S667 Low Rates of Colonoscopy Follow-Up After Positive Non-Invasive Stool Tests at a Tertiary Care Hospital

Introduction: Timely follow-up colonoscopy after a positive noninvasive stool-based screening test is critical to the effectiveness of colorectal cancer screening, as it enables early detection and intervention. This study aimed to evaluate the rates of follow-up colonoscopy within 180 days of a positive stool test and to characterize the demographic profiles of patients who did and did not complete the follow-up procedure. Methods: This descriptive study was conducted at the Cleveland Clinic and included patients aged 45 to 75 with a positive noninvasive stool-based screening test between August 1, 2023, and August 1, 2024. The tests evaluated were the guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and multi-target stool DNA (mt-sDNA). We assessed whether patients completed a follow-up colonoscopy within 180 days of the positive result and analyzed demographic differences between those who did and did not complete the procedure. Outcomes were reported as percentages, with a P-value < 0.05 considered statistically significant. Results: Of the 4,346 patients with a positive stool-based screening test, 1,642 were excluded due to insufficient follow-up time (<180 days remaining in the study period). The final analysis included 2,704 patients. Among these, only 1,378 (50.96%) underwent a follow-up colonoscopy within 180 days of the positive test. For those who completed the colonoscopy, the mean time to the procedure was 54.32 ± 38.76 days. mt-sDNA was the most used test (85.8%). Patients who completed colonoscopy within 180 days were more likely to be female, non-Hispanic, have undergone mt-sDNA or FIT rather than gFOBT, and have private insurance. Conclusion: Our results show that colonoscopy completion following a positive noninvasive stool test is only 50%, well below the 80% benchmark recommended by the US Multi-Society Task Force. Significant disparities were observed by sex, ethnicity, stool-based test type, and insurance status. Comprehensive, multi-level interventions are needed to address barriers at the patient, provider, and institutional levels.