Incidence Of Colonoscopy Research Articles

Optimal Noninvasive Colon Cancer Screening Modality in Patients Not Receiving Colonoscopy

Colon cancer is the third most common among cancer deaths in the US for both men and women. The incidence of colonoscopy has been soaring in younger patients, which led to changes in recent United States Preventive Services Task Force (USPSTF) guidelines to reduce the age for screening from 50 years to 45 years. Demand for colonoscopy services is surging due to increased incidences of colorectal cancer (CRC) in the both aging and younger population. Increased referrals have led to an insufficient workforce in hospitals and long waiting lists. Further, results from colonoscopy reveal a low percentage of CRC or another severe bowel disease (SBD). Therefore, colon cancer screening is a growing concern, particularly in patients who otherwise have a very long-life expectancy, and who are most likely to benefit from screening. Another reason to boost CRC screening is to minimize the load on hospitals by reducing the patients that undergo colonoscopy unnecessarily because only a low percentage of CRC occurrence is observed in individuals undergoing colonoscopy. In recent years, there are a variety of screening options available for CRC. Noninvasive alternatives include fecal immunochemical test (FIT), multitarget stool DNA testing (MT-sDNA, available under the brand name Cologuard), computed tomography (CT) colonography (previously called virtual colonoscopy), guaiac-based fecal occult blood testing (gFOBT), and capsule colonoscopy (CC). These tests have varied the degree of evidence supporting their use. This study focuses on the most recent survey and efficacy of noninvasive methods to prevent and detect colorectal cancer (CRC).

Parameters for evaluating the main indicators of coloproctological care in the adult population in the subjects of the far Eastern Federal District in 2016–2018

Aim.To work out the unified model for description of coloproctological service at the level of federal district.Material and methods.The study is the summary analysis of data from the annual statistical observation “The Report of the Chief Coloproctologist of the Russian Federal District” in 2016–2018. The analysis included the following stages: the estimation of staff situation; the assessment of the main parameters of out- and inpatient coloproctological care in 2018 in the Far Eastern Federal District (FEFD) and in its federal subjects.Results.Staff number of doctors in federal subjects of the FEFD did not change significantly in 2016-2018, it was 0.7 per 100 thousand population. An extremely low availability of outpatient consultation of coloproctologist in all federal subjects of FEFD was found (550.2 per 100 thousand population vs 3000 per 100 thousand population in Russian Federation). The incidence of colonoscopy is the lowest among all Federal Districts of Russia as well – 5.5%. A mean number of endoscopists is above 7.0 per 100 thousand population, which can be considered as the minimal threshold parameter. The total average staffing of endoscopists in the far Eastern Federal district was 86.0% in 2016, 87.3% – in 2017, 85.8% – in 2018. The staffing situation improved in Khabarovsk Territory and in Sakhalin Region while other federal subjects showed negative trend.Conclusion.The analyzed parameters can be considered as an objective tool for the assessment of coloproctological care efficacy. In the FEFD it needs further development.

Modestly Increased Use of Colonoscopy When Copayments Are Waived

Colorectal cancer (CRC) screening with colonoscopy often requires expensive copayments from patients. The 2010 Patient Protection and Affordable Care Act mandated elimination of copayments for CRC screening, including colonoscopy, but little is known about the effects of copayment elimination on use. The University of Texas employee, retiree, and dependent health plan instituted and promoted a waiver of copayments for screening colonoscopies in fiscal year (FY) 2009; we examined the effects of removing cost sharing on colonoscopy use. We conducted a retrospective cohort study of 59,855 beneficiaries of the University of Texas employee, retiree, and dependent health plan, associated with 16 University of Texas health and nonhealth campuses, ages 50-64 years at any point in FYs 2002-2009 (267,191 person-years of follow-up evaluation). The primary outcome was colonoscopy incidence among individuals with no prior colonoscopy. We compared the age- and sex-standardized incidence ratios for colonoscopy in FY 2009 (after the copayment waiver) with the expected incidence for FY 2009, based on secular trends from years before the waiver. The annual incidence of colonoscopy increased to 9.5% after the copayment was waived, compared with an expected incidence of 8.0% (standardized incidence ratio, 1.18; 95% confidence interval, 1.14-1.23; P < .001). After adjusting for age, sex, and beneficiary status, the copayment waiver remained significantly associated with greater use of colonoscopy, with an adjusted hazard ratio of 1.19 (95% confidence interval, 1.12-1.26). Waiving copayments for colonoscopy screening results in a statistically significant, but modest (1.5%), increase in use. Additional strategies beyond removing financial disincentives are needed to increase use of CRC screening.

Iatrogenic colonoscopic perforations: a review of 8 158 patients

Purpose. The aim of the study is to determine the incidence of perforation after colonoscopy (CP) in our institution, and to evaluate the endoscopic information, clinical presentation, diagnosis workup, intra-operative findings, management and outcomes of patients with CP. Methods. All colonoscopies performed between January 2005 and December 2011 at the Oncology Institute of Vilnius University, Lithuania, searched for colonoscopic perforations. Medical records of all CP patients were reviewed. Incidence of CP, patients’ characteristics, endoscopic information, intra-operative findings, management and outcomes were analyzed. Results. A total of 8,158 colonoscopies (7,467 diagnostic and 691 therapeutic) were performed in our hospital over a 7-year period. Five patients (0.061%) had CP: 2 from diagnostic colonoscopy (incidence 0.027%) and 3 from therapeutic one (0.43%). In two cases, perforation was noticed by the endoscopist through visualization of extra-intestinal tissue during the procedure. Other perforations (n = 3, 60%) were diagnosed after the procedure. The most consistent symptom was abdominal pain followed by tenderness, abdominal distension, leukocytosis. The most common site of perforation was in the sigmoid colon (n = 3, 60%). Perforations were caused by direct trauma from the endoscope (n = 2, 40%) and endoscopic polypectomy (n = 3, 60%). All patients with CP underwent surgical management: primary repair. The mortality rate was 0% and the postoperative complication rate was 40%. Conclusions. CP is a serious but rare complication of colonoscopy. Incidence of CP was 0.061%. Therapeutic procedures have a higher perforation risk than diagnostic procedures. The sigmoid colon is the area at the greatest risk of perforation. Surgery is still the mainstay of CP management.