Stephen Curtis, MD, Adam Tritsch, MD
Walter Reed National Military Medical Center, Bethesda, MD
Introduction: Despite proven efficacy in improving mortality from colorectal cancer (CRC), CRC screening remains underutilized in the U.S. with nearly 1/3 of eligible patients not screened. Open access colonoscopy (OAC) allows for patients at low-risk for endoscopic complications to receive a colonoscopy without a pre-procedural visit. Although the ASGE has published guidelines on enacting an OAC program, there has been little published on the yield of such a program.
Methods: At Walter Reed National Military Medical Center, we enacted an OAC program in 2014. Patients due for CRC screening or surveillance can arrange a procedure by an online form. Our schedulers’ review all forms, and patients reporting concerning symptoms, sedation limiting comorbidities, or who are age < 45 or > 75 have a clinic visit prior to their procedure. The remainder of patients have their forms reviewed by a gastroenterologist for suitability and are scheduled for colonoscopy or computed tomographic colonography (CTC).
Results: Prior to expanding Walter Reed’s OAC program to other military hospitals in the NCR, 10,676 total screening requests were made. 48.7% were male, 53.4% were Caucasian, 18.0% were African American. The requested screening method was CTC in 19.1% of submitted forms. Of patients who fell outside the 45-75 age range, 11.4% were under the age of 45, and 1.2% were over the age of 75. Half of the patients using the OAC program had a previous screening exam, and a total of 12.7% reported a family history of CRC. Since incorporating other military hospitals in the NCR, 2,882 screening forms have been completed : 33.6% were male, 35.1% were Caucasian, 14.6% were African American, 14.9% requested a CTC, 5.1% were under the age of 45, 1.0% were over the age of 75, 33.3% had a previous screening, and 9.2% had a family history of CRC. Prior to incorporating the NCR, 20.4% of patients were referred for a clinic visit based on answers in their form, and another 6.0% were referred for a clinic visit after provider review. After the incorporation, 16.4% were referred for a clinic visit.
Discussion: By avoiding unnecessary clinic visits for patients needing a colonoscopy, OAC programs reduce wait times for colonoscopies and increase availability in gastroenterology practices to see symptomatic patients. Our program in a single payer model, analyzed across two different catchments, shows that over 80% of pre-procedural visits can be avoided by using a questionnaire.
Citation: Stephen Curtis, MD, Adam Tritsch, MD. P0231 - OPEN ACCESS COLON CANCER SCREENING WITH OPTICAL AND VIRTUAL COLONOSCOPY. Program No. P0231. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.