Quality Indicators for Colonoscopy and the Risk of Interval Cancer

Department of Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
New England Journal of Medicine (Impact Factor: 55.87). 05/2010; 362(19):1795-803. DOI: 10.1056/NEJMoa0907667
Source: PubMed


Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain.
We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer.
A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons).
The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy.

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Available from: Joanna Didkowska, May 27, 2014
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    • "In contrast, Yamano et al. (2010) reported a significantly faster cecal intubation time and a trend toward a shorter examination time in 66 patients undergoing colonoscopy with carbon dioxide insufflation. The high rate of cecal intubation in our study is consistent with data published by Kaminski et al. (2010), who reported a median cecal intubation rate of 95% (interquartile range 92–98%) for most experienced endoscopists with at least 20% adenoma detection rate. "
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    ABSTRACT: One of the methods used to reduce pain and discomfort during colonoscopy is insufflation of carbon dioxide instead of air. However, the actual benefit of carbon dioxide insufflation is not unequivocally proven. The aim of the study was to evaluate the advantages of carbon dioxide insufflation during screening colonoscopy. A total of 200 patients undergoing screening colonoscopy between 2010 and 2011 were included in the prospective, randomized study carried out in a surgical referral center. Screening unsedated colonoscopy with either air or carbon dioxide insufflation was performed; patients were randomly assigned to air or carbon dioxide group by means of computer-generated randomization lists. All examinations were performed in an ambulatory setting with standard videocolonoscopes. The main outcomes analyzed were (a) duration of the entire procedure, (b) cecal intubation time, and (c) pain severity immediately, 15, and 60 min after the procedure. Group I included 59 women and 41 men and group II included 51 women and 49 men. The duration of the procedure was circa 10 min in both groups. Pain score values immediately and 15 min after the procedure were similar in both groups (P=0.624 and 0.305, respectively). A lower pain score was observed only after 60 min in patients insufflated with carbon dioxide (1.28 vs. 1.54, P=0.008). No pain reduction was observed in women and in obese patients (BMI>30). Carbon dioxide insufflation during unsedated screening colonoscopy does not decrease the duration of the procedure and appears to reduce pain intensity at 60 min after examination to an extent without clinical significance. The study was registered at ClinicalTrials.gov, number NCT01461564.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 06/2014; 24(1). DOI:10.1097/CEJ.0000000000000047 · 3.03 Impact Factor
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    • "A study with 23-year follow-up found an ~53% mortality reduction in patients undergoing CS; a similar rate was found at 10 years in patients with and without adenomatous lesions (Zauber et al., 2012). CS requires specialized personnel: poor operator skill, partial examination, poor patient preparation and inadequate sedation are the main causes of failure and false negatives (Kaminski et al., 2010); successful examination with concomitant lesion removal reduces the risk of same-site recurrence (Brenner et al., 2013). CS screening is usually offered at 10-year intervals to individuals aged ≥50. "
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    ABSTRACT: Colorectal cancer is a major public health challenge worldwide. In Europe it is the first malignancy in terms of incidence and the second in terms of mortality in both genders. Despite evidence indicating that removal of premalignant and early-stage cancer lesion scan greatly reduce mortality, remarkable differences are still found among countries both in terms of organized screening programs and of the tests used. In 2003 the European Council recommended that priority be given to activation of organized cancer screening programs, and various States have been making significant efforts to adopt effective prevention programs with international quality standards and centralizing screening organization and result evaluation. After a 2008 EU report on the state of screening program activation highlighted that little more than 50% (12/22) of Member States had colorectal cancer screening programs, screening programs have been adopted or earlier pilot projects have been extended nationwide. This paper examines the state of activation and the screening strategies of colorectal cancer screening programs in EU States as of July 2013.
    Preventive Medicine 05/2014; 62. DOI:10.1016/j.ypmed.2014.02.010 · 3.09 Impact Factor
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    • "These cut-offs might be an underestimation of the true prevalence of adenomas in the population. A large cohort study found that as the ADR increased, the rate of interval adenocarcinomas detected between a screening colonoscopy and the next scheduled surveillance colonoscopy decreased.[14] Furthermore, a retrospective chart review from Mayo Clinic, Arizona, found that the ADR reached up to 42% for some gastroenterologists.[15] "
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    ABSTRACT: Background/Aims: Colorectal cancer (CRC) is the second most common malignancy in the Saudi population, with an increasing incidence over the past 20 years. We aim to determine the baseline polyp as well as adenoma prevalence in a large cohort of patients and to find the possible age in which, if deemed appropriate, a CRC screening program should be initiated. Patients and Methods: A retrospective cohort study was conducted using an endoscopic reporting database of individuals seen at a major tertiary care university hospital (King Khalid University Hospital) in Riyadh, Saudi Arabia. Consecutive Saudi patients who underwent a colonoscopy between August 2007 and April 2012 were included. Patients were excluded if the indication for the colonoscopy was colon cancer, colonic resection, active colitis, active diverticulitis, inflammatory bowel disease, or if the patient was referred for polypectomy. Results: 2654 colonoscopies were included in the study. The mean age of the study population was 50.5 years [standard deviation (SD) 15.9] and females represented 57.7%. The polyp detection rate in completed colonoscopies was 20.8% (95% CI: 19.2-22.5). Adenomas were found in 8.1% (95% CI: 7.1-9.1), while advanced adenomas were found in only 0.5% (95% CI: 0.2-0.7). Adenomas were found in the left side of the colon in 33.9%, followed by the rectum in 14.6%, ascending colon and cecum in 14.2%, transverse colon in 8.7%, and in multiple locations in 28.7%. Those with a prior history of polyps or CRC were more likely to have an adenoma at colonoscopy than those who did not (14.3% vs. 6.6%; P < 0.01). The adenoma prevalence varied between age groups and ranged from 6.2% to 13.6% with a higher proportion in older individuals; this trend was seen both in males (6.0-14.5%) and females (6.4-14.6%) as well as in those who had screening colonoscopies (6.3-18.4%). No age could be found at which a CRC screening program would be appropriate to initiate. Conclusion: The prevalence of polyps and adenomas in this cohort is less than that reported in the Western populations. But as this cohort included younger and symptomatic patients with only a small proportion undergoing screening, further studies in an asymptomatic population are needed.
    Saudi Journal of Gastroenterology 05/2014; 20(3):154-61. DOI:10.4103/1319-3767.132986 · 1.12 Impact Factor
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