Colonoscopy For Colorectal Cancer Screening Research Articles

Gender, having a positive FIT and type of hospital are important factors for colonoscopy experience in colorectal cancer screening – findings from the SCREESCO study

Objectives Assessing the experience of screening procedures is crucial for improving the quality and acceptance of colonoscopy in colorectal cancer screening. The aim of the study was to investigate the colonoscopy experience and associated factors among individuals who underwent a colonoscopy in the Screening of Swedish Colons (SCREESCO) study. Methods Participants in the Screening of Swedish Colons (SCREESCO; n = 7593) randomized clinical trial (colonoscopy vs. faecal immunochemical test (FIT)) were enrolled. The primary outcome was overall colonoscopy experience measured with a study-specific questionnaire. Secondary endpoints were measured using multiple regression analyses with factors that included sex, randomization group, geographical regions, university hospital, complications, sedation, clean bowel, time to cecum, and presence of polyps or cancer. Results A total of 6572 (87%) individuals responded to the questionnaire. The majority was satisfied with the information, care and treatment. Women reported more worry, discomfort and pain, but also better information, care and treatment compared with men. The FIT group was more worried and perceived more discomfort and pain than the colonoscopy group. Type of hospital (geographical region; university hospital vs. not university hospital) was also a significant predictor for the colonoscopy experience. Conclusions Although most participants were satisfied with the colonoscopy experience, the study has highlighted areas for improvement. Important factors for colonoscopy experience were gender, randomization group, and type of hospital and therefore crucial to bear in mind when designing screening programs.

Patient Preferences in Surveillance: Findings From a Discrete Choice Experiment in the "My Follow-Up" Study.

Approximately 800 000 people die globally from colorectal cancer (CRC) every year. Prevention programs promote early detection, but for people with precancerous lesions, tailoring surveillance to include lifestyle-change programs could enhance prevention potential and improve outcomes. Those with intermediate or high-risk polyps removed during CRC screening colonoscopy within the Northern Ireland CRC Screening Programme were invited to complete 8 discrete choice questions about tailored surveillance, analyzed using random-parameters logit and a latent class modeling approach. A total of 231 participants (77% male) self-reported comorbid hypertension (53%), high cholesterol (48%), and mean body mass index of 28.7 (overweight). Although 39% of participants were unaware of their CRC risk status, 30.9% indicated they were already making changes to reduce their risk. Although all respondents were significantly risk- and cost-averse, the latent class analysis identified 3 segments (classes): 1. Class 1 (26.8%) significantly favored phone or email support for a lifestyle change, a 17-month testing interval, and noninvasive testing. 2. Class 2 (48.4%) preferred the status quo. 3. Class 3 (24.7%) significantly favored further risk reduction and invasive testing. This is the first documented preference study focusing on postpolypectomy surveillance offering lifestyle interventions. Although current care is strongly preferred, risk and cost aversion are important for participants. Latent class analysis shows that some respondents are willing to change diet and lifestyle behaviors, reflecting a teachable moment, with opportunities to personalize and optimize surveillance. Significant discordance between perceived and known risk of recurrence and limited recall of risk information provided within current practice suggest necessary improvements to surveillance programs.

Impact of COVID-19 Pandemic on Colorectal Cancer Screening Program

IntroductionOne of the main clusters of coronavirus disease-2019 (COVID-19) has been identified in Italy. Following European and local guidelines, Italian endoscopy units modulated their activity. We aimed at analyzing the need and safety to continue selective colorectal cancer screening (CRCS) colonoscopies during the COVID-19 pandemic. Patients and MethodsWe carried out a retrospective controlled cohort study in our “COVID-free” hospital to compare data of the CRCS colonoscopies of the lockdown period (March 9 to May 4, 2020) with those of the same period of 2019 (control group). A pre/post endoscopic sanitary surveillance for COVID-19 infection was organized for patients and sanitary staff. ResultsIn the lockdown group, 60 of 137 invited patients underwent endoscopy, whereas in the control group, 238 CRCS colonoscopies (3.9-fold) were performed. In the lower number of examinations during the lockdown, we found more colorectal cancers (5 cases; 8% vs. 3 cases; 1%; P = .002). The “high-risk” adenomas detection rate was also significantly higher in the “lockdown group” than in controls (47% vs. 25%; P = .001). A multiple regression analysis selected relevant symptoms (hazard ratio [HR], 3.1), familiarity (HR, 1.99), and lockdown period (HR, 2.2) as independent predictors of high-risk lesions (high-risk adenomas and colorectal cancer). No COVID-19 infections were reported among staff and patients. ConclusionsThe overall adherence to CRCS decreased during the pandemic, but the continuation of CRCS colonoscopies was efficacious and safe.

Importance of Screening Colonoscopy for Colorectal Cancer among Inflammatory Bowel Disease Patients in Qatar

Since 1920, inflammatory bowel disease (IBD) has been linked to increased incidence and mortality from colorectal adenocarcinoma (CRC). Several studies have found that screening colonoscopy reduced CRC mortality and improved survival in IBD patients. However, there are little or no data about the prevalence of CRC/Dysplasia in Qatar detected by screening colonoscopy and weather the Qatar gastroenterologists adhere to the international guidelines. Thus, the focus of the present study was to examine the rate of CRC and dysplasia in IBD patients who underwent a screening colonoscopy. The sample consisted of 153 patients who were diagnosed and treated for IBD. The results of the study showed high incidence rate of CRC/Dysplasia among IBD patients and it was also found that the gastroenterologists in Qatar did not strictly adhere to the international guidelines in relation to the time of first screening colonoscopy of IBD patients.

A diffuse large B-cell lymphoma detected during colorectal cancer screening colonoscopy

A diffuse large B-cell lymphoma detected during colorectal cancer screening colonoscopy

Perceived Deterrence Towards Colonoscopy for Colorectal Cancer Screening among Northern Malaysia Population: A Qualitative Study

Background:Patients with positive immunochemical faecal occult blood test results were found to have poor compliance for a subsequent colonoscopy procedure. This study was conducted to explore patients’ perceived deterrence for colonoscopy following a positive stool test. Methods:Using qualitative study method, a phone interview was conducted with 16 patients to elicit their views on the reasons for failure to attend the colonoscopy procedure following a positive stool test. The interviews were audio recorded, transcribed verbatim and translated before proceeded with the data analysis. Content analysis was made on the translated interview, followed by systematic classification of data by major themes. Results:Reasons for nonattendance were categorized under five main themes; unnecessary test, fear of the procedure, logistic obstacles (subthemes; time constraint, transportation problem), social influences, and having other health priority. Lacking in information about the procedure during the referral process was identified to cause misperception and unnecessary worry towards colonoscopy. Fear of the procedure was commonly cited by female respondents while logistic issues pertaining to time constraint were raised by working respondents. Conclusions:More effective communication between patients and health care providers are warranted to avoid misconception regarding colonoscopy procedure. Support from primary care doctors, customer-friendly appointment system, use of educational aids and better involvement from family members were among the strategies to increase colonoscopy compliance.

Factors to Improve Endoscopic Screening for Colorectal Cancer.

Colorectal cancer is one of the most sprayed cancers; the gold standard of diagnostic is a colonoscopy. The quality of this examination is depended on many factors, which includes doctors' experience. The purpose of this study is to establish the main factors affecting the completeness of colonoscopy in colorectal cancer screening. Endoscopists were questioned; descriptive statistics methods and logistic regression were used. The main factors that influence the quality of screening colonoscopy were identified: experience in colonoscopy, theoretical training, participation in the screening program, and number of annual colonoscopies. The calculated odds ratio for the selected dependent variable is calculated. The experience for more than 5years (p = 0.017) and at least 200 colonoscopies per year (p = 0.004) are the main factors that allow to perform complete colonoscopy in 90% or more of cases.

The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention.

Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection. This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9−3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.

Comparative Evaluation of Participation and Diagnostic Yield of Colonoscopy vs Fecal Immunochemical Test vs Risk-Adapted Screening in Colorectal Cancer Screening: Interim Analysis of a Multicenter Randomized Controlled Trial (TARGET-C).

In colorectal cancer screening, implementing risk-adapted screening might be more effective than traditional screening strategies. We aimed to compare the effectiveness of a risk-adapted screening strategy with colonoscopy and fecal immunochemical test (FIT) in colorectal cancer screening. A randomized controlled trial was conducted in 6 centers in China since May 2018. Nineteen thousand five hundred forty-six eligible participants aged 50-74 years were recruited and randomly allocated into 1 of the 3 screening groups in a 1:2:2 ratio: (i) one-time colonoscopy (n = 3,916), (ii) annual FIT (n = 7,854), and (iii) annual risk-adapted screening (n = 7,776). Based on the risk-stratification score, high-risk subjects were referred for colonoscopy and low-risk ones were referred for FIT. All subjects with positive FIT were referred for diagnostic colonoscopy. The detection rate of advanced neoplasm was the primary outcome. The study is registered with the China Clinical Trial Registry (www.chictr.org.cn Identifier: ChiCTR1800015506). For baseline screening, the participation rates of the colonoscopy, FIT, and risk-adapted screening groups were 42.5% (1,665/3,916), 94.0% (7,386/7,854), and 85.2% (6,628/7,776), respectively. For the intention-to-screen analysis, the detection rates of advanced neoplasm were 2.40% (94/3,916), 1.13% (89/7,854), and 1.66% (129/7,776), with odds ratios (95% confidence intervals) of 2.16 (1.61-2.90; P < 0.001) for colonoscopy vs FIT, 1.45 (1.10-1.90; P < 0.001) for colonoscopy vs risk-adapted screening, and 1.49 (1.13-1.97; P < 0.001) for risk-adapted screening vs FIT, respectively. The numbers of subjects who required a colonoscopic examination to detect 1 advanced neoplasm were 18 in the colonoscopy group, 10 in the FIT group, and 11 in the risk-adapted screening group. For baseline screening, the risk-adapted screening approach showed a high participation rate, and its diagnostic yield was superior to that of FIT at a similarly low load of colonoscopy.

Smartphone Application to Reinforce Education Increases High-Quality Preparation for Colorectal Cancer Screening Colonoscopies in a Randomized Trial

Sufficient bowel preparation is crucial for successful screening and surveillance colonoscopy. However, rates of inadequate preparation are still high. We investigated the effects of reinforced patient education using a smartphone application software (APP) for colonoscopy preparation in participants in a CRC screening program. We performed a prospective, endoscopist-blinded study of 500 patients undergoing split-dose bowel preparation for CRC screening or surveillance colonoscopies at multiple centers in Germany, from November 2017 through January 2019. Participants (n = 500) were given oral and written instructions during their initial appointment and then randomly assigned (1:1) to groups that received reinforced education starting 3 days before the colonoscopy (APP group) or no further education (controls). The primary outcome was quality of bowel preparation according to the Boston bowel preparation scale. Secondary outcomes included polyp and adenoma detection rates, compliance with low-fiber diet, split-dose laxative intake, perceived discomfort from the preparation procedure. The mean Boston bowel preparation scale score was significantly higher in the APP-group (7.6 ± 0.1) than in the control group (6.7 ± 0.1) (P < .0001). The percentage of patients with insufficient bowel preparation was significantly lower in the APP group (8%) than in the control group (17%) (P = .0023). The adenoma detection rate was significantly higher in the APP group (35% vs 27% in controls) (P= .0324). Use of the APP was accompanied by a lower level of non-compliance with correct laxative intake (P=.0080) and diet instructions (P=.0089). The APP group reported a lower level of discomfort during preparation (P < .0001). In a randomized trial, reinforcing patient education with a smartphone application optimized bowel preparation in the 3 days before colonoscopy, increasing bowel cleanliness, adenoma detection, and compliance in patients undergoing CRC screening or surveillance. ClinicalTrials.gov no: NCT03290157.

Two Low Volume Regimens for Colorectal Cancer Screening Colonoscopy

Two Low Volume Regimens for Colorectal Cancer Screening Colonoscopy

Performance of Initial Screening Tests for Colorectal Cancer and Subsequent Adherence to Colonoscopy: An Ecological Study

Background: Adherence to colonoscopy in colorectal cancer (CRC) screening is at a low level and varies greatly across populations. No study has examined the influencing factors of colonoscopy adherence at a population level, and this remains to be an unaddressed knowledge gap. We therefore aimed to analyze the correlation between performance of initial CRC screening tests and subsequent adherence to colonoscopy base on an ecological evaluation. Methods: The sensitivity, specificity, and positive predictive value (PPV) of initial CRC screening tests and subsequent adherence to colonoscopy in different populations were extracted from relevant studies published in English up to December 31, 2018. The age-standardized incidences (ASR) of CRC across populations in the year of screening were obtained from the Cancer Statistics data. Locally weighted regression smoothing was used to examine the relationship between adherence to colonoscopy and ASR of CRC. Cut-off points of adherence on ASR were identified by Joinpoint Regression and used in Regression Discontinuity as potential thresholds. Spearman’s correlation analysis was used to calculate correlation coefficients. Findings: We identified 192 eligible articles. The median and interquartile range of adherence to colonoscopy was 82·5% (71·8%-90·5%). The adherence was significantly correlated with ASR of CRC in the study populations (r=0·187, p<0·001) and marginally with the PPV of initial screening tests (r=0·105, p=0·077). The change points of the adherence to colonoscopy were identified at the ASR of 32·5 and 142·5/100,000, and the ratio of adherence to colonoscopy at 143/100,000 was 0·900. In countries / areas with a moderate ASR, adherence to colonoscopy was negatively correlated with the sensitivity (r=-0·367, p=0·023) and positively with the PPV (r=0·143, p=0·040), whereas in populations with a high ASR, flexible sigmoidoscopy was more widely used as an initial screening test and achieved a high subsequent adherence to colonoscopy. Interpretation: Adherence to colonoscopy is correlated with the performance of initial screening tests, particularly among populations with moderate CRC incidence. Initial screening tests with high PPV or specificity may help to increase population adherence to colonoscopy, but different strategies should be used in countries / areas with a high or moderate incidence of CRC. Funding Statement: This study was supported by the Local High Level University Construction Project of Shanghai and the Health Commission of the Pudong New Area of Shanghai (PW2019A-5). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Not required.

Issue Highlights

Issue Highlights

Aiming at more efficient utilization of colonoscopy for colorectal cancer screening in Japan

Aiming at more efficient utilization of colonoscopy for colorectal cancer screening in Japan

Safety of propofol sedation administered by an endoscopy team for outpatient colonoscopy.

Sedation during colonoscopy increases comfort and reduces unexpected patient movement. Colorectal cancer (CRC) screening colonoscopies performed under propofol sedation controlled by our endoscopy team (ET) were retrospectively studied for eight months.

Alarming endoscopic data in young and older asymptomatic people: Results of an open access, unlimited age colonoscopic screening for colorectal cancer.

There is a lack of a national organized screening program for colorectal cancer in Greece, and asymptomatic detection is usually the result of individual decisions. The collection of epidemiologic endoscopic data from a population of interest would therefore provide valuable information for future treatment guidance, especially during periods of economic austerity. The current cross-sectional study included 380 asymptomatic, average risk individuals undergoing screening colonoscopy for the first time, during the period of one year in a tertiary public hospital in Athens. Descriptive and analytic epidemiologic data were analyzed. The prevalence of adenomas and advanced lesions were compared between the younger and older cohort, and a regression model was applied for risk evaluation. The mean age of participants was 63 years, and 53% were male. A significant proportion of patients presented with polyps (51.5%) and 25% of them had lesions in the proximal colon. The prevalence of adenomas and advanced adenomas was 29.5 and 11.8%, respectively. Similar high prevalence rates of lesions were identified in the cohort of individuals <50 years of age and the older cohort (>50 years of age). Regression models identified age, number and size of polyps as the major risk factors for the detection of adenomas. The increase of advanced lesions in the older and younger cohort requires confirmation by larger studies. Overall, the results of the present study indicate the requirement for a well-organized screening colonoscopy program starting from as early as 40 years of age. This program may confer an additional endoscopic burden with socioeconomic consequences in a country with limited health resources.

Efficacy and cost-effectiveness of fecal immunochemical test versus colonoscopy in colorectal cancer screening: a systematic review and meta-analysis

The fecal immunochemical test (FIT) and colonoscopy are the most commonly used strategies for colorectal cancer (CRC) screening worldwide. We aimed to compare their efficacy and cost-effectiveness in CRC screening in an average-risk population. PubMed, Embase, and National Health Services Economic Evaluation Database were searched. Risk ratio (RR) was used to evaluate the differences in detection rates of colorectal neoplasia between FIT and colonoscopy groups. A random-effects model was used to pool RRs. Incremental cost-effectiveness ratios (ICERs) were calculated to evaluate the cost-effectiveness of FIT versus colonoscopy. Six randomized controlled trials and 17 cost-effectiveness studies were included. The participation rate in the FIT group was higher than that in the colonoscopy group (41.6% vs 21.9%). In the intention-to-treat analysis, FIT had a detection rate of CRC comparable with colonoscopy (RR, .73; 95% confidence interval, .37-1.42) and lower detection rates of any adenoma and advanced adenoma than 1-time colonoscopy. Most included cost-effectiveness studies showed that annual (13/15) or biennial (5/6) FIT was cost-saving (ICER< $0) or very cost-effective ($0< ICER≤ $25000/quality-adjusted life-year) compared with colonoscopy every 10 years. FIT may be similar to 1-time colonoscopy in the detection rate of CRC, although it has lower detection rates of any adenoma and advanced adenoma than 1-time colonoscopy. Furthermore, annual or biennial FIT appears to be very cost-effective or cost-saving compared with colonoscopy every 10 years. These findings indicate, at least partly, that FIT is noninferior to colonoscopy in CRC screening in an average-risk population. Our findings should be treated with caution and need to be further confirmed.

Promoting colonoscopy screening among low-income Latinos at average risk of colorectal cancer: A randomized clinical trial.

Screening colonoscopy (SC) for colorectal cancer (CRC) is underused by Latino individuals. The current randomized clinical trial examined the impact of 3 interventions: 1) patient navigation; 2) patient navigation plus standard Centers for Disease Control and Prevention print materials; and 3) patient navigation plus culturally targeted print materials for Latinos referred for SC. Demographic, personal and health history, and psychometric factors associated with SC also were examined. A total of 344 urban Latino individuals aged 50 to 85years with no personal and/or immediate family history of CRC diagnosed before age 60years, no personal history of a gastrointestinal disorder, no colonoscopy within the past 5years, with insurance coverage, and with a referral for SC were consented. Participants were randomized to patient navigation (20%), patient navigation plus standard Centers for Disease Control and Prevention print materials (40%), and patient navigation plus culturally targeted print materials (40%). The completion of SC was assessed at 12months. The interventions had an overall SC rate of 82%. Counterintuitively, patients with an average income of <$10,000 were found to have higher SC rates (87%) than those with a greater income (75%). The addition of standard or culturally targeted print materials did not appear to increase SC rates above those for patient navigation. Indeed, after controlling for other variables, culturally targeted print materials were found to be associated with lower SC rates among Puerto Rican individuals.

Select group of patients might benefit from early colonoscopic screening for colorectal cancer.

Recently, the American Cancer Society made a qualified recommendation to start colorectal cancer (CRC) screening at 45years of age in all average-risk individuals. In this study, our primary aim is to calculate the prevalence and also evaluate the predictors of increased prevalence of detected adenomas in the 40-49-year-old individuals undergoing colonoscopy. A retrospective cross-sectional study was performed using our endoscopy database. Study subjects included all 40-49-year-old patients undergoing their first colonoscopy at our institution from January 1, 2010 to September 30, 2017. Exclusion criteria included patients who underwent colonoscopy for overt gastrointestinal bleeding, inflammatory bowel disease, a history of familial adenomatous polyposis, hereditary non-polyposis CRC. Univariate analysis and multivariate analysis were performed to identify factors associated with increased adenoma detection rate (ADR). A total of 2059 patients were included in the study, and 317 of these patients had family history (FH) of CRC. Patients with FH of CRC had significantly higher ADR (27.8% vs. 19.7%, p = 0.001) as compared to those without FH of CRC. There was no significant difference in ADR in patients between 40-44 years and 45-49 years of age (17.7% vs. 21.4%, p = 0.058). On a multivariate analysis while adjusting for multiple patient and procedural variables, FH of CRC, male sex, BMI > 30kg/m2, chronic kidney disease, and age were associated with high ADR. Our study shows that in addition to FH of CRC, age, male sex, BMI, and CKD are independent predictors of increased ADR in patients between 40 and 49years of age.

2844 Does Access Matter? A Retrospective Analysis of Patients Undergoing Colonoscopy for Colorectal Cancer Screening Based on Health Insurance

INTRODUCTION: Implementation of the Affordable Care Act (ACA) in 2010 has expanded access to health care for millions of Americans. Although there were few large registry based studies that showed a positive impact of ACA on colorectal cancer screening and early cancer detection there are no published studies from community practice setting. The aim of this retrospective study in a single provider gastroenterology community practice is to study the ultilization of colonoscopy for colorectal cancer screening among patients with health exchange plans. METHODS: This is a retrospective study from a single provider gastroenterology community practice. All the patients who had colonoscopy for colon cancer screening between January 1st 2018 and December 31, 2018 were extracted from the database. Colorectal polyp rates based on health insurance plan (health exchange AC insurance/commercial insurance/Medicare and Tricare) were studied. RESULTS: A total of 746 (Male 310, Female 436) patient records who had a colonoscopy for screening were reviewed. Median age was 59 years. 54% (400/746) of them had Affordable Care Insurance. 59% (437/746) were found to have polyps. Among those with colon polyps 49% (214/437) had Affordable Care Insurance, 28% had commercial insurance and 22% had Medicare and Tricare. 54% (214/400; median age 59) of patients with health exchange plans, 73% (98/135; median age 69) of patients with medicare/tricare, 59% (120/202; median age 57) of patients with commercial insurance plans had colon polyps. CONCLUSION: About half of the patient cohort with colorectal polyps relied on Affordable Care Insurance to receive colorectal cancer screening. About 74% of patients with colorectal polyps were under the age of 65. As expected patients with medicare plan had high rates of colorectal polyps (73%) compared to commercial and health exchange insurance plans. If access to preventive care via ACA is not available a significant proportion of patients with colorectal polyps would have not had their screening. If they were to wait untill they are eligible for medicare to get their colonoscopy for screening a significant proportion of these patients would develop advanced adenomas or cancer. So it is important to have access to preventive health via ACA. This issue is particularly more important now with attention being brought to the ACA and the possibility of it being repealed.