SSAT - THE QUALITY OF DENTATE LINE EVALUATION DURING ROUTINE SCREENING AND SURVEILLANCE COLONOSCPIES IN PATIENTS WITH ANAL CANCER

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THE QUALITY OF DENTATE LINE EVALUATION DURING ROUTINE SCREENING AND SURVEILLANCE COLONOSCPIES IN PATIENTS WITH ANAL CANCER
Sareena Ali^*¹, Madeline Sesselmann¹, Yannis S. Lafazanos¹, Augusta C. Okolo¹, Thomas A. Wichelmann², Eli D. Ehrenpreis¹
¹Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL; ²Henry Ford Providence Southfield, Southfield, MI

Introduction
10,540 new cases of anal cancer are expected in the United States, accounting for 2% of gastrointestinal malignancies. Anal cancer slowly progresses from anal intraepithelial neoplasia (AIN) and some at-risk populations undergo screening. Since retroflexion during colonoscopy is an opportunity to examine for anal lesions, colonoscopy may represent an opportunity to screen for anal cancer. This study evaluated the quality of retroflexed views of the dentate line during colonoscopy in a group of patients with anal cancer.

Methods
Our group performed a retrospective analysis of the Advocate Aurora Health System electronic medical records (EMR) to identify patients from 2012 to 2022 with a diagnosis of anal cancer, using the ICD code "anal cancer." Demographic data included age and gender, presentation at the time of diagnosis (i.e. bleeding), and if a prior colonoscopy was conducted within 4 years of diagnosis. Patients with colonoscopies within 4 years before diagnosis, and any additional colonoscopies after anal cancer diagnosis were analyzed. Performance of retroflexion, as documented in the report, and retroflexion images were collected. A grading system based on visualization of the dentate line was developed (full view as 2 points, partial view as 1 point, no view as 0 points), and images were analyzed by a board-certified gastroenterologist.

Results
A total of 357 cases of anal cancer were identified. 117 of 357 (33%) of patients had a colonoscopy performed within 4 years of diagnosis. Retroflexion was documented in the report of 55 cases (47%). Retroflexion was documented with images in 39 of 117 colonoscopies (33%). Of these, 7 (18%) had a full view of the dentate line, 21 (54%) had a partial view, and 11 (28%) had no view (Figures 1 and 2).

Discussion
Full visualization of the dentate line during colonoscopy appears to be a missed opportunity to screen for anal cancer. Emphasis on proper technique for fully visualizing the dentate line is recommended.

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