Implementing Screening Colonoscopy at a VAMC. A 1 Year Experience

Abstract

Purpose: Implementing colonoscopy for CRC screening may be challenging when the demand exceeds the supply creating significant backlogs that may be perceived as detrimental. Aim: (1) To report the results of a rapid and progressive implementation of screening colonoscopy at a VAMC. (2) To determine whether a delay in performing the procedure, negatively influences the findings at colonoscopy Methods: Endoscopic, medical and pathology records of patients undergoing screening colonoscopy (1/04–12/04). Demographics, presence/absence of polyps, size and location were noted. Cecal intubation rate was calculated. Proximal location = proximal to splenic flexure. Advanced neoplasia = adenoma ≥ 10 mm, villous component, HGD, or invasive carcinoma. The delay between the date of performance and date of request was calculated. Results: Of 2617 colonoscopies, 915 were for CRC screening; mean age: 61 yrs. The screening colonoscopy: flexible sigmoidoscopy ratio was 74%: 26% during the 1st QTR and 98%: 2% during the 4th QTR. The overall waiting time for colonoscopy was 141 days. By the 4th QTR, the time delay (169.1 ± 7.3 days) was significantly longer than the 1st QTR (135.6 ± 3.6 days) (p < 0.05). The cecal intubation rate was 97.4%. The no show up rate for outpatiens colonoscopy was 8%. There was 1 post-polypectomy bleeding. 643 patients (71%) had no adenomas/advanced neoplasia; 9 had: leiomyomas (3), carcinoids (2), lipoma, lipogranuloma, ganglioneuroma and juvenile polyps, 1 each. 212 (23.2%) had adenomas < 10 mm and 51 (5.6%) advanced neoplasias Of the 6 advanced neoplasias found proximally only, 4 were adenomas ≥ 10 mm and 2 villous adenomas. During the 1st QTR, 29.9% of colonoscopies yielded adenomas and advanced neoplasia whereas in the 4th QTR, the yield was 20.7% (p = 0.03). For advanced neoplasia only however, the yield was 6.6% and 5.5%, respectively (NS) Conclusions: Implementation of a screening colonoscopy program at a VAMC is challenging and is associated with time delays due to a progressive backlog The prevalence of adenoma and advanced neoplasia was 28.7% Proximal adenomas and advanced neoplasia without any other adenoma(s) distally were found in 24.7% Proximal advanced neoplasia was found in 11.8% (0.7% of total number of screening colonoscopies) The time delay did not negatively affect the yield for advanced neoplasiaTable: Location Distribution of Adenomas < 10 mm and Advanced Neoplasias