ID: 3524342 IMPACT OF COVID-19 PANDEMIC ON COLORECTAL CANCER SCREENING WHEN COLONOSCOPY IS THE DOMINANT SCREENING MODALITY

Abstract

SATURDAY, MAY 22, 2021 Colon and Rectum 1 Lecture ID: 3524139 MONITORING COLONOSCOPY QUALITY ACROSS THE SPECTRUM OF CANCER CONTROL INDICATIONS: THE ADR-ESS (ADENOMA DETECTION RATE – EXTENDED TO ALL SCREENING AND SURVEILLANCE) SCORE Uri Ladabaum*, Ajitha Mannalithara Background: The adenoma detection rate (ADR), strictly based on first-time screening colonoscopies, is the best validated colonoscopy quality metric. Auditing other colonoscopy indications could increase sample size per endoscopist and improve the precision of ADR estimates and their stability over time, as well as emphasize quality across the spectrum of preventive colonoscopies. Aims: To develop the aggregate ADR-ESS (ADR extended to all screening and surveillance) score and assess its precision and stability vs. ADR. Methods: Data were extracted for 15,253 colonoscopies by 35 endoscopists in the Stanford Colonoscopy Quality Assurance Program for Oct,2017–Jan,2020. Two versions of ADR-ESS were explored: ADR-ESS1 was a simple aggregation of preventive colonoscopies (first screening, subsequent screening, surveillance, family history of colorectal neoplasia), and ADR-ESS2 included normalization of rates with respect to first screening and weighting of indications based on the proportions of an endoscopist’s colonoscopies. We compared ADR-ESS1 vs. ADR-ESS2 vs. ADR by endoscopist with respect to width of confidence intervals (CI), endoscopist ranking, and stability over time and colonoscopy volume. Results: Relative to first screening, adenoma detection rates were lower for subsequent screening (RR 0.80, 95%CI 0.74-0.87) and family history (RR 0.84, 95%CI 0.74-0.96) and higher for surveillance (RR 1.22, 95%CI 1.15-1.31). Colonoscopy volumes for ADR-ESS were 3.4-fold (range 2.0-7.9-fold) higher than for ADR. The quintiles for ADR were <27%, 27 to <35%, 35 to <38%, 38 to <44% and 44% vs. quintiles for ADR-ESS1 of <32%, 32 to <35%, 35 to <39%, 39 to <43% and 43%, and for ADR-ESS2 of <31%, 31 to <35%, 35 to <40%, 40 to <43% and 43%. The CIs for ADR-ESS1 and ADR-ESS2 were substantially narrower than for ADR; the numerical ranking of endoscopists by ADR-ESS1 vs. ADR-ESS2 were very similar, but differed somewhat from ranking by ADR (Fig 1). Endoscopists’ ADR-ESS1 showed less variability by quarter than ADR (Fig 2). Quarter-to-quarter fluctuations in ADR-ESS1 were minimal for endoscopists with 500 total colonoscopies. Period-to-period variability decreased substantially with AB96 GASTROINTESTINAL ENDOSCOPY Volume 93, No. 6S : 2021 semi-annual audit for ADR-ESS1, but less substantially for ADR (Fig 2). ADR-ESS1 and ADR were both relatively stable year-to-year, except for endoscopists with the lowest colonoscopy volumes. Conclusions: A simple aggregation of the four major preventive colonoscopy indications into the ADR-ESS score yields a more precise and stable metric than the classic ADR based only on first time screens, without requiring changes to detection benchmarks. Beyond increasing the colonoscopy volume available for audit, ADR-ESS has the added advantage of emphasizing quality assurance across the range of CRC control indications. Fig 1. ADR-ESS and ADR confidence intervals and endoscopist ranking Fig 2. Stability of ADR-ESS vs. ADR quarter-to-quarter and semester-tosemester SATURDAY, MAY 22, 2021 Colon and Rectum 1 Lecture ID: 3524342 IMPACT OF COVID-19 PANDEMIC ON COLORECTAL CANCER SCREENING WHEN COLONOSCOPY IS THE DOMINANT SCREENING MODALITY Gabrielle Waclawik*, Mark Benson, Patrick Pfau, Jennifer Weiss Background: The COVID-19 pandemic led to a temporary cessation of elective procedures throughout the country and a dramatic decrease in screening colonoscopies. It is unknown if the COVID-19 pandemic affected all CRC screening modalities equally and overall screening rates. Aim: To determine CRC screening rates during the COVID-19 pandemic in a large unified health system where colonoscopy is the dominant screening modality. Methods: Billing and electronic medical record (EMR) data was collected to determine the number of CRC screening tests completed by modality over 15 months (July 2019–Sept 2020). Data collection was limited to age appropriate patients (50-75 years). CRC screening test completion was determined by CPT codes for (a) fecal occult blood test (FIT/gFOBT), (b) multitarget stool DNA,