Utilization of fecal immunochemical testing in open access screening during pandemic endoscopy restrictions

ABSTRACT

INTRODUCTION: At our institution we utilize an Open Access Colonoscopy (OAC) program that allows patients to self-refer for colorectal cancer (CRC) screening and polyp surveillance. Patients are offered the choice of optical colonoscopy or CT colonography (CTC) and the submission is the reviewed for appropriateness. Open access procedures account for approximately 20% of the endoscopic procedures performed at our institution. Following the directive to postpone elective procedures due to the COVID-19 pandemic, our department had 202 OAC patientswhose CRC screening would be delayed. We utilized fecal immunochemical testing (FIT) to provide timely CRC screening to appropriate patients. FIT is a top tier, stool based, CRCscreening test for average risk patients. METHODS: This was an observational study which assessed all patients previously scheduled for CRC screening through a pre-existing OAC program. The rates of FIT eligibility, patient acceptance, patient completion, and results were tracked. RESULTS: A physician reviewed the 202 OAC patient request forms for FIT eligibility. We found 143 patients that were eligible for FIT with the primary exclusions being a personal history of polyps or a significant family history. Our eligibleOAC patients were proactively notified of delays and offered FIT by a nurse. Of the eligible patients, 100 (70%) accepted, 41 (29%) declined and 2 (1%) were unable to be reached. Nine weeks into our initiative, 64 eligible patients (64%) hadcompleted screening with 8 positive and 56 negative tests. Patients with positive FITs received scheduling precedence. Two advanced adenomas were detected in the first six weeks. CONCLUSION: FIT has been used for programmatic CRC screeningby healthcare systems due to low cost and ease of participation.Still, FIT is not widely utilized in many medical systems where patients are often screened opportunistically after presenting forcare via self-referral or referral from their primary care provider. Our findings suggest that the majority of our patients prioritizedtimely CRC screening over a specific modality of screening in a self-referral system. We propose that the utilization of FIT in OAC programs can decrease wait times for screening, particularly during periods of limited resources. This highlightsthe feasibility of FIT in a self-referral OAC program forproviders and health systems working to maintain access to care through streamlining of CRC screening. (Figure Presented) .