Repeat colonoscopy has a low yield even in symptomatic patients

Development of polyps and cancer in patients with a negative colonoscopy: a follow-up study of more than 20 years

Background. Adenomas are missed during colonoscopy. Aim. Assess the occurrence of colorectal cancer (CRC) and polyps in patients with a negative index colonoscopy (IC). Patients and Methods. All patients with a IC in 1992–1994, aged 40 and 60 years, were included. Exclusion criterion was presence of abnormalities, a family history, or surveillance. At the end of 2013 all records were studied in order to gather follow-up information. Results. 394 patients were included in four groups: group 1 patients who died, group 2 patients who were not in the hospital systems anymore, group 3 patients still visiting the hospital but not the department of gastroenterology, and group 4 patients undergoing new colonoscopies. In group 1, 2 patients died of CRC and 4 developed a polyp. No data were available from the patients in group 2. Patients in group 3 visited the outpatient clinics but did not undergo new colonoscopy. Patients in group 4 underwent additional colonoscopies. The yield was 35 patients polyps and three CRCs. Five patients (1.3%) developed CRC, and 39 (9%) developed a polyp. Conclusion. Given these results the number of potentially missed adenomas in IC is very low and the consequences of missed adenomas are highly exaggerated.

Symptoms associated with finding colorectal cancer during colonoscopy

BACKGROUND

Patients with an increased risk of having colorectal cancer (CRC) should have priority on the colonoscopy list.

OBJECTIVE

To investigate whether presenting symptoms of patients referred for colonoscopy could help in identifying patients with an increased risk of CRC.

PATIENTS AND METHODS

Between February 2007 and November 2010, random outpatients referred for colonoscopy were asked to fill out a questionnaire with respect to symptoms for which the colonoscopy was performed. Informed consent was obtained to review the colonoscopy and histology reports. Multivariate logistic regression was performed to identify predictors for CRC.

RESULTS

In total, 1458 (21%) patients returned the questionnaire, of whom 925 (63.4%) had undergone previous sigmoidoscopy or colonoscopy. CRC was detected in 41 patients (2.8%). Age over 50 years [adjusted odds ratio (aOR) 3.00; 95% confidence interval (CI) 1.30-6.91] and presenting symptoms of rectal blood loss (aOR 4.62; 95% CI 2.31-9.22) and a change in bowel habits (aOR 3.33; 95% CI 1.50-7.40) were associated independently with an increased risk of finding CRC. Previous sigmoidoscopy or colonoscopy (aOR 0.24; 95% CI 0.12-0.49) and fatigue as presenting symptoms (aOR 0.22; 95% CI 0.09-0.56) were associated with a decreased risk of CRC. Weight loss, self-reported anemia, and abdominal pain were not associated with CRC in this study.

CONCLUSION

Patients presenting with rectal blood loss, change in bowel habits, and those older than 50 years of age have an increased risk of a finding of CRC during colonoscopy. We recommend that these risk groups should be prioritized on the colonoscopy list over patients who have undergone a previous endoscopy or who are presenting with fatigue.

Colonoscopic yield of colorectal neoplasia in daily clinical practice

AIM: To assess the prevalence and location of advanced neoplasia in patients undergoing colonoscopy, and to compare the yield per indication.

METHODS: In a multicenter colonoscopy survey (n = 18 hospitals) in the Amsterdam area (Northern Holland), data of all colonoscopies performed during a three month period in 2005 were analyzed. The location and the histological features of all colonic neoplasia were recorded. The prevalence and the distribution of advanced colorectal neoplasia and differences in yield between indication clusters were evaluated. Advanced neoplasm was defined as adenoma > 10 mm in size, with > 25% villous features or with high-grade dysplasia or cancer.

RESULTS: A total of 4623 eligible patients underwent a total colonoscopy. The prevalence of advanced neoplasia was 13%, with 281 (6%) adenocarcinomas and 342 (7%) advanced adenomas. Sixty-seven percent and 33% of advanced neoplasia were located in the distal and proximal colon, respectively. Of all patients with right-sided advanced neoplasia (n = 228), 51% had a normal distal colon, whereas 27% had a synchronous distal adenoma. Ten percent of all colonoscopies were performed in asymptomatic patients, 7% of whom had advanced neoplasia. In the respective procedure indication clusters, the prevalence of right-sided advanced neoplasia ranged from 11%-57%.

CONCLUSION: One out of every 7-8 colonoscopies yielded an advanced colorectal neoplasm. Colonoscopy is warranted for the evaluation of both symptomatic and asymptomatic patients.

Colorectal cancer screening tests: pros and cons, and for whom?

The past decade has seen major advances internationally in the implementation of colorectal cancer screening, influenced in differing ways by the profession, the public and by government. Relatively unique to colorectal cancer screening is the availability of so many test alternatives, which have substantial variation in methodology. While perhaps spoilt for choice, discerning the key advantages and disadvantages of each test is often difficult, depending on the perspective from which screening is viewed. Accordingly, this article provides an evaluation of screening tests as might be perceived by governments, the patient and the profession. Aligned issues such as choosing a screening test and provision of informed consent are discussed. Finally, the article identifies current problems with various screening tests that, if attended to, might change the perception of a test's value to a particular interest group.

Education improves colonoscopy appropriateness

BACKGROUND

Appropriateness in GI endoscopy is critical to face the rising amount of demands. Education of physicians has been advocated to reduce the level of inappropriateness.

OBJECTIVE

Our purpose was to assess the effectiveness of an educational program in determining a reduction of inappropriate colonoscopies in an open access system.

DESIGN

Prospective study.

SETTING

A single endoscopy unit in Italy.

PATIENTS

A total of 495 consecutive outpatients referred to our endoscopy unit by family physicians for diagnostic colonoscopy before the educational course and 522 after its completion, for a total of 1017 patients.

MAIN OUTCOME MEASUREMENTS

Inappropriate colonoscopy reduction rates, cost savings, and reduction of waiting lists were evaluated.

RESULTS

With regard to inappropriate colonoscopies, the post-course group rate of inappropriateness was significantly lower than that of the pre-course group (P < or = .001). The economic savings for 1 year was estimated to be euro19,000. The reduction of the waiting list was about 15% of the original value.

CONCLUSIONS

Education has a high incidence in reducing inappropriate colonoscopies in an open-access system determining reduction of costs and waiting lists.