P2165 - Colorectal Cancer Screening in a Patient With Cystic Fibrosis Status-Post Lung Transplant

Ishaan Madhok, MD¹, Baharak Moshiree, MD^2
1Atrium Health, Charlotte, NC; ²Advocate Health Wake Forest Medical University, Charlotte, NC

Introduction: Cystic fibrosis (CF) is an autosomal recessive disorder that has manifestations of the GI tract in addition to its pulmonary complications. Recent advances in research and management such as CFTR modulator therapies have increased the life spans and quality of life of patients with cystic fibrosis. Patients with CF have higher rates of GI malignancies, with colorectal cancer being reported to be 6 times higher than the average population. The CF Foundation published the first and only colon cancer screening guidelines in 2018, so there is a relative paucity of data regarding optimal cancer screening recommendations in this population. This is a case of patient with CF seen in our clinic for his history of adenomas.

Case Description/Methods: A 65 year old male with a CF who underwent lung and pancreas transplants at age 45 presented to discuss colonoscopy for adenoma surveillance. He had his first colonoscopy at age 51, which showed a small tubular adenoma in the terminal ileum and suboptimal prep. He underwent a repeat colonoscopy after 4 years where again he had poor prep. His next colonoscopy was 5 years later where he was noted to have adequate colon prep and a small tubular adenoma was removed. The terminal ileum was not examined on either of these exams. The patient denied any significant changes in bowel habits or concerning symptoms. We elected to proceed with colonoscopy with an extended bowel prep. This revealed a large partially obstructing mass in the terminal ileum, multiple carpet like cecal polyps removed piecemeal, and other polyps that were unable to be removed due to time constraints. Biopsies of the mass showed a tubulovillous adenoma and the cecal polyps were tubular adenomas and a tubulovillous adenoma with focal high grade dysplasia. CT scan showed defect from the mass in the terminal ileum and no evidence of cancer. Repeat colonoscopy was performed to remove remaining adenomas, and referral was placed to surgery. Right hemicolectomy was performed where the distal terminal ileum mass proved to be a 3.5 cm tubulovillous adenoma. The patient recovered well.

Discussion: Colonoscopies can be challenging in the CF population due to comorbidities and intense bowel prep required. There is also lack of data for stool based testing in this population. Our patient did have a positive FIT and Cologuard tests prior to colonoscopy. Effort should be made to intubate the terminal ileum, and EGD should be considered given increased rates of small bowel cancer in CF patients.


Disclosures:


Ishaan Madhok, MD¹, Baharak Moshiree, MD². P2165 - Colorectal Cancer Screening in a Patient With Cystic Fibrosis Status-Post Lung Transplant, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.