T05.01.14 WATER IMMERSION VS CO2 INSUFFLATION IN FLEXIBLE SIGMOIDOSCOPY FOR CRC SCREENING: A SINGLE CENTER DATA

Colorectal cancer (CRC) is third in mortality rate amongst Asian Americans. However, CRC characteristics in this patient population have been poorly defined. A retrospective review at an urban tertiary hospital located in an underserved region was performed to determine CRC characteristics for Asian Americans in comparison to other races. Four hundred fourteen patients were represented by Hispanics (n = 161), African Americans (n = 101), Asians (n = 83), and Whites (n = 69). The majority of Asian American patients (n = 70,84%) presented with a left-sided lesion. This proportion was higher than that seen in African Americans (59%, P < 0.0003), Hispanics (66%, P < 0.0033), and Whites (63%, P < 0.0036). Thirty-six Asian American patients presented with Stage III disease which was the most frequent presenting stage for this patient population and also statistically higher than all the other races. Furthermore, Asian Americans in this study still presented predominantly with left-sided lesions and in a more advanced stage. These findings suggest a potential benefit of initially offering flexible sigmoidoscopy given the decreased compliance among Asian Americans to obtain routine CRC screening. Ultimately, this modality may be more acceptable, leading to higher compliance for CRC screening in Asian Americans without likely degradation in cancer detection rates.

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Colorectal Cancer Screening: Video-Reviewed Flexible Sigmoidoscopy by Nurse Endoscopists — A Canadian Community-Based Perspective

Canadian Journal of Gastroenterology ◽

10.1155/2001/193846 ◽

2001 ◽

Vol 15 (7) ◽

pp. 441-445 ◽

Cited By ~ 11

Author(s):

TF Shapero ◽

PE Alexander ◽

J Hoover ◽

E Burgis ◽

R Schabas

Keyword(s):

Colorectal Cancer ◽

Flexible Sigmoidoscopy ◽

Screening Program ◽

Early Stage ◽

Community Setting ◽

Average Risk ◽

Crc Screening ◽

Asymptomatic Patients ◽

Incident Cancer

BACKGROUND: Colorectal cancer (CRC) is the third most common incident cancer and the second most fatal cancer in Canada. Flexible sigmoidoscopy (FS) is one of the modalities under consideration for CRC screening. The present series reports on a screening program of FS performed by nonphysician endoscopists in a Canadian community setting, with video review of procedures by physicians and recommendation of follow-up colonoscopy where polyps are identified.RESULTS: Five hundred twenty-five, average-risk, asymptomatic patients were examined. After exclusion of inappropriate referrals, 488 remained for analysis. The duration and extent of examination were comparable with those of previous studies elsewhere. Compliance with suggested follow-up was 97.3%. Polyps were identified at FS in 15.4% of examinees. In 8.2% of patients, the polyps were neoplastic at subsequent histology. Four malignant lesions were detected, all at an early stage. There were no complications of FS.INTERPRETATION: This report shows that FS can be carried out safely and effectively by nonphysician personnel in a community setting in Canada. The manpower cost for nonphysician operators is considerably less than that for specialist physician endoscopists. This approach deserves consideration in cost effectiveness analyses of CRC screening.

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Comparative Effectiveness of Fecal Immunochemical Tests versus Flexible Sigmoidoscopy for Colorectal Cancer Screening: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-3432 ◽

2021 ◽

Author(s):

Hemant Mutneja ◽

Rohit Agrawal ◽

Abhishek Bhurwal ◽

Shilpa Arora ◽

Andrew Go ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Flexible Sigmoidoscopy ◽

Colorectal Neoplasia ◽

Meta Analysis ◽

Detection Rates ◽

Crc Screening ◽

Advanced Colorectal Neoplasia

Background and Aims: Fecal immunochemical tests (FITs) and flexible sigmoidoscopies are commonly used modalities for colorectal cancer (CRC) screening. We performed a systematic review and meta-analysis to compare the effectiveness of FIT and sigmoidoscopy in CRC screening. Methods: PRISMA statement and Cochrane guidelines were followed for this review. Digital dissertation databases were searched from inception till December 1st 2020 and randomized clinical trials comparing the detection rates of CRC for FIT and sigmoidoscopy were included. Outcomes for analysis included participation rates and detection rates of CRC, advanced adenomas and advanced colorectal neoplasia for both screening modalities. Results: Five randomized clinical trials with a total of 261,755 patients were included for the analysis. The participation rate for FIT was significantly higher compared to flexible sigmoidoscopy (OR 2.11, 95% CI 1.29-3.44, p=0.003). In intention-to-screen analysis, the detection rate for advanced colorectal neoplasia was significantly lower with FIT (OR 0.62, 95% CI 0.45-0.84, p=0.002) as compared to flexible sigmoidoscopy but not statistically different for CRC (OR 1.15, 95% CI 0.65-2.02, p=0.63). Conclusion: Despite lower participation amongst patients, CRC screening with flexible sigmoidoscopy leads to higher detection of advanced colorectal neoplasia, when compared to a single round of fecal immunochemical testing.

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Effects of Alternative Offers of Screening Sigmoidoscopy and Colonoscopy on Utilization and Yield of Endoscopic Screening for Colorectal Neoplasms: Protocol of the DARIO Randomized Trial (Preprint)

10.2196/preprints.17516 ◽

2019 ◽

Author(s):

Petra Schrotz-King ◽

Michael Hoffmeister ◽

Peter Sauer ◽

Anja Schaible ◽

Hermann Brenner

Keyword(s):

Colorectal Neoplasms ◽

Flexible Sigmoidoscopy ◽

Cross Sectional Study ◽

Screening Tests ◽

Screening Colonoscopy ◽

Endoscopic Screening ◽

Cross Sectional ◽

Tissue Samples ◽

Crc Screening ◽

Screening Endoscopy

BACKGROUND Flexible sigmoidoscopy and colonoscopy are recommended screening options for colorectal cancer (CRC). Despite colonoscopy being offered for CRC screening in Germany, the uptake of this offer has been very limited. OBJECTIVE The objective of this study was to assess the potential for increasing use of endoscopic CRC screening and the detection of advanced colorectal neoplasms by offering the choice between use of flexible sigmoidoscopy and colonoscopy. METHODS The DARIO study includes a cross-sectional study (part I), followed by a prospective 2-arm randomized controlled intervention trial (part II) with an associated biobank study (part III). Participation is possible in part I of the DARIO study only, parts I and II, or all 3 study parts. After obtaining informed consent from the municipalities, 12,000 people, aged 50-54 years, from the Rhine-Neckar region in Germany were randomly selected from residential lists of the responsible population registries and invited to complete a standardized questionnaire to investigate the nature, frequency, timing, and results of previous CRC screening and eventual diagnostic colonoscopies. In study part II participants from study part I with no colonoscopy in the preceding 5 years are randomized into 2 arms: arm A offering screening colonoscopy only, and arm B offering both options, either screening colonoscopy or screening sigmoidoscopy. The primary endpoint is the proportion of participants in whom colorectal neoplasms >0.5 cm are detected and removed at screening endoscopy. The secondary endpoints are the detection rate of any neoplasm and use of any endoscopic screening. Part III of the study will use samples from participants in study part II to construct a liquid and tissue biobank for the evaluation of less invasive methods of early detection of colon cancer and for the more detailed characterization of the detected neoplasms. Blood, urine, stool, and saliva samples are taken before the endoscopy. Tissue samples are obtained from the neoplasms removed during endoscopy. RESULTS A total of 10,568 from 12,000 randomly selected women and men aged 50-54 years living in the Rhine-Neckar-Region of Germany have been invited for participation. The remaining 1432 (11.93%) could not be invited because they reached the age of 55 at the time of contact. Of those invited, 2785/10,568 (26.35%) participated in study part I; 53.60% (1493/2785) of these participants were female. Study parts II and III are ongoing. CONCLUSIONS This study will answer the question if alternative offers of either screening sigmoidoscopy or screening colonoscopy will increase utilization and effectiveness of endoscopic CRC screening compared with an exclusive offer of screening colonoscopy. In addition, alternative noninvasive screening tests will be developed and validated. CLINICALTRIAL German Clinical Trials Register DRKS00018932; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00018932 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17516

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