Relationship between 25(OH)D and Colorectal Cancer Prevalence at Dr. Moewardi Hospital Surakarta-Indonesia: A Cross-Sectional Study

Background: Colorectal cancer is a malignancy of the colon and / or rectum. Vitamin D has a role as an inhibitor of tumor progression, namely through the process of influencing cellular differentiation and proliferation. (VDR) Vitamin D Receptor affects cell differentiation by upregulating brush boundary enzymes and improving morphological microvilli. This study seeks to determine the relationship between 25(OH)D levels and colorectal cancer in dr. Moewardi Hospital, Surakarta, Indonesia. Methods: A cross-sectional design study with quantitative-analytical observation was conducted. All patients had symptoms of colorectal cancer, either undiagnosed or previously diagnosed. 25(OH)D samples were taken from a total of 50 patients at dr. Moewardi Surakarta and subsequent diagnostic measures from the results of histopathology were assessed. The parameters assessed were 25(OH)D level and a diagnosis of colorectal malignancy. Statistical analysis of 25(OH)D levels and colorectal diagnosis using the Chi Square test. Results: The prevalence of colorectal cancer is higher in respondents with 25(OH)D deficiency and insufficiency compared to respondents with normal 25(OH)D concentrations who tend to have non-colorectal cancer. Based on the Chi-Square test result, the significance value was 0.004, marking a statistically significant association. Conclusion: This study shows a significant relationship between deficiency and insufficiency of 25(OH)D concentrations with the occurrence of colorectal malignancy

EP.WE.231Emergency Presentations of Colorectal Cancer during the COVID-19 Era

Aims COVID-19 has reduced the ability to provide red flag investigations for colorectal patients. The aim of this study is to assess the number of emergency presentations of new colorectal malignancy during the COVID-19 era and if there is an increase in palliative cases. Methods A retrospective review of all patients presenting to unscheduled care with a new diagnosis of colorectal malignancy from 31st March 2020 - 25th January 2021 in a single UK Trust. An institutional data base and electronic care records were used to review patient demographics, management and curative intent. Data points for the same period in 2019-2020 were recorded for comparison. Results 45 patients diagnosed with new colorectal malignancy during an unscheduled admission to hospital within the study timeframe. 22% (10/45) presented in January 2021. 29 diagnosed during the same time interval 2019-2020. Median age at presentation was 77.5 and 79 respectively. 40% (18/45) of patients in 2020-2021 proceeded to emergency surgery, compared to 58% (17/29) in 2019-2020 (p = 0.12). 10.3% (3/29) of 2019-2020 patients were managed with colonic stenting. This increased in 2020-2021 to 17.8% (8/45) (p = 0.38). 77.8% (35/45) patients in 2020/2021 presented at a palliative stage of disease compared to 62.1% (18/29) in 2019-2020 (p = 0.15). Conclusions Overall the data has not shown a statistically significant difference in patients presenting as an emergency with new colorectal malignancy. However, there was a rise in admissions noted in January 2021; should this trend continue, alongside the persistent pressures of COVID-19 ongoing research is needed to assess the true impact.

SP1.2.1The use of first-line CT scan in the Suspected Colorectal Cancer Pathway at a District General Hospital during the COVID-19 Pandemic

Aim During the initial phase of the COVID-19 pandemic the British Society of Gastroenterology and Joint Advisory Group on GI Endoscopy published guidance to halt all non-emergency endoscopy. CT was used as the first-line investigation with delayed completion endoscopy. We reviewed the efficacy of this change to determine its influence on future practice. Methods All patients referred via the suspected colorectal cancer pathway (SCCP) to our district general hospital from 15/04/20-15/05/20 (initial COVID-19 lockdown) were included. Retrospective analysis of patient records was performed. Results were analysed using χ² statistic. Significant incidental pathology (SIP) was defined as non-colorectal pathology requiring referral to different speciality or further imaging. Results There were 115 patients for analysis, mean age 68 years. 2/115 (1.7%) demonstrated a colorectal malignancy on CT, with no further diagnoses at completion colonoscopy. CT imaging detected SIP in 31/115 (27%). This included 8/42 (19%) who would have otherwise been referred direct to endoscopy alone based on symptoms and fitness. Subgroup analysis by presenting complaint showed SIP was most likely to be detected in those presenting with weight loss (13/36, 36.1%, p = 0.049) or anaemia (12/31, 38.7% p = 0.084). Conclusions CT is a valuable first-line investigation in SCCP patients. In this cohort, no colorectal malignancies were missed on CT that were later detected at endoscopy and 27% detected SIP. Weight loss demonstrated a statistically significant correlation with incidental pathology. These findings suggest CT as a possible first-line investigation in patients presenting with weight loss, anaemia or where there is delayed access to endoscopy.

1277 A Closed-Loop Audit of the use of qFIT in Symptomatic “Two Week Wait” referrals in Somerset Foundation Trust

Introduction Quantitative faecal immunochemical test (qFIT) is recommended as the replacement test for faecal occult blood testing by NICE. We audited qFIT use in two week-wait (2WW) referrals in Somerset Foundation Trust (SFT) following its introduction in 2019. Method Following qFIT being made available to general practitioners, all 2WW referrals received before (July 2019) and after (December 2019) the introduction of the new 2WW referral form were reviewed. Electronic patient records were analysed to determine investigations performed and if a diagnosis of cancer was made. Results July 2019: 288 2WW referrals with 74 patients eligible for qFIT – only 7 of these underwent qFIT; total of 93 qFIT performed by GPs with 11 positive tests. December 2019: 222 2WW referrals with 18 patients eligible for qFIT – all of whom underwent qFIT; total of 155 qFIT performed by GPs with 18 positive (and 137 negative) tests. 1 patient with a positive qFIT was found to have colorectal malignancy (qFIT = 267 g/dL, investigation showed benign TVA). An increase in qFIT was observed over time, coinciding with a reduction in 2WW referrals, including reduction in patients who were qFIT eligible. The 2WW service identified 11 (3.8%) cases of colorectal cancer in July 2019 compared to 12 (5.4%) cases in December 2019, showing an increased pickup rate. Conclusions High proportions of 2WW referrals undergo investigation. The results of this audit highlight the utility of qFIT in screening 2WW referrals and reducing burden on the service, particularly where access to investigations is severely restricted due to coronavirus.

Cost effectiveness of using Faecal Immunochemical Testing (FIT) as an initial diagnostic investigation for patients with lower gastrointestinal symptoms suggestive of malignancy

Background There has been an increase in the numbers of patients presenting to primary care with suspected colorectal malignancy and subsequently an increase in demand for endoscopy. This study aims to forecast the cost of faecal immunochemical testing (FIT) compared to conventional diagnostic tests as a primary investigation for patients with symptoms suggestive of colorectal malignancy. Methods Retrospectively, 1950 patients with symptoms suggestive of colorectal malignancy who were referred through primary care and underwent investigations through standard endoscopic evaluation were included. These patients were used to forecast the cost of faecal immunochemical testing creating theoretical data for sensitivity and specificity. Outcome measures included: the number of investigations under current protocol; cost of current investigations; number of predicted false negatives and false positives and positive/negative predictive values using current sensitivity data for FIT; the cost forecast of using FIT as the primary investigation for colorectal malignancy. Results Median age was 65 (IQR 47–82) with 43.7% male and 56.3% female. A total of 1950 investigations were carried out with a diagnostic yield of 26 cancers (18 colon, 8 rectal), 138 polyps and 29 high risk adenomas (HGD ± > 10 mm). In total, £713,948 was spent on the investigations. The commonest investigation was colonoscopy totalling £533,169. The total cost per cancer diagnosis was £27,459. Sensitivity (92.1% CI 86.9–95.3) and specificity (85.8% CI 78.3–90.1) for FIT in colorectal cancer was taken from NICE and was costed via the manufacturer(s). The projected total cost of FIT for the same population using a ≥ 4 μg haemoglobin cut off was £415,680 (£15,554 per cancer). The total cost of high-risk polyps using ≥ 4 μg cut off was £404,427 (sensitivity 71.2% CI 60.5–87.2, specificity 79.8%CI 76.1–83.7) or £13,945 per polyp. Conclusions FIT is a cheaper and effective alternative test with the potential to replace current expensive methods. The forecast is based on the limited data available for sensitivity/specificity in the current literature. FIT has now been commenced for symptomatic patients in the UK and therefore sensitivity may change in the future.

Clinicopathological Characteristics and Surgical Outcomes of Crohn Disease-Associated Colorectal Malignancy

Purpose: Carcinoma arising from Crohn disease (CD) is rare, and there is no clear guidance on how to properly screen for at-risk patients and choose appropriate care. This study aimed to evaluate the clinicopathological characteristics, treatment, and oncologic outcomes of CD patients diagnosed with colorectal cancer (CRC).Methods: Using medical records, we retrospectively enrolled a single-center cohort of 823 patients who underwent abdominal surgery for CD between January 2006 and December 2015. CD-associated CRC patients included those with adenocarcinoma, lymphoma, or neuroendocrine tumors of the colon and rectum.Results: Nineteen patients (2.3%) underwent abdominal surgery to treat CD-associated CRC. The mean duration of CD in the CD-associated CRC group was significantly longer than that in the benign CD group (124.7 ± 77.7 months vs. 68.9 ± 60.2 months, P = 0.006). The CD-associated CRC group included a higher proportion of patients with a history of perianal disease (73.7% vs. 50.2%, P = 0.035) and colonic location (47.4% vs. 6.5%, P = 0.001). Among 19 CD-associated CRC patients, 17 (89.5%) were diagnosed with adenocarcinoma, and of the 17 cases, 15 (88.2%) were rectal adenocarcinoma. On multivariable analyses for developing CRC, only colonic location was a risk factor (relative risk, 7.735; 95% confidence interval, 2.862–20.903; P = 0.001).Conclusion: Colorectal malignancy is rare among CD patients, even among patients who undergo abdominal surgery. Rectal adenocarcinoma accounted for most of the CRC, and colonic location was a risk factor for developing CRC.