The place and detection rates of colonoscopy within a faecal occult blood test-based screening program
Authors:
J. Špičák 1; P. Štirand 1; P. Drastich 1; M. Beneš 1; R. Bužga 2; T. Hucl 1; P. Wohl 1; J. Šperl 1; E. Honsová 1; R. Brůha 3; J. Hnuta 4; J. Jungwirt 5; J. Jungwirtová 5; J. Kotrlík 6; J. Koželuhová 7; M. Lukáš 3; V. Nosek 8; J. Petrtýl 3; D. Pulgretová 9; M. Řehoř 8; D. Šperl 10; P. Vyhnálek 11
Authors‘ workplace:
Klinika hepatogastroenterologie, IKEM, Praha
1; Interní oddělení, Vítkovická nemocnice, Ostrava
2; IV. interní klinika, VFN, Praha
3; Almeda, a. s., Městská nemocnice Neratovice
4; Fakultní nemocnice u sv. Anny, Praha
5; Gastroenterologické oddělení Městské nemocnice následné péče, Praha
6; I. interní klinika, FN Plzeň
7; Endoskopické oddělení Nemocnice Jablonec nad Nisou
8; Oblastní nemocnice v Příbrami
9; Interní oddělení Nemocnice Mariánské lázně
10; Interní oddělení Krajské nemocnice Pardubice
11
Published in:
Gastroent Hepatol 2010; 64(6): 4-9
Category:
Original Article
Overview
Background, aim of the Study: Colorectal cancer is one of the most common cancers whose incidence is most likely to be reduced by screening. The aim of this prospective multicentre study was to review the detection rates of colorectal cancer and polyps and to assess the efficacy of colonoscopy and a screening program. Results: A total of 3,827 consecutive colonoscopy procedures performed in 2005–2006 were assessed. Of these, 927 (24.2%) were scheduled on the basis of screening while 2,990 (75.8%) were based on the patient‘s complaints. The most common symptom was faecal blood (32.5%) followed by abdominal pain (27.5%). In symptom--related colonoscopy procedures, the caecum was reached in 87.4% of cases (terminal ileum, in 36.3%) while, in screening-based ones, in 88.6% of cases (terminal ileum, in 45.6%). Twenty-four percent of examinations were performed without premedication. The rates of reaching the caecum varied between 75% and 98% with individual endoscopists. A total of 2,614 polyps were found in 1,169 patients (30.6%). Advanced adenomas were detected in 259 patients (6.8%), and carcinomas in 146 (3.8%). Among the polyps, 1,620 (62%) were pedunculated ones. Of the 1,081 histologies, 580 (53.6%) revealed tubular adenomas. A total of 212 (81.9%) significant adenomas and 106 (72.6%) carcinomas were localized in the left-side colon. The detection rates of large polyps by the 10 most active endoscopists were in the range of 7 to 20%, with the detection rates of all polyps varying between 28 and 145% depending on the number of colonoscopy procedures. A total of 485 patients having colonoscopy reported a family history. Of these, colonoscopy was indicated as a diagnostic procedure in 257 whereas 228 (47.0%) were scheduled for colonoscopy within the screening program. In the group of patients with a family history, advanced adenoma was present in 25 (5.1%), and carcinoma in 7 (1.4%). Of these 32 patients, 17 (53%) were diagnosed as having advanced cancer by screening; their mean age was 47 years. The detection rates of cancer after positive and negative FOBTs were 8.1% and 2%, respectively; the rates with primary screening-based colonoscopy were 4.2%. Overall, screening detected 96 (37%) advanced adenomas and 52 (35.6%) carcinomas. Conclusion: The ratio of screening-based colonoscopy procedures to those scheduled based on symptoms is about 1 : 4. The guidelines recommending colonoscopy as a secondary screening procedure in patients with a positive FOBT are not strictly adhered to. The ratio of histologies to detected polyps is clearly inadequate. The low detection rates of screening in those with a family history can be explained by the patients‘ significantly younger age. These individuals apparently undergo screening earlier, being aware as they are of the potential risks. Screening was successful in detecting a greater numbers of major lesions compared with the number of screening procedures actually performed.
Key words:
colorectal cancer – screening – faecal occult blood test – colonoscopy – polyps
Sources
1. Regula J, Rupinski M, Kraszewska E et al. Colonoscopy in Colorectal-Cancer Screening for Detection of Advanced Neoplalsia. N Engl J Med 2006; 355(18): 1863–1872.
2. Maar C. Increasing Public Acceptance for CRC Screening through Public Relation Campaigns and Networking. Z Gastroenterol 2008; 465 (Suppl 1): S35–S36.
3. Zavoral M, Suchanek S, Zavada F et al. Colorectal cancer screening in Europe. World J Gastroenterol 2009; 15(47): 5907–5915.
4. Cohen LB, Aisenberg J. Sedation for Colonoscopy. V: Colonoscopy. Principles and Practice. Wiley-Blackwell 2009: 101–113.
5. Rex DK. Quality in colonoscopy: caecal intubation first, then what? Am J Gastroenterol 2006; 101: 732–734.
6. Xirasagar S, Hurley TG, Sros L et al. Quality and Safety of Screening Colonoscopies Performed by Primary Care Physicians with Standby Specialist Support. Med Care 2010; 48(8): 703–709.
7. Shah HA, Paszat LF, Saskin R et al. Factors Associated with Incomplete Colonoscopy: a Population-Based Study. Gasteroenterology 2007; 132(7): 2297–2303.
8. Heitman SJ, Ronksley PE, Hilsden RJ et al. Prevalence of Adenomas and Colorectal cancer in Average Risk Individuals: a systematic Review and Metaanalysis. Clin Gastroenterol Hepatol 2009; 7: 1272–1278.
9. Prajappati DN, Saeian K, Binion DG et al. Volume and Yield of Screening Colonoscopy at a Tertiary Medical Center after Change in Medicare Reimbursement. Am J Gastroenterol 2003; 98(1): 194–199.
10. Lieberman DA, de Garmo PL, Fleischer DE et al. Colonic neoplasia in patients with nonspecific GI symptoms. Gastrointest Endosc 2000; 51(6): 647–651.
11. Bond JH. Colon Polyps and Cancer. Endoscopy 2003; 35(1): 27–35.
12. Winawer S, Fletcher R, Rex D et al. Colorectal Cancer Screening and Surveillance: Clinical Guidelines and Rationale-Update Based on New Evidence. Gastroenterology 2003; 124(2): 544–560.
13. Johnson DA, Gurney MS, Volpe RJ et al. A Prospective Study of the Prevalence of Colonic Neoplasms in Asymptomatic Patiens with an Age-related Risk. Am J Gastroenterol 1990; 85(8): 969–974.
14. Mehran A, Jaffe P, Efron J et al. Screening Colonoscopy in the Asymptomatic 50-59 Year-old Population. Surg Endosc 2003; 17(12): 1974–1977.
15. Church J. Adenoma Detection Rate and the Quality of Colonoscopy: The Swoord has Two Edges. Dis Colon Rectum 2008; 51(5): 520–523.
16. Frič P, Zavoral M, Dvořáková H et al. An adapted program of colorectal cancer screening--7 years experience and cost-benefit analysis. Hepatogastroenterology 1994; 41(5): 413–416.
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