Isn't it time to stop talking about colonoscopy quality and start doing something about it?

Screening for Colorectal Cancer

Colorectal cancer (CRC) is the second leading cause of cancer death. Screening has been proven to reduce both cancer incidence and cancer-related mortality. Various screening tests are available, each with their own advantages and disadvantages and varying levels of evidence to support their use. Clinicians should offer CRC screening to average-risk persons aged 50 to 75 years; starting screening at age 45 years remains controversial. Screening may be beneficial in select persons aged 76 to 85 years, based on their overall health and screening history. Offering a choice of screening tests or sequentially offering an alternate test for those who do not complete screening can significantly increase participation.

Serrated polyps detected during screening colonoscopies

AIM OF THE STUDY

It is estimated that between 15% and 35% of sporadic colorectal cancers (CRC) developing from adenomas come from serrated polyps. Currently, the most effective method used to prevent CRC is the removal of adenomas, including serrated polyps, during colonoscopy. The aim of this paper is to analyze the changes characterized as serrated polyps and detected during screening colonoscopies performed as part of the Screening Program for Early Colorectal Cancer Detection (SPED).

MATERIAL AND METHODS

In our center, as part of the nationwide SPED between 2000 and 2009, 1,442 screening colonoscopies were performed.

RESULTS

Serrated polyps were found in 11.9% of all patients and in 45.8% of patients who had polyps removed by endoscopy. In screening colonoscopy of the large intestine, the following polyps were found most frequently: hyperplastic, < 1 cm, without a stalk, multiple, located in the distal part of the large intestine, in men and in patients with a first-degree relative with a history of abdominal cancer. Detecting and removing polyps was facilitated by the fact that the cecum was intubated and the bowel preparation had been performed either very well or well. The detection rate of serrated polyps was not influenced by patients' place of residence or their age.

CONCLUSIONS

Serrated polyps constitute a frequent, and very frequent among removed polyps, abnormality detected during screening colonoscopy.

Prevention of interval colorectal cancers: what every clinician needs to know

Colonoscopic screening and surveillance have been very effective tools in the fight against colorectal cancer (CRC). Colonoscopy is more than a cancer screening test; it also can prevent CRC by detecting and removing precancerous lesions. Despite this potential, there has been increasing concern about CRCs that occur after a previous colonoscopy and before the next screening/surveillance examination (interval CRCs). The etiology of interval CRC is thought to be caused mostly by missed or incompletely resected lesions on index colonoscopy with some contribution of rapidly progressive new lesions. If this is true, many interval cancers should be preventable by improving colonoscopy technique. There are a variety of strategies to decrease interval CRC rates including use of a split-dosed bowel preparation, optimizing withdrawal technique, ensuring complete polypectomy, and careful pathologic examination of the tissue removed. Furthermore, there should be an increased emphasis on how endoscopists are trained to cultivate high-quality technique throughout their careers. It is important to inform patients that even high-quality colonoscopy is not perfectly sensitive for the detection of advanced neoplasia. Improving colonoscopy quality can decrease interval CRC rates and further decrease CRC incidence and mortality.

Variation of quality of colonoscopy in Italy over five years: a nation-wide observational study

BACKGROUND/AIM

A nation-wide survey of colonoscopy practice carried out in 2004 showed disappointing data on colonoscopy quality in Italy. Present study was aimed prospectively at re-evaluating quality indicators of colonoscopy and their changes over a five-year-period.

METHODS

The main features of each Endoscopy Unit and performance indicators on consecutive colonoscopies performed in a 2-week period were recorded. Variation of colonoscopy quality was assessed by comparing caecal-intubation and polyp-detection rates in present survey with those collected five-years before; statistical analysis was restricted to centres participating in both data collections.

RESULTS

6158 colonoscopies from 116 centres were evaluated; unadjusted caecal-intubation rate was 83.0%, with 21.6% centres reporting a value >90%; mean polyp-detection rate was 32.0% (range 9.6-71.2% across centres). To assess variation of performance indicators, 4452 procedures from 77 centres were compared to 3589 procedures performed five-years before, in the same centres. A significant difference between the two rounds of data collections was observed for both caecal-intubation (82.6% versus 80.9%, p=0.043) and polyp-detection (31.3% versus 28.1%, p=0.002). However, 52 centres maintained a caecal-intubation rate constantly <90%.

CONCLUSIONS

Present data show that colonoscopy in Italy is still far below quality standards and that a significant improvement of practice did not occur over the last five years. Strategies to enhance colonoscopy quality should be pursued by professional societies.