Diagnostic yield of early repeat colonoscopy after suboptimal bowel preparation in a fecal immunochemical test-based screening program

Endoscopy ◽  
2020 ◽  
Vol 52 (12) ◽  
pp. 1093-1100 ◽  
Author(s):  
Sandra Baile-Maxía ◽  
Carolina Mangas-Sanjuan ◽  
Lucía Medina-Prado ◽  
Juan Martínez-Sempere ◽  
Oscar Murcia ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Screening Program ◽  
Diagnostic Yield ◽  
Fecal Immunochemical Test ◽  
High Rate ◽  
Screening Colonoscopy ◽  
Advanced Adenoma ◽  
Adenoma Detection ◽  
Immunochemical Test ◽  
Repeat Colonoscopy

Abstract Background Current guidelines regarding surveillance after screening colonoscopy assume adequate bowel preparation. However, follow-up intervals after suboptimal cleansing are highly heterogeneous. We aimed to determine the diagnostic yield of early repeat colonoscopy in patients with suboptimal bowel preparation in fecal immunochemical test (FIT)-based screening colonoscopy. Methods An observational study including patients who underwent colonoscopy with suboptimal bowel preparation after positive FIT screening and then repeat colonoscopy within 1 year. Suboptimal preparation was defined as a Boston Bowel Preparation Scale (BBPS) score of 1 in any segment. Patients with a BBPS score of 0 in any segment or incomplete examination were excluded. The adenoma detection rate (ADR), advanced ADR (AADR), and colorectal cancer rate were calculated for the index and repeat colonoscopies. Results Of the 2474 patients with FIT-positive colonoscopy at our center during this period, 314 (12.7 %) had suboptimal preparation. Of the 259 (82.5 %) patients who underwent repeat colonoscopy, suboptimal cleansing persisted in 22 (9 %). On repeat colonoscopy, the ADR was 38.7 % (95 %CI 32.6 % to 44.8 %) and the AADR was 14.9 % (95 %CI 10.5 % to 19.4 %). The per-adenoma miss rate was 27.7 % (95 %CI 24.0 % to 31.6 %), and the per-advanced adenoma miss rate was 17.6 % (95 %CI 13.3 % to 22.7 %). After repeat colonoscopy, the post-polypectomy surveillance recommendation changed from 10 to 3 years in 14.7 % of the patients with previous 10-year surveillance recommendation. Conclusions Patients with suboptimal bowel preparation on FIT-positive colonoscopy present a high rate of advanced adenomas in repeat colonoscopy, with major changes in post-polypectomy surveillance recommendations.

scholarly journals Gender-specific cut-off levels in colorectal cancer screening with fecal immunochemical test: A population-based study of colonoscopy findings and costs

2021 ◽  
pp. 096914132110200
Author(s):  
Hanna Ribbing Wilén ◽  
Deborah Saraste ◽  
Johannes Blom
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Diagnostic Yield ◽  
Population Based ◽  
Fecal Immunochemical Test ◽  
High Rate ◽  
Lower Sensitivity ◽  
Screening Cost ◽  
Immunochemical Test ◽  
Gender Specific

Objective In the population-based Swedish regional colorectal cancer (CRC) screening program of Stockholm–Gotland using the fecal immunochemical test (FIT), gender-specific cut-off levels of fecal hemoglobin are applied, since previous studies have indicated a lower sensitivity of FIT for CRC in women. The aim was to evaluate the diagnostic yield and the screening costs overall and per detected CRC of this strategy. Methods All individuals aged 60–69 invited to screening in 2015–2017 were included. Cut-off level for positive FIT was 40 µg/g in women and 80 µg/g in men. Those with a positive FIT were referred to colonoscopy. The yield of CRC and screening cost for the study period were assessed and compared to cut-off levels of 80 µg/g in both genders. Results Approximately 230,000 individuals were invited. Overall participation rates were 72% in women and 65% in men ( p < 0.05). FIT was positive in 4256 individuals (2.7% in both genders). In 3758 colonoscopies, 258 (6.9%) CRCs were detected. The positive predictive value for CRC was significantly higher in men (8.3% vs. 5.8%). In 120 women with CRC, 28 (23%) had FIT < 80 µg/g. Negative colonoscopies were more common in women (24% vs. 17%, p < 0.05). Total costs for the study period were 52,000,000SEK (≈5,200,000€), i.e. 16% higher compared to using cut-off levels of 80 µg/g in both genders, and corresponding to a 3% increment in cost per detected CRC. Conclusion The high rate of CRC detected in women in the lowest FIT category outweighs the minor reduction in screening costs if the same cut-off level was used as for men.

scholarly journals Polyprev: Randomized, Multicenter, Controlled Trial Comparing Fecal Immunochemical Test with Endoscopic Surveillance after Advanced Adenoma Resection in Colorectal Cancer Screening Programs: A Study Protocol

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1520
Author(s):  
Cristina Regueiro ◽  
Raquel Almazán ◽  
Isabel Portillo ◽  
María Besó ◽  
Carlos Tourne-Garcia ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Practice ◽  
Diagnostic Yield ◽  
Fecal Immunochemical Test ◽  
Endoscopic Surveillance ◽  
Advanced Adenoma ◽  
Colonic Lesion ◽  
Screening Programs ◽  
Crc Screening ◽  
Immunochemical Test

Colorectal cancer (CRC) screening programs have been implemented to reduce the burden of the disease. When an advanced colonic lesion is detected, clinical practice guidelines recommend endoscopic surveillance with different intervals between explorations. Endoscopic surveillance is producing a considerable increase in the number of colonoscopies, with a limited effect on the CRC incidence. Instead, participation in CRC screening programs based on the fecal immunochemical test (FIT) could be a non-inferior alternative to endoscopic surveillance to reduce 10-year CRC incidence. Based on this hypothesis, we have designed a multicenter and randomized clinical trial within the Spanish population CRC screening programs to compare FIT surveillance with endoscopic surveillance. We will include individuals aged from 50 to 65 years with complete colonoscopy and advanced lesions resected within the CRC screening programs. Patients will be randomly allocated to perform an annual FIT and colonoscopy if fecal hemoglobin concentration is ≥10 µg/g, or to perform endoscopic surveillance. On the basis of the non-superior CRC incidence, we will recruit 1894 patients in each arm. The main endpoint is 10-year CRC incidence and the secondary endpoints are diagnostic yield, participation, adverse effects, mortality and cost-effectiveness. Our results may modify the clinical practice after advanced colonic resection in CRC screening programs.

Prevalence of adenomatous polyposis in a fecal immunochemical test-based colorectal cancer screening program and risk of advanced neoplasia during follow-up

Endoscopy ◽  
2021 ◽  
Author(s):  
Sabela Carballal ◽  
Ariadna Sánchez ◽  
Leticia Moreira ◽  
Jesús-Eduardo Cuellar Monterrubio ◽  
Julio Bernuy ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Colorectal Adenomas ◽  
Advanced Adenoma ◽  
Multivariable Logistic Regression Analysis ◽  
Crc Screening ◽  
Advanced Neoplasia ◽  
Immunochemical Test

Background and study aims: current guidelines recommend genetic counseling and intensive colonoscopy surveillance for patients with ≥10 colorectal adenomas based on scarce data. We investigated the prevalence of this condition in a FIT (fecal immunochemical test)-based colorectal (CRC) screening program and the incidence of metachronous lesions during follow-up. Patients and methods: we retrospectively included all FIT-positive participants with ≥10 adenomas at index colonoscopy between 2010 and 2018. Surveillance colonoscopies (SVC) were collected until 2019. Patients with inherited syndromes, serrated polyposis syndrome, total colectomy or lacking surveillance data, were excluded. Cumulative incidence of CRC and advanced neoplasia (AN) were analyzed by Kaplan-Meyer analysis. Risk factors of metachronous AN were investigated by multivariable logistic-regression analysis. Results: 215/9,582 (2.2%) participants had ≥10 adenomas. Germline genetic testing was performed in 92% of patients with ≥20 adenomas identifying 2 (3.3%) inherited syndromes. 3-year cumulative incidence of CRC and AN was 1%, and 16%, respectively. In 39 (24.2%) patients no polyps were found at first SVC. The presence of advanced adenoma was independently associated with a higher risk of AN at first SVC (OR: 3.91, 95% confident interval : 1.12-13.62; p=0.03). Beyond the first SVC, the risk of metachronous AN was lower. Conclusions: the prevalence of ≥10 adenomas in a FIT-based CRC screening program is 2.2% and a small proportion of inherited syndromes are detected even amongst those with ≥ 20 adenomas. Low rate of post-colonoscopy CRC is observed and the risk of AN beyond the first SVC tends to progressively decrease throughout successive follow-up.

scholarly journals Impact of Video Aid on Quality of Bowel Preparation Among Patients Undergoing Outpatient Screening Colonoscopy

2018 ◽  
Vol 11 ◽  
pp. 117955221880330
Author(s):  
Sanna Fatima ◽  
Deepanshu Jain ◽  
Christopher Hibbard
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Adenoma Detection Rate ◽  
Screening Colonoscopy ◽  
Advanced Adenoma ◽  
Control Group ◽  
P Value ◽  
Group I ◽  
Adenoma Detection

Aim: To investigate the effect of video aid on quality of bowel preparation. Study: A retrospective study was done on patients undergoing outpatient screening colonoscopy. All subjects received educational video prior to colonoscopy in addition to the standard counseling. Patient charts were reviewed to collect data regarding quality of bowel preparation (adequate or inadequate). The study population was stratified into four groups according to viewing status: Group I 0% (control group), Group II <50%, Group III >50% to <75%, and Group IV watched ⩾75% of the video. Results: A total of 338 patients with an average age of 59.1 years and 60.3% females were included in the final study cohort. Of the patients in Groups I, II, III, and IV, 94.3%, 90.9%, 100%, and 91.7%, respectively, had adequate preparation ( P value = .827). Adenoma detection rate (ADR) for Groups I, II, III, and IV was 28.8%, 50%, 50%, and 22.6%, respectively ( P value = .305). The mean cecal intubation time was 20.7, 16.4, 16.57, and 17 minutes for Groups I, II, III, and IV, respectively ( P value = .041). Conclusions: Video aid use for patients undergoing screening colonoscopy lacked a statistically significant impact on the quality of bowel preparation, ADR, and advanced adenoma detection rate when compared with standard practice.

scholarly journals Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study

2021 ◽  
Vol 09 (11) ◽  
pp. E1649-E1657
Author(s):  
Bernard Denis ◽  
Isabelle Gendre ◽  
Philippe Perrin ◽  
Nicolas Tuzin ◽  
Mathieu Pioche
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Endoscopic Resection ◽  
Screening Program ◽  
Population Based ◽  
Fecal Immunochemical Test ◽  
Detection Rates ◽  
Cancer Screening Program ◽  
Adenoma Detection ◽  
Immunochemical Test

Abstract Background and study aims The aim of this study was to analyze presentation, management, and outcomes of large polyps (LPs; ≥ 20 mm) detected in a colorectal cancer (CRC) screening program using a quantitative fecal immunochemical test (FIT). Patients and methods This was a retrospective community- and population-based observational study of all LPs detected in patients aged 50 to 74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening program organized in Alsace (France). Results Among 13,633 FIT-positive colonoscopies, 1256 LPs (8.5 % malignant and 51.8 % nonpedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). The sensitivity of optical diagnosis of malignancy was 54 % for nonpedunculated and 27 % for pedunculated T1 CRCs. The endoscopic resection rate was 82.7 % (95 % confidence interval [CI] 80.3–84.9) for benign LPs (70.2 % [95 % CI 66.4–74.1]) nonpedunculated, 95.2 % [95 % CI 93.4–97.1] pedunculated), varying from 0 to 100 % depending on the endoscopist. It was correlated with cecal intubation (Pearson r = 0.49, P < 0.01) and adenoma detection rates (r = 0.25, P = 0.01). Most endoscopists did not refer patients to more experienced endoscopists, and as a result, 60 % to 90 % of 183 surgeries for benign LPs were unwarranted. Endoscopic resection was curative for 4.3 % (95 % CI 0.9–12.0) of nonpedunculated and 37.8 % (95 % CI 22.5–55.2) of pedunculated T1 CRCs. Overall, 22 endoscopic submucosal dissections had to be performed to avoid one surgery. Conclusions Compared with current recommendations, there is tremendous room for improvement in community endoscopy practices in the diagnosis and management of LPs. Detection and polypectomy competencies are correlated and highly variable among endoscopists. Endoscopic resection is curative for 83 % of benign LPs and 16 % of T1 CRCs.

scholarly journals Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a population-based study

2020 ◽  
Author(s):  
Bernard Denis ◽  
Isabelle Gendre ◽  
Philippe Perrin ◽  
Nicolas Tuzin ◽  
Mathieu Pioche
Keyword(s):  
Colorectal Cancer ◽  
Endoscopic Resection ◽  
Screening Program ◽  
Population Based ◽  
Fecal Immunochemical Test ◽  
Cecal Intubation ◽  
Population Based Study ◽  
Cancer Screening Program ◽  
Adenoma Detection ◽  
Immunochemical Test

Objective: To analyze presentation, management and outcomes of large (≥ 20 mm) polyps (LPs) detected in a colorectal cancer (CRC) screening program using a fecal immunochemical test (FIT). Design: Retrospective population-based study of all LPs detected in patients aged 50-74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening program organized in Alsace (France). Results: Among 13,633 FIT-positive colonoscopies, 1256 LPs (8.5% malignant and 51.8% non-pedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). The sensitivity of optical diagnosis of malignancy was 54% for non-pedunculated and 27% for pedunculated T1 CRCs. Endoscopic resection rate was 82.7% [95% CI 80.3-84.9] for benign LPs (70.2% [95% CI 66.4-74.1] non-pedunculated, 95.2% [95% CI 93.4-97.1] pedunculated, p<0.001), varying from 0 to 100% depending on the endoscopist. It was correlated with cecal intubation (Pearson r = 0.49, p<0.01) and adenoma detection (r = 0.25, p=0.01) rates. Most endoscopists did not refer patients to more experienced endoscopists, so that 60 to 90% of 183 surgeries for benign LPs were unwarranted. Endoscopic resection was curative for 4.3% [95% CI 0.9-12.0] of non-pedunculated and 37.8% [95% CI 22.5-55.2] of pedunculated T1 CRCs. Overall, 22 endoscopic submucosal dissections had to be performed to avoid one surgery. Conclusion: Compared with current recommendations, there is tremendous room for improvement of community endoscopy practices for the diagnosis and management of LPs. Detection and polypectomy competencies are correlated and highly variable among endoscopists. Endoscopic resection is curative in 83% of benign LPs and 16% of T1 CRCs.

Adenoma detection by Endocuff-assisted versus standard colonoscopy in an organized screening program: the “ItaVision” Randomized Controlled Trial

Endoscopy ◽  
2021 ◽  
Author(s):  
Manuel Zorzi ◽  
Cesare Hassan ◽  
Jessica Battagello ◽  
Giulio Antonelli ◽  
Maurizio Pantalena ◽  
...  
Keyword(s):  
Screening Program ◽  
Controlled Trial ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Organized Screening Program ◽  
Immunochemical Test ◽  
Medical Design ◽  
Standard Colonoscopy ◽  
To Receive ◽  
Screening History

Objective Endocuff Vision (EV, Arc Medical Design Ltd., Leeds, England) has shown to increase mucosal exposure, and consequently adenoma detection rate (ADR), during colonoscopy. This nationwide multicentre study assessed possible benefits and harms of implementing EV in a Faecal Immunochemical Test (FIT)-based screening program. Design Patients undergoing colonoscopy after a FIT+ test were randomised 1:1 to receive colonoscopy with EV or standard colonoscopy, stratified by gender, age, and screening history. Primary outcome was ADR, Secondary outcomes were ADR stratified by endoscopists’ ADR, advanced ADR (AADR), adenoma per colonoscopy (APC), withdrawal time (WT), and adverse events (AE). Results Overall, 1,864 patients were enrolled in 13 centres. After exclusions, 1,813 (males: 53.7%; mean age: 60.1 years) were randomised, 908 in the EV arm and 905 in the control. ADR was significantly higher in the EV arm (47.8% vs 40.8%; RR 1.17, 95%CI 1.06-1.30) with no differences between arms regarding size or morphology. When stratifying for endoscopists’ ADR, only low detectors (ADR< 33.3%) showed a statistically significant ADR increase (EV = 41.1%, 95%CI 35.7-46.7 vs control = 26%, 95%CI 21.3-31.4 . AADR (24.8% vs 20.5%, RR 1.21; 95%CI 1.02-1.43) and APC (0.94 vs. 0.77, p=0.001) were higher in the EV arm. WT and AE were similar between arms. Conclusion EV increased ADR in a FIT-based screening program, supporting a complete exploration of colonic mucosa. Its utility was highest among endoscopists with a low ADR. ClinicalTrial.gov NCT03612674

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