scholarly journals Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial

2021 ◽  
Vol 09 (07) ◽  
pp. E1070-E1076
Author(s):  
Marco Alburquerque ◽  
Antonella Smarrelli ◽  
Julio Chevarria Montesinos ◽  
Sergi Ortega Carreño ◽  
Ana Zaragoza Fernandez ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Complication Rates ◽  
Withdrawal Time ◽  
Equivalence Trial ◽  
Crc Screening ◽  
Intention To Treat ◽  
Adenoma Detection ◽  
Group A ◽  
Cecal Intubation Rate

Abstract Background and study aims Efficacy and safety of NAAP for gastrointestinal endoscopy have been widely documented, although there is no information about the outcomes of colonoscopy when the endoscopist supervises the sedation. In this context, the aim of this trial was to determine the equivalence of adenoma detection rate (ADR) in colorectal cancer (CRC) screening colonoscopies performed with non-anesthesiologist-administered propofol (NAAP) and performed with monitored anesthesia care (MAC). Patients and methods This was a single-blind, non-randomized controlled equivalence trial that enrolled adults from a national CRC screening program (CRCSP). Patients were blindly assigned to undergo either colonoscopy with NAAP or MAC. The main outcome measure was the ADR in CRCSP colonoscopies performed with NAAP. Results We included 315 patients per group. The median age was 59.76 ± 5.81 years; 40.5 % of patients were women. The cecal intubation rate was 97 %, 81.8 % of patients had adequate bowel preparation, withdrawal time was > 6 minutes in 98.7 %, and the median global exploration time was 24.25 ± 8.86 minutes (range, 8–70 minutes). The ADR was 62.9 % and the complication rate (CR) was 0.6 %. Analysis by intention-to-treat showed an ADR in the NAAP group of 64.13 % compared with 61.59 % in the MAC group, a difference (δADR) of 2.54 %, 95 %CI: −0.10 to 0.05. Analysis by per-protocol showed an ADR in the NAAP group of 62.98 %, compared with 61.94 % in the MAC group, δADR: 1.04 %, 95 %CI: −0.09 to 0.07. There was no difference in CR (NAAP: 0,63 vs. MAC: 0.63); P = 1.0. Conclusions ADR in colorectal cancer screening colonoscopies performed with NAAP was equivalent to that in those performed with MAC. Similarly, there was no difference in complication rates.

scholarly journals Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joaquín Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). Results We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87–1.19), due to colonoscopy complications (0.02, 95% CI 0.00–0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85–1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11–2.23), sex (female = 2.10, 95% CI 1.52–2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87–185.59; intermediate risk = 5.63, 95% CI 1.89–16.80; low risk = 1.43; 95% CI 0.36–5.75), the endoscopist’s ADR (Q4 = 0.44, 95% CI 0.28–0.68; Q3 = 0.44, 95% CI 0.27–0.71; Q2 = 0.71, 95% CI 0.44–1.14) and the hospital (tertiary = 0.54, 95% CI 0.38–0.79). Conclusions In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

scholarly journals Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

2020 ◽  
Author(s):  
Joaquin Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background: Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study is to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods: We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI).Results: We included 15,707 patients in the analysis with high (19.3%), intermediate (25.1%) low risk (21.7%) adenomas and normal colonoscopy (27.8%) detected in the analyzed period. Colorectal surgery was performed in 162 (10.3‰, 95% CI 8.7-11.9), due to colonoscopy complications (0.2‰, 95% CI 0.005-0.5) and resection of colorectal benign lesions (10.0‰, 95% CI 8.5-11.6). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications, one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years= 1.57, 95% CI 1.11-2.23), sex (female= 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk= 67.94, 95% CI 24.87-185.59; intermediate risk= 5.63, 95% CI 1.89-16.80; low risk= 1.43; 95% CI 0.36-5.75), the endoscopist’s ADR (Q4= 0.44, 95% CI 0.28-0.68; Q3= 0.44, 95% CI 0.27-0.71; Q2= 0.71, 95% CI 0.44-1.14) and the hospital (third level= 0.54, 95% CI 0.38-0.79). Conclusions: In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are acceptable and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

Risk of Colonoscopy-related Complications in a Fecal Immunochemical Test-based Population Colorectal Cancer Screening Program

Endoscopy ◽  
2020 ◽  
Author(s):  
Wen-Feng Hsu ◽  
Chi-Yang Chang ◽  
Chun-Chao Chang ◽  
Li-Chun Chang ◽  
Chien-Hua Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Complication Rate ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Research Database ◽  
Complication Rates ◽  
Related Complication ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
Immunochemical Test

Background and study aims: The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive subjects than in the general population. The magnitude of colonoscopy-related complication rate in FIT-positive subjects, however, remains unknown. This study aims to elucidate the colonoscopy-related complication rate after positive FIT and compared with colonoscopy performed for other purposes. Patients and methods: Information regarding colonoscopy after positive FIT (FIT-colonoscopy) and ordinary colonoscopy related severe complications during 2010-2014 was ascertained from the Taiwanese Colorectal Cancer (CRC) Screening Program Database and National Health Insurance Research Database (NHIRD). Severe complications included significant bleeding, perforation, and cardiopulmonary events <14 days of colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications in comparison with ordinary colonoscopy. Results: A total of 319,114 FIT-colonoscopies (214,955 subjects) were identified. Of those, 51,242 (16.1%) underwent biopsy and 94,172 (29.5%) underwent polypectomy; 2,125 had significant bleeding (6.7‰) and 277 had perforation (0.9‰) <14 days after colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications [adjusted odds ratio (aOR)= 4.41 (95% Confidence Interval {CI}=4.05–4.81); 1.35 (95%CI=1.12–1.53); and 1.88 (95%CI=0.61–5.84), respectively]. Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding [aOR= 3.10 (95%CI=2.90–3.32)]. Conclusions: FIT-colonoscopy was associated with more than two-fold risk of significant bleeding, especially when polypectomy is performed.

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

scholarly journals National Colorectal Cancer Screening Program in Lithuania: Description of the 5-Year Performance on Population Level

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1129
Author(s):  
Audrius Dulskas ◽  
Tomas Poskus ◽  
Inga Kildusiene ◽  
Ausvydas Patasius ◽  
Rokas Stulpinas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Assurance ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Screening Program ◽  
Histopathological Examination ◽  
Insurance Fund ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
The Impact

We aimed to report the results of the implementation of the National Colorectal Cancer (CRC) Screening Program covering all the country. The National Health Insurance Fund (NHIF) reimburses the institutions for performing each service; each procedure within the program has its own administrative code. Information about services provided within the program was retrieved from the database of NHIF starting from the 1 January 2014 to the 31 December 2018. Exact date and type of all provided services, test results, date and results of biopsy and histopathological examination were extracted together with the vital status at the end of follow-up, date of death and date of emigration when applicable for all men and women born between 1935 and 1968. Results were compared with the guidelines of the European Union for quality assurance in CRC screening and diagnosis. The screening uptake was 49.5% (754,061 patients) during study period. Participation rate varied from 16% to 18.1% per year and was higher among women than among men. Proportion of test-positive and test-negative results was similar during all the study period—8.7% and 91.3% annually. Between 9.2% and 13.5% of test-positive patients received a biopsy of which 52.3–61.8% were positive for colorectal adenoma and 4.6–7.3% for colorectal carcinoma. CRC detection rate among test-positive individuals varied between 0.93% and 1.28%. The colorectal cancer screening program in Lithuania coverage must be improved. A screening database is needed to systematically evaluate the impact and performance of the national CRC screening program and quality assurance within the program.

scholarly journals To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jesper Bo Nielsen ◽  
Gabriele Berg-Beckhoff ◽  
Anja Leppin
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Demographic Data ◽  
Survey Study ◽  
Stepwise Logistic Regression ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Screening Programs ◽  
Crc Screening ◽  
Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50–80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

scholarly journals Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population

2018 ◽  
Vol 17 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Theresa L. Byrd ◽  
Jessica Calderón-Mora ◽  
Rebekah Salaiz ◽  
Navkiran K. Shokar
Keyword(s):  
Colorectal Cancer ◽  
Focus Groups ◽  
Screening Program ◽  
El Paso ◽  
Barriers And Facilitators ◽  
Hispanic Population ◽  
Community Based ◽  
Crc Screening ◽  
Predominantly Hispanic ◽  
9Th Grade

Introduction: Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites. Method: The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed. Results: Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle. Conclusion: Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.

scholarly journals The impact of Endocuff-assisted colonoscopy on adenoma detection in an organized screening program

2018 ◽  
Vol 06 (04) ◽  
pp. E437-E442 ◽  
Author(s):  
Lucas Cavallaro ◽  
Cesare Hassan ◽  
Pierenrico Lecis ◽  
Ermenegildo Galliani ◽  
Elisabetta Dal Pont ◽  
...  
Keyword(s):  
Detection Rate ◽  
Screening Program ◽  
Occult Blood ◽  
Adenoma Detection Rate ◽  
Advanced Adenoma ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Adenoma Detection ◽  
Number Of Patients ◽  
The Impact

Abstract Background and study aims Colorectal cancer (CRC) screening with biennial fecal occult blood test has been shown to reduce CRC mortality. For the effectiveness of the CRC screening program is crucial that a high-quality colonoscopy with a high adenoma detection rate (ADR) be performed. To improve ADR, various endoscopic devices have been developed. Endocuff, an endoscopic cap with finger-like projections, has been shown to improve ADR. The aim of this study was to compare in an organized CRC screening program ADR, advanced adenoma detection rate (AADR) and mean number of adenomas per patient (MAP) using standard colonoscopy (SC) and Endocuff-assisted colonoscopy (EAC). Patients and methods We compared performance of SC (in 2014) and EAC (in 2015) in consecutive participants in an organized CRC screening program. Results SC and EAC were performed in 546 (284 males) and 519 (293 males) subjects, respectively (mean age 60 years). Cecal intubation rate was 97.4 % for SC and 97.1 % for EAC and not significantly different (P = 0.7). ADR was 47 % for SC and 52 % for EAC, P = 0.1. MAP in SC and EAC were 0.87 (range: 0 – 7) and 1.11 (range: 0 – 13) respectively, P = 0.02. AADR rate was 25 % and 23 % for SC and EAC, respectively, P = 0.5. Conclusion Endocuff-assisted colonoscopy does not improve the number of patients with at least one adenoma but it may increase the number of detected adenomas per procedure.

scholarly journals Detection Rate of Colorectal Cancer or Precancer Adenoma by Colonoscopy After 1, 2, or 3 Positive Results via Fecal Immunochemical Testing

2019 ◽  
Vol 50 (3) ◽  
pp. 263-267
Author(s):  
Jill A Hancock ◽  
Glen A Palmer
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Optimal Number ◽  
Screening Methods ◽  
Data Set ◽  
Crc Screening ◽  
Fecal Immunochemical Testing ◽  
Fit Testing ◽  
Risk Patients ◽  
Standard Practices

Abstract Background Single-vial fecal immunochemical testing (FIT) is an accepted method of colorectal cancer (CRC) screening. The available 3-vial FIT data set allows for comparison of colonoscopy results using various screening methods. Objective To determine the optimal number of vials for a strong FIT-screening program by examining whether using only a single vial impacts the use of colonoscopy for CRC screening. Methods Patients were given 3-vial FIT collection kits that were processed with a positive hemoglobin cut-off detection level of 100 ng per mL. If FIT results were positive, colonoscopy testing was performed using standard practices. Results Detection of CRC and precursor adenoma was examined in 932 patients, with a positive colonoscopy sensitivity of 56.2% and 3.0% CRC detection after 3-vial FIT; after single-vial screening, those values were 60.9% and 4.7%, respectively. Conclusions Prescreening patients with FIT testing before colonoscopy allows colonoscopy testing to be targeted to higher-risk patients. Implementing use of only a single vial from the 3-vial FIT screening kit would reduce the colonoscopy reflex rate, colonoscopy complication numbers, facility costs, and patient distress by more than 40%, compared with 3-vial screening.

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