonoscopy rate, especially for patients who had poor tolerance to BP on index colonoscopy and no gastroenterology visit. Providing a well-tolerated BP regimen may lead to an increase in surveillance colonoscopy compliance.

Italian Association of Clinical Endocrinologists (AME) 20th National Congress

The proceedings contain 9 papers. The topics discussed include: dulaglutide and NAFLD risk reduction;correlation between plasmatic long pentraxin PTX3 and nodular thyroid disease: a preliminary report;the fructose-bisphosphate aldolase a act as autoantigen in primary autoimmune hypophysitis;cortisol deficiency in Lenvatinib treatment;side effects of mitotane treatment: a retrospective study in 35 patients with adrenocortical carcinoma in adjuvant therapy;non-functioning pituitary adenoma: do predictor factors exist?;incidence and features of adrenal crisis in a series of 133 patients with Addison's disease;serological evidence and self-reported outcomes in patients with adrenal insufficiency during the first waves of COVID-19 in the North-East Italy;and persistent effects of spironolactone after its withdrawal in patients with hyperandrogenic skin disorders.

Approach to the Patient With Pituitary Adenoma Using Telemedicine: Knowledge Gaps and Recommendations

Telemedicine (TM) can be defined as the practice of medicine using technology such as video teleconferencing, telephone calls, or emails in order to provide health care from a distance. The emergence of the coronavirus disease 2019 (COVID-19) pandemic and its potential complications have created an urgent need for the transformation of physical visits into virtual encounters. Pituitary adenomas are one of the common endocrine tumors and can manifest with hormonal or mass effects. COVID-19 impacted the common pathway of diagnosis and treatment of these masses. TM utilization for pituitary adenomas has not been addressed thoroughly in the literature despite how common they are. In this review article, we discuss and implement what has been written in the literature about TM for pituitary adenoma alongside our suggested protocol.

Appropriateness and Completion of Multitarget Stool DNA Testing in Primary and Subspecialty Care

Introduction: Colorectal cancer (CRC) is the third most prevalent cancer in the United States, with a 4% lifetime incidence. While more clinicians have begun ordering multitarget stool DNA (mt-sDNA) testing due to the COVID-19 pandemic, adherence to guidelines on mt-sDNA and rates of subsequent follow-up testing has not been well studied. We assessed the appropriateness of mt-sDNA orders and rate of high-quality colonoscopy completion following a positive result in a large academic medical center. Method(s): We identified patients ordered for mt-sDNA in primary care and gastroenterology clinics at our institution between April 2020 and July 2021. For each case, we reviewed the appropriateness of mtsDNA testing, documentation of shared decision making, result of testing, and subsequent follow-up. Appropriateness was defined in accordance to the most recent American College of Gastroenterology guidelines on mt-sDNA use for CRC screening. Result(s): Of the 797 patients in our study, 685 (86%) met all appropriateness criteria for mt-sDNA testing (Table). Shared decision making was documented in 488 (62%) cases, and the most common reason for ordering mt-SDNA was hesitancy for colonoscopy. 483 patients (61%) completed mt-sDNA testing, of which 74 cases (15%) were positive. Rates of positivity were higher in cases of inappropriate (28%) rather than appropriate (13.7%) orders (p = 0.01). Colonoscopy was ordered in 73 cases (99%) and completed by 59 patients (80%). Of the 56 patients who underwent colonoscopy at our institution, most had documentation of a high-quality colonoscopy, defined as adequate prep (84%), cecal intubation (93%), visualization of the appendiceal orifice and ileocecal valve (94%), and right colon retroflexion (83%). Sixteen patients (29%) were found with advanced adenomas and 19 (34%) had other adenomas or sessile polyps. Among the 409 patients with negative tests, a 3-year follow-up recommendation was documented for 369 patients (90%). Conclusion(s): Most clinicians at our institution identified appropriate patients for mt-sDNA testing and provided appropriate follow-up< and the majority of patients who underwent colonoscopy had documentation of a high-quality colonoscopy. In contrast, there were suboptimal rates of mt-sDNA completion and documentation of shared decision making. Further studies are needed to identify barriers to documentation of shared-decision making and to completion of high-quality colonoscopies in patients being screened with mt-sDNA.

The Burden of Sars-Cov-2 Pandemic on Colorectal Cancer Screening Program Delay: Data from a Large Screening Centre in Campania

Background and aim: SARS-CoV-2 pandemic has led to a dramatic rearrangement of colorectal cancer (CRC) screening programs until complete suspension in the period March-September 2020,especially in Covid Hospitals. However,the real impact of CRC screening program delay due to pandemic on CRC outcomes has yet to be explored. Aim(s):to evaluate whether screening procedure delays may affect the outcomes of CRC screening. Material(s) and Method(s): we performed a prospective study including all patients undergoing their first screening colonoscopy according to regional CRC program from January 2021 to October 2022 (Group 1-post-Covid), therefore after a 6-month period of CRC screening program suspension (March-September 2020).This group was compared with a historical cohort of patients who underwent first screening colonoscopy in the same Centre from January 2018 to October 2019 (Group 2-pre-Covid).For each group, anthropometric and oncological variables were evaluated,and the effects of delay were evaluated by comparing groups in terms of adenoma detection rate (ADR),cancer rate and stage. Statistical analysis included chisquare, Student's t-test and odds ratio (OR) when indicated. Result(s): finally, 746 screening colonoscopies were performed in the period January 2021-October 2022 (Group 1), as compared with 741 screening colonoscopies in the period January 2018-October 2019 (Group 2). No differences were seen about gender (males 49.6% vs 54%, p=0.1) or age (mean age 63.17+/-6.32 vs 63.77+/-6.47, p=0.07) between the two groups, respectively. Similarly,ADR was 40.9% in the Group 1 vs 45.6% in the Group 2 (p=0.07),although a lower number of adenoma per patient was found in the Group 1 (mean adenoma number per patient 1.58+/-0.94 vs 1.76+/-1.21, p=0.01). A total of 36 CRC were diagnosed in the Group 1 (4.8%), while the CRC rate in the pre-Covid group was 6.6% (49 patients) (p=0.17). However, CRC patients in the Group 1 presented a significantly higher CRC stage when compared with those in the Group 2 (T4 stage 36.1% vs 14.3%, p=0.02, OR 3.39, 95% CI 1.19-9.69),and significantly higher lymph node metastases rate (58.3% vs 30.6%, p=0.01, OR 3.17, 95% CI 1.29-7.79).No differences were seen in the rate of distant metastases (25% vs 12.1%, p=0.1). Conclusion(s): A 6-month screening delay significantly increases advanced CRC cases.Magnitudes of CRC screening delays on prognosis and mortality will be manifest in the next few years.Healthcare systems should adopt policies to preserve the regularity of CRC screening during other Covid-19 waves or pandemics.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.

A Prospective Study of Patient-Reported Quality of Life Outcomes in Standard and Expanded Endoscopic Endonasal Skull Base Surgery at a Tertiary Center

Introduction: Transient alterations in patient's quality of life (QOL) following endoscopic endonasal approach skull base surgery (EEA) are inevitable despite substantial progress in techniques and equipment over the last two decades. We have prospectively evaluated patient-reported QOL at our institution using multiple metrics, to better understand the sensitivity of such testing and evaluate for risk factors for worsened quality of life after EEA. Method(s): Prospective, review-board-approved, single-institution cohort study of patients undergoing EEA surgery between 2019 and 2022 (enrollment was paused March to September 2020 due to COVID-19 research restrictions). Patient-reported global PROMIS-29 and sinonasal-specific ASK-Nasal 12 metrics were obtained prior to and at routine intervals after EEA. Result(s): We enrolled 90 patients with baseline and follow-up data available. Average age was 50 years and there was a 58:32 female:male predominance. Most procedures involved at least transsellar (N = 73) surgery, although numerous expanded anatomic compartments (total N = 61) were also accessed. Pituitary adenoma was the most common pathology treated, although a wide range of others were represented. PROMIS-29 evaluation of global QOL demonstrated an expected worsening in symptoms within physical function (+2.9), social interaction (+1.1), and pain (+0.4) metrics at 2-weeks postoperatively compared with baseline;averages in these domains returned to baseline or were improved by 6 months. Anxiety and depression symptom domains were immediately improved as early as 2-weeks after surgery (-1.2 and -0.8, respectively), remaining improved compared with baseline 6 months after surgery. Sinonasal-specific QOL demonstrated expected worsening at 2 weeks postoperative (average sum ASK-Nasal 12 score 21, versus 9.7 baseline, p < 0.05) but returned to baseline at 6 months (average 9.2, p = NS). Subgroup analysis revealed that patients with functional pituitary adenoma (FPA) reported worse baseline global QOL in every PROMIS-29 domain, but similar baseline sinonasal-specific QOL, when compared with the entire cohort. FPA patients reported more absolute improvement in every domain of PROMIS-29 global QOL than did the cohort average at 6 months post-surgery (average change across all PROMIS-29 symptom domains at 6 months -1.96 for FPA, versus -1.2 for all patients, p < 0.05). Discussion(s): We prospectively assessed patient-reported global and sinonasal-specific QOL after EEA at a tertiary center using modern techniques. The PROMIS-29 global QOL metric has not been previously utilized in this patient group;expected postoperative alterations in physical and social function and pain were found and these resolved within six months of surgery. Patient symptoms in Anxiety and Depression QOL domains immediately improved at two weeks postoperatively despite objectively worse reported sinonasal QOL in the same time interval;this implies patients are strongly relieved to have completed surgery even if still suffering sinonasal QOL alterations in the early perioperative period. Patients with functional pituitary tumors have, not surprisingly, worse baseline global QOL than do average EEA patients;nevertheless, functional tumor patients also show more absolute improvement in QOL after surgery. (Figure Presented).

A Point-of-Care Faecal Test Combining Four Biomarkers Allows Avoidance of Normal Colonoscopies and Prioritizes Symptomatic Patients with a High Risk of Colorectal Cancer.

Most colonoscopies performed to evaluate gastrointestinal symptoms detect only non-relevant pathologies. We aimed to evaluate the diagnostic accuracy of a qualitative point-of-care (POC) test combining four biomarkers (haemoglobin, transferrin, calprotectin, and lactoferrin), a quantitative faecal immunochemical test (FIT) for haemoglobin, and a quantitative faecal calprotectin (FC) test in symptomatic patients prospectively recruited. Colorectal cancer (CRC), adenoma requiring surveillance, inflammatory bowel disease (IBD), microscopic colitis, and angiodysplasia were considered significant pathologies. A total of 571 patients were included. Significant pathology was diagnosed in 118 (20.7%), including 30 CRC cases (5.3%). The POC test yielded the highest negative predictive values: 94.8% for a significant pathology and 100% for CRC or IBD if the four markers turned negative (36.8% of the patients). Negative predictive values of FIT, FC, and its combination for diagnosis of a significant pathology were 88.4%, 87.6%, and 90.8%, respectively. Moreover, the positive predictive value using the POC test was 82.3% for significant pathology when all biomarkers tested positive (6% of the patients), with 70.6% of these patients diagnosed with CRC or IBD. The AUC of the POC test was 0.801 (95%CI 0.754-0.848) for the diagnosis of a significant pathology. Therefore, this POC faecal test allows the avoidance of unnecessary colonoscopies and prioritizes high risk symptomatic patients.

Management of colorectal cancer screening backlog due to the COVID-19 pandemic: A retrospective analysis of the use of a colorectal cancer screening clinical-decision support tool in Argentina.

BACKGROUND: The COVID-19 pandemic created a backlog in colorectal cancer (CRC) screening and surveillance colonoscopies. The real impact in Argentina is not fully known. GOAL: To estimate the impact of the COVID-19 pandemic on CRC prevention by comparing the number of CRC screening and surveillance consults in a clinical decision support-tool used in Argentina before, during and after pandemic lockdown. METHODS: We analyzed data from May 2019 to December 2021 from CaPtyVa, a clinical decision support tool for CRC screening and surveillance. Queries were divided in pre-pandemic (May 2019 to March 2020), lockdown (April 2020 to December 2020), and post-lockdown (January 2021 to December 2021). The number of CRC monthly screening and surveillance visits were compared among the three periods and stratified according to CRC risk. RESULTS: Overall, 27,563 consults were analyzed of which 9035 were screening and 18,528 were surveillance. Pre-pandemic, the median number of screening consults was 346 per month (IQR25-75 280-410). There was a decrease to 156 (80-210)/month (p<0.005) during lockdown that partially recovered during post-lockdown to 230 (170-290)/month (p=0.05). Pre-pandemic, the median number of surveillance consults was 716 (560-880)/month. They decreased to 354 (190-470)/month during lockdown (p<.05) and unlike screening, completely recovered during post-lockdown to 581 (450-790)/month. CONCLUSIONS: There was a >50% decrease in the number of CRC screening and surveillance consults registered in CaPtyVa during lockdown in Argentina. Post-lockdown, surveillance consults recovered to pre-pandemic levels, but screening consults remained at 66% of pre-pandemic levels. This has implications for delays in CRC diagnoses and patient outcomes.

[Pituitary apoplexy and SARS-CoV-2 (COVID-19) infection]

Coronavirus disease (SARS-CoV-2/COVID-19) is responsible for a wide variety of extrapulmonary manifestations, among which direct or indirect neurological compromise stands out. Pituitary apoplexy is a clinical and neurosurgical entity of variable severity, usually associated with a pituitary adenoma. Literature is scarce regarding the association between these diseases. This paper reports a case of pituitary apoplexy, manifested concomitantly to the diagnosis of COVID 19 in a patient with unknown pituitary macroadenoma, and its therapeutic management, reviewing the mechanisms potentially underlying the link between both entities.

Role of race in accelerating progression of colorectal cancer

African Americans present earlier in age and have higher incidence and mortality from colorectal cancer (CRC) compared to Whites. Socioeconomic inequality in the US that leads to higher comorbid illness among African Americans is likely a driver. Subsequent biological differences in African Americans include higher risk adenoma precursors that are more often proximally located in the colon, low microstatellite instability prevalence, and deficient immunologic profiles compared to Whites that contribute to cancer progression and outcome. Screening for CRC among African Americans had been recommended by some organizations to commence at age 45 or 40 years due to the observed epidemiology;this was not implemented until the US Preventive Services Task Force recommended CRC screening to commence at age 45 years for all races and ethnicities in 2021.Screening for CRC is one modality of intervention that can eliminate disparities;both colonoscopic and non-invasive screening have been shown to eliminate incidence and mortality differences between African Americans and Whites when using navigation. Recent gains in screening utilization among African Americans compared to Whites might be erased as a result of the COVID-19 pandemic. Navigated non-invasive CRC screening might help the unevenness of preventive services recovery from the pandemic if it can be fully implemented.

Retrospective Analysis of Quantitative Faecal Immunochemical Testing (Qfit) Levels in Colorectal Malignancy during the Covid-19 Pandemic, and Correlations between Qfit Value and Site of Neoplasia

Aim: Routine endoscopic services were significantly reduced in response to the COVID-19 pandemic. As a response, two-week- wait referral for patients with rectal bleeding suspicious of colorectal cancer, incorporated qFIT as a tool to identify patients that may require further investigation. This study aimed to analyse the accuracy and sensitivity of qFIT as a tool to identity malignant colorectal neoplasia. Correlations between qFIT, anatomical site of neoplasia and haemoglobin status (Hb) was similarly considered. Method(s): Participants were included if they had confirmed colorectal adenocarcinoma or adenoma detected via the two-week- wait referral system alongside a qFIT score. A qFIT score of >=10mg/g was interpreted as positive. Exclusion criteria included anal cancers, neuroendocrine cancers, small bowel tumours and participants without a qFIT level. Participants with polyps and confirmed rectal, sigmoid and/or colonic cancer were included. Haemoglobin level at diagnosis, colonoscopy report and histological outcomes were analysed. Result(s): 3664 patients were referred in on the two-week- wait pathway in 2020. Of these 372 (10%) were coded as having a gastrointestinal tumour or polyp cancer diagnosis. 119 (32%) of participants fulfilled the criteria to be amenable for review. Of these 10 (8.4%) participants only had a polyp, while 109 (91.6%) participants had colorectal adenocarincoma +/-polyps. A total of 12 (11%) participants with colorectal adenocarcinoma had a qFIT level of <=10mg/g, with 2 (16%) of these having concurrent anaemia. There was no demonstratable level of qFIT that correlated with right versus left sided colonic tumours. Conclusion(s): Symptomatic patients with a qFIT of >=10mg/g should undergo further investigation for malignant colorectal neoplasia. This study found that qFIT did not reliably predict the site of neoplasia. A qFIT of <=10mg/g was present in 11% of participants with colorectal adenocarcinomas and is therefore not a sensitive tool in excluding colorectal neoplasia.

Florid cystitis cystica et glandularis mimicking a bladder tumour: A rare case report

Background: An 80 years old male patient presented with urinary retention. He had lower urinary tract symptoms for the last two years. The patient was catheterized and subsequently developed gross hematuria. The patient was COVID- 19 positive. Method(s): The ultrasonography showed bladder wall thickening with bladder mass around the neck. The computerized tomography scan showed heterogeneously enhancing thickening in the left lateral wall of the urinary bladder and was suspected to be neoplastic. There was a suspicious heterogeneously enhancing lesion in the base of the prostate. His serum prostate-specific antigen level was 5.79 ng/ml. His repeated urine cytology for malignant cells was non-diagnostic. Result(s): The patient underwent transurethral resection of bladder tumour (TURBT) and transurethral resection of the prostate (TURPT). The TURBT biopsy showed florid cystitis cystica et glandularis and the TURPT biopsy showed adenomatous hyperplasia. Conclusion(s): The florid cystitis cystica et glandularis mimic a malignancy, and it is, therefore, important to consider it as a differential diagnosis while evaluating catheterized patients with lower urinary tract symptoms.

Diagnostic Yield Vs Diagnostic Accuracy for Lung Nodule Biopsy Evaluation: Evidence Supporting a Pragmatic End Point for Future Studies

SESSION TITLE: Lung Nodule Biopsy: Yield and Accuracy SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: A variety of endpoints have been used to evaluate the diagnostic performance of navigational bronchoscopy for sampling peripheral pulmonary lesions (PPLs), including diagnostic yield (rate of biopsies with a specific diagnosis that facilitates clinical decisions) and diagnostic accuracy (yield plus a follow-up to assess for false negative/positive initial results). There is also significant variation in what non-malignant findings are considered diagnostic, especially regarding nonspecific inflammatory changes. We hypothesized a diagnostic yield definition excluding nonspecific findings as diagnostic would lead to few false negative PPL biopsies. METHOD(S): Our center maintains a prospective cohort of consecutive PPLs targeted via navigational bronchoscopy. Diagnostic yield was defined as specific findings readily explaining the presence of a PPL (malignancy, organizing pneumonia, granulomatous inflammation, frank purulence, other specific finding) permitting management without immediate additional diagnostic intervention. "Other specific finding" required pulmonologist and lung pathologist agreement. All other findings were considered non-diagnostic. RESULT(S): A total of 450 PPLs biopsied 2017-2019 with complete two-year follow-up were included in the analysis. Ultimately, 274 of 450 (60.9%) PPLs were determined to be malignant. Diagnostic biopsies were obtained in 331 cases (73.6%). There was a single false-positive among 228 malignant biopsies (0.4%, carcinoid tumor on cytopathology, alveolar adenoma on resection surgical pathology). Among 223 PPLs without malignant diagnosis at initial bronchoscopy, 48 were later determined to be malignant. Most (n=39) exhibited nonspecific abnormalities on initial pathology. Two of 104 specific benign biopsies were false negative (1.9%). Both demonstrated organizing pneumonia on initial pathology but re-biopsy months after index bronchoscopy revealed Hodgkin's lymphoma and metastatic renal cell carcinoma, respectively. The sensitivity, specificity, and positive predictive value of specific benign findings for an ultimately benign nodule were 58% (95% CI, 51-66%), 95% (86-99%), and 90% (70-97%). The sensitivity, specificity, and positive predictive value of nonspecific benign findings for an ultimately benign PPL diagnosis were 32% (95% CI, 25-39%), 19% (9-33%), and 20% (16-24%). CONCLUSION(S): A definition of diagnostic yield excluding nonspecific benign findings had low false positive/negative rates. If bronchoscopy is not diagnostic of malignancy, a specific benign finding was highly predictive of an ultimately benign PPL, while nonspecific findings poorly predicted benignity. CLINICAL IMPLICATIONS: This definition of diagnostic yield could be used as the primary outcome in future studies, permitting distribution of reliable diagnostic results without requiring years of follow-up. DISCLOSURES: No relevant relationships by Joyce Johnson No relevant relationships by Robert Lentz No relevant relationships by Kaele Leonard No relevant relationships by See-Wei Low PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Briana Swanner Copyright © 2022 American College of Chest Physicians

EVALUATION OF A COLONOSCOPY REFERRAL FORM IN QUEBEC: WHICH INDICATIONS CARRIES A HIGHER RISK OF ADVANCED NEOPLASIA?

Background: Patients referral for colonoscopy in the province of Quebec are organized through a standardized triage sheet that includes all indications categorized in 5 hierarchal scheduling priorities. In the context of a restricted access to colonoscopy, exacerbated by the COVID-19 pandemic, postponed elective endoscopies lead to potential diagnostic and therapeutic delays in patients with colorectal neoplasia. There is currently an important need to evaluate available tools to improve patients prioritization. Aims: This study aims to determine CRC and advanced adenomas (AA) rates associated with indications of priority 3 (P3 fig.1). The secondary objective is to regroup and compare indications with higher and lower rate of CRC and AA. Methods: This retrospective study included all adult patients who underwent a single diagnostic colonoscopy from March 2013 to March 2016 following a single FIT test in a tertiary teaching hospital. A literature review informed the adopted definition of higher-risk of CRC and AA according to P3 colonoscopy indications. These include: Positive FIT test (IN5), hematochezia in ≥ 40 years old patients (IN4), unexplained iron deficiency anemia (IN6) and symptoms suspicious of occult colorectal cancer (IN18). Lower risk P3 indications were defined as: suspicion of IBD (IN3), recent change in bowel habits (IN7), polyp viewed on imaging (IN17), inadequate bowel preparation (IN19), and diverticulitis follow-up (IN20). Higher and lower risk indications findings were analyzed. Results: In our cohort of 2226 patients, indications for colonoscopy referral according to the standardized form were available for 1806 patients (10 P1, 69 P2, 1056 P3, 56 P4 and 615 P5). In our studied group of P3 indications, the mean age was 62.6±11.3 years, 54.1% were female and 173 (16.4%) patients had a significant finding of CRC or AA (table 1). Patients referred for higher risk indications had a significantly increased rate of CRC and AA (19.3% vs 5.1% p≤ 0.01) compared to patients referred for lower risk indications. Conclusions: A standardized colonoscopy referral tool may be adapted to improve prioritization of patients at risk of advanced neoplasia. These findings are especially.

Risk-stratified FIT for urgent colonoscopy in Lynch syndrome: A clinical service throughout the COVID-19 pandemic

Background: Lynch syndrome (LS) is an inherited disorder characterized by pathogenic variants within mismatch repair genes resulting in an increased risk of colorectal cancer (CRC). In England, the fecal immunochemical test for Haemoglobin (FIT) is currently used in non-LS symptomatic and screening populations to guide subsequent colonoscopy. Herein, we report results from a national emergency clinical service implemented during the COVID-19 pandemic which used FIT to prioritize colonoscopy in LS patients while endoscopy services were limited. Methods: Regional genetic and endoscopy services across England were invited to participate. Patient eligibility was determined by 1) Diagnosis of Lynch Syndrome 2) Planned colonoscopic surveillance between 1 March 2020 and 31 March 2021. Requests for FIT testing from participating NHS Trusts were sent to the NHS Bowel Cancer Screening South of England Hub's Research Laboratory in Surrey. The Hub sent patients a FIT kit (OC-Sensor? (Eiken, Japan)), instructions for use, a questionnaire, and a pre-paid return envelope. Lab reports with feecal haemoglobin (f-Hb) results were returned electronically for clinical action. LS patients were risk-stratified for colonoscopy based upon the following f-Hb thresholds: (1) f-Hb ≥10mg of Haemoglobin (Hb)/g (mg/g) faeces: triaged for colonoscopy via an urgent two-week wait (2WW) pathway, (2) f-Hb ≤10mg/g: schedule patients for colonoscopy within 6-12 weeks, where local endoscopy service availability permits. Results: Fifteen centers across England participated in the clinical service from 9th June 2020 to 31st March 2021. An uptake rate of 64% was observed from this cohort (375/588 invites), though 21 cases were removed from analysis due to repeat FITs, insufficient sample, missing clinical data, or FIT completed after colonoscopy. Of the remaining 354 patients analyzed, 269 patients (76%) had a f-Hb of <6mg/g. 6% (n=23) of patients had a f-Hb that was at or between greater than the limit of detection of the assay (≥6mg/g) yet below 10mg/g.18% (n=62) had FIT results of ≥10mg/g and met criteria for urgent colonoscopy triage via the 2WW pathway. Of the 62 urgently triaged patients, 22 had detectable adenomas, 6 had advanced adenomas (AAs), and 4 were diagnosed with CRC (table). Conclusions: The utility of FIT during the pandemic has demonstrated clinical value for LS patients requiring CRC surveillance. Further longitudinal investigation on the efficacy of FIT in people with LS is warranted and will be examined as part of the multi-center prospective research study “FIT for Lynch Syndrome” (ISRCTN15740250) which is presently recruiting patients in the UK.

Modeling analysis of COVID 19-related delays in colorectal cancer screening on simulated clinical outcomes

Background: Colorectal cancer (CRC) screening disruptions have been observed with the COVID-19 pandemic, putting patients at risk for more advanced-stage disease at the time of diagnosis. We estimated the impact of increased use of stool-based tests for screening during the COVID-19 pandemic on near-term clinical outcomes in a simulated United States (US) population. Methods: A previously developed budget impact model was adapted to assess the impact of increasing use of multi-target stool DNA [mt-sDNA] or fecal immunochemical [FIT] tests to offset the COVID-19 related disruption in colonoscopy screening. Adults, ages 50 - 75 years, at average risk for CRC were included over a 3-year time horizon (2020 - 2023) to explore the impact of increased screening for CRC using mt-sDNA or FIT, from the perspective of a US payer. Compared to the base case (S0;85% colonoscopy and 15% non-invasive tests), the estimated number of missed CRCs and advanced adenomas (AAs) were determined for four COVID-19-affected screening scenarios: S1, 9 months of CRC screening at 50% capacity, followed by 21 months at 75% capacity;S2, S1 followed by increasing stool-based testing by an average of 10% over 3-years;S3, 18 months of CRC screening at 50% capacity, followed by 12 months of 75% capacity;and S4, S3 followed by increasing stool-based testing by an average of 13% over 3-years. Results: Increasing the proportional use of mt-sDNA, the detection of AAs improved by 6.0% (Scenario 2 versus 1) to 8.4% (Scenario 4 versus 3) and the number of missed CRCs decreased by 15.1% to 17.3% respectively. Increasing FIT utilization improved the detection of AAs by 3.3% (Scenario 2 versus 1) to 4.6% (Scenario 4 versus 3) and the number of missed CRCs decreased by 12.9% (Scenario 2 versus 1) to 14.9% (Scenario 4 versus 3). Across all scenarios, the number of AAs detected was higher for mt-sDNA than for FIT, and the number of missed CRCs was lower for mt-sDNA than for FIT. Conclusions: Using home-based stool tests for average-risk CRC screening can mitigate the consequences of reduced colonoscopy screening resulting from the COVID-19 pandemic. Use of mt-sDNA led to fewer missed CRCs and more AAs detected, compared to FIT.