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Okagawa Y, Sumiyoshi T, Hanada K, Hirokawa S, Tomita Y, Yoshida M, Minagawa T, Morita K, Yane K, Ihara H, Hirayama M, Kondo H. Is annual screening by fecal immunochemical test necessary after a recent colonoscopy? DEN OPEN 2025; 5:e385. [PMID: 38770399 PMCID: PMC11103454 DOI: 10.1002/deo2.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Objective The population-based colorectal cancer screening guidelines in Japan recommend an annual fecal immunochemical test (FIT). However, there is no consensus on the need for annual FIT screening for patients who recently performed a total colonoscopy (TCS). Therefore, we evaluated the repeated TCS results for patients with positive FIT after a recent TCS to assess the necessity of an annual FIT. Methods We reviewed patients with positive FIT in opportunistic screening from April 2017 to March 2022. The patients were divided into two groups: those who had undergone TCS within the previous 5 years (previous TCS group) and those who had not (non-previous TCS group). We compared the detection rates of advanced neoplasia and colorectal cancer between the two groups. Results Of 671 patients, 151 had received TCS within 5 years and 520 had not. The detection rates of advanced neoplasia in the previous TCS and non-previous TCS groups were 4.6% and 12.1%, respectively (p < 0.01), and the colorectal cancer detection rates were 0.7% and 1.5%, respectively (no significant difference). The adenoma detection rates were 33.8% in the previous TCS group and 40.0% in the non-previous TCS group (no significant difference). Conclusions Only a few patients were diagnosed with advanced neoplasia among the patients with FIT positive after a recent TCS. For patients with adenomatous lesions on previous TCS, repeated TCS should be performed according to the surveillance program without an annual FIT. The need for an annual FIT for patients without adenomatous lesions on previous TCS should be prospectively assessed in the future.
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Affiliation(s)
- Yutaka Okagawa
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | | | - Kota Hanada
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Sota Hirokawa
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Yusuke Tomita
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | | | | | - Kohtaro Morita
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Kei Yane
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Hideyuki Ihara
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | | | - Hitoshi Kondo
- Department of GastroenterologyTonan HospitalHokkaidoJapan
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Baile‐Maxía S, Mangas‐Sanjuan C, Sala‐Miquel N, Barquero C, Belda G, García‐del‐Castillo G, García‐Herola A, Penalva JC, Picó M, Poveda M, de‐Vera F, Zapater P, Jover R. Incidence, characteristics, and predictive factors of post-colonoscopy colorectal cancer. United European Gastroenterol J 2024; 12:309-318. [PMID: 38234220 PMCID: PMC11017761 DOI: 10.1002/ueg2.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/27/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Post-colonoscopy colorectal cancer (PCCRC) is colorectal cancer (CRC) diagnosed after a colonoscopy in which no cancer is found. OBJECTIVE As PCCRC has become an important quality indicator, we determined its rates, characteristics, and index colonoscopy-related predictive factors. METHODS We carried out a multicenter, observational, retrospective study between 2015 and 2018. Rates were calculated for PCCRC developing up to 10 years after colonoscopy. PCCRC was categorized according to the most plausible explanation using World Endoscopy Organization methodology. Our PCCRC population was compared to a control cohort without CRC matched 1:4 by sex, age, index colonoscopy date, indication, endoscopist, and hospital. RESULTS One hundred seven PCCRC and 2508 detected CRC were diagnosed among 101,524 colonoscopy (0.1%), leading to rates of 0.4%, 2.2%, 3.1%, and 4.1% at 1, 3, 5, and 10 years, respectively. PCCRC was in right (42.4%), left (41.4%), and transverse (16.4%) colon with 31.5% at stage I, 24.7% stage II, 32.6% stage III, and 11.2% stage IV. Twenty point three percent were classified as incomplete resection, 5.4% as unresected lesions, 48.6% as missed lesions with adequate colonoscopy, and 25.7% as missed lesions with inadequate colonoscopy. The median time from colonoscopy to PCCRC was 42 months. Previous inadequate preparation (OR 3.05, 95%CI 1.73-5.36) and piecemeal polypectomy (OR 19.89, 95%CI 8.67-45.61) were independently associated with PCCRC. CONCLUSIONS In our population, 4.1% of CRC cases were PCCRC. Most of these lesions were in right colon and attributable to lesions not visualized despite adequate bowel cleansing. Previous inadequate cleansing and piecemeal polypectomy were associated with PCCRC.
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Affiliation(s)
- Sandra Baile‐Maxía
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
| | - Carolina Mangas‐Sanjuan
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
| | - Noelia Sala‐Miquel
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
| | - Claudia Barquero
- Gastroenterology DepartmentHospital Universitario de TorreviejaTorreviejaSpain
| | - Germán Belda
- Gastroenterology DepartmentHospital Universitario Vega BajaOrihuelaSpain
| | | | | | | | - María‐Dolores Picó
- Gastroenterology DepartmentHospital General Universitario de ElcheElcheSpain
| | | | - Félix de‐Vera
- Gastroenterology DepartmentHospital General Universitario de EldaEldaSpain
| | - Pedro Zapater
- Clinical Pharmacology UnitHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Universidad Miguel HernándezIDIBECIBERehdAlicanteSpain
| | - Rodrigo Jover
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
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3
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Baile-Maxía S, Jover R. Surveillance after colorectal polyp resection. Best Pract Res Clin Gastroenterol 2023; 66:101848. [PMID: 37852710 DOI: 10.1016/j.bpg.2023.101848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 07/02/2023] [Indexed: 10/20/2023]
Abstract
Post-polypectomy surveillance has proven to reduce colorectal cancer (CRC) incidence in patients with high-risk polyps, but it implies a major burden on colonoscopy units. Therefore, it should be targeted to individuals with a higher risk. Different societies have published guidelines on surveillance after resection of polyps, with notable discrepancies among them, and many recommendations come from low-quality evidence based on surrogate measures, such as risk of advanced adenoma, and not CRC risk. In this review, we aimed to summarize the evidence supporting post-polypectomy surveillance, compare the recently updated major guidelines, and discuss the existing discrepancies on this topic. Briefly, patients with adenomas ≥10 mm or high-grade dysplasia and patients with serrated polyps ≥10 mm or dysplasia are generally considered to have an increased risk of metachronous CRC and require surveillance, whereas the indication of surveillance is not clearly established in patients without these high-risk features.
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Affiliation(s)
- Sandra Baile-Maxía
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
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4
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Rattan N, Willmann L, Aston D, George S, Bassan M, Abi-Hanna D, Anandabaskaran S, Ermerak G, Ng W, Koo JH. To scope or not - the challenges of managing patients with positive fecal occult blood test after recent colonoscopy. World J Gastrointest Oncol 2022; 14:1798-1807. [PMID: 36187395 PMCID: PMC9516652 DOI: 10.4251/wjgo.v14.i9.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/12/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a major health problem. There is minimal consensus of the appropriate approach to manage patients with positive immunochemical fecal occult blood test (iFOBT), following a recent colonoscopy.
AIM To determine the prevalence of advanced neoplasia in patients with a positive iFOBT after a recent colonoscopy, and clinical and endoscopic predictors for advanced neoplasia.
METHODS The study recruited iFOBT positive patients who underwent colonoscopy between July 2015 to March 2020. Data collected included demographics, clinical characteristics, previous and current colonoscopy findings. Primary outcome was the prevalence of CRC and advanced neoplasia in a patient with positive iFOBT and previous colonoscopy. Secondary outcomes included identifying any clinical and endoscopic predictors for advanced neoplasia.
RESULTS The study included 1051 patients (male 53.6%; median age 63). Forty-two (4.0%) patients were diagnosed with CRC, 513 (48.8%) with adenoma/sessile serrated lesion (A-SSL) and 257 (24.5%) with advanced A-SSL (AA-SSL). A previous colonoscopy had been performed in 319 (30.3%). In this cohort, four (1.3%) were diagnosed with CRC, 146 (45.8%) with A-SSL and 56 (17.6%) with AA-SSL. Among those who had a colonoscopy within 4 years, none had CRC and 7 had AA-SSL. Of the 732 patients with no prior colonoscopy, there were 38 CRCs (5.2%). Independent predictors for advanced neoplasia were male [odds ratio (OR) = 1.80; 95% confidence interval (CI): 1.35-2.40; P < 0.001), age (OR = 1.04; 95%CI: 1.02-1.06; P < 0.001) and no previous colonoscopy (OR = 2.07; 95%CI: 1.49-2.87; P < 0.001).
CONCLUSION A previous colonoscopy, irrespective of its result, was associated with low prevalence of advanced neoplasia, and if performed within four years of a positive iFOBT result, was protective against CRC.
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Affiliation(s)
- Nivedita Rattan
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - Laura Willmann
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | - Diana Aston
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | - Shani George
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | - Milan Bassan
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - David Abi-Hanna
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | | | - George Ermerak
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - Watson Ng
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - Jenn Hian Koo
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
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5
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A True Positive and a False Negative? The Dilemma of Negative Colonoscopy After a Positive Fecal Occult Blood Test. Dig Dis Sci 2022; 67:1843-1849. [PMID: 33939150 DOI: 10.1007/s10620-021-06986-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/30/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Many colonoscopies following a positive fecal immunochemical test (FIT) will not identify a probable cause for fecal blood, and missed neoplasia is a concern. The study determined whether the absence of neoplasia at a FIT positive diagnostic colonoscopy was due to a missed lesion and whether the initial FIT hemoglobin (f-Hb) concentration could predict missed lesions. METHODS This was a retrospective audit of patients who had undergone diagnostic colonoscopy after FIT screening (2 sample ≥ 20 µg Hb/g feces). Probable bleeding lesions including cancer, advanced adenoma, colitis, and angiodysplasia were considered a "positive colonoscopy outcome." For those with a negative outcome, findings at the subsequent colonoscopy were assessed. RESULTS There were 1087 good quality colonoscopies within 12 months of a positive FIT. In total, 171 (15.7%) patients had a positive outcome at the diagnostic colonoscopy. Subsequent colonoscopies of negative outcome cases (n = 418, median of 3.1y later) were reviewed; of these, there were 57 (13.6%) cases with a positive outcome. This included CRC in 0.5% (n = 2) and advanced adenoma in 11.7% (n = 49). High f-Hb and having both FIT samples ≥ 20 µg/g feces were associated with a positive outcome at the original diagnostic colonoscopy (p < 0.05). However, f-Hb was not predictive for a positive outcome at the subsequent colonoscopy by either maximum f-Hb (p = 0.768), total f-Hb (p = 0.459), or both FIT samples ≥ 20 µg/g (p = 0.091). CONCLUSION A small proportion of "false" positive FIT results had cancer or advanced adenoma found at the subsequent colonoscopy. A missed lesion could not be predicted by the initial FIT f-Hb.
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6
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Nielsen JC, Ploug M, Baatrup G, Kroijer R. Risk of post colonoscopy colorectal cancer following screening colonoscopy with low-risk or no adenomas: A population-based study. Colorectal Dis 2021; 23:2932-2936. [PMID: 34427981 DOI: 10.1111/codi.15886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
AIM In the Danish faecal occult blood test based bowel cancer screening programme, the first round was rolled out over 4 years. After roll-out, the planned faecal test recall procedure for individuals with either no or low risk adenomas at colonoscopy is 8 and 2 years, respectively. Here, we aimed to investigate the post colonoscopy colorectal cancer incidence in these two groups. METHODS All Danish screening individuals from 2014 to 2015 with a positive faecal test and either no or low risk adenomas at colonoscopy were included and followed for 3 years post screening for the event of colorectal cancer through national registries. RESULTS Out of 533,023 submitted faecal tests and 36,673 positive tests, 17,627 had no or low risk adenomas. We identified 60 (0.34%) individuals diagnosed with colorectal cancer within 3 years, 18 (0.29%) in the low risk adenoma group, and 42 (0.37%) in the no adenomas group (p = 0.44). Advancing age (HR = 1.079, p < 0.001) and higher faecal test value (HR = 1.001, p = 0.002) increased hazard of colorectal cancer occurrence, whereas male sex (HR = 1.3, p = 0.308) and having low risk adenomas (HR = 0.729, p = 0.264) did not. CONCLUSION We found no difference in post colonoscopy colorectal cancer occurrence between individuals with either no or low risk adenomas. Instead, advancing age and increased faecal test value was associated with a higher risk of post colonoscopy colorectal cancer.
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Affiliation(s)
| | - Magnus Ploug
- Surgical Department, Hospital South West Jutland, Esbjerg, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rasmus Kroijer
- Surgical Department, Hospital South West Jutland, Esbjerg, Denmark
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7
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Cusumano VT, Myint A, Corona E, Yang L, Bocek J, Lopez AG, Huang MZ, Raja N, Dermenchyan A, Roh L, Han M, Croymans D, May FP. Patient Navigation After Positive Fecal Immunochemical Test Results Increases Diagnostic Colonoscopy and Highlights Multilevel Barriers to Follow-Up. Dig Dis Sci 2021; 66:3760-3768. [PMID: 33609211 DOI: 10.1007/s10620-021-06866-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The fecal immunochemical test (FIT) is a common colorectal cancer screening modality in the USA but often is not followed by diagnostic colonoscopy. AIMS We investigated the efficacy of patient navigation to increase diagnostic colonoscopy after positive FIT results and determined persistent barriers to follow-up despite navigation in a large, academic healthcare system. METHODS The study cohort included all health system outpatients with an assigned primary care provider, a positive FIT result between 12/01/2016 and 06/01/2019, and no documentation of colonoscopy after positive FIT. Two non-clinical patient navigators engaged patients and providers to encourage follow-up, offer solutions to barriers, and assist with colonoscopy scheduling. The primary intervention endpoint was completion of colonoscopy within 6 months of navigation. We documented reasons for persistent barriers to colonoscopy despite navigation and determined predictors of successful follow-up after navigation. RESULTS There were 119 patients who received intervention. Of these, 37 (31.1%) patients completed colonoscopy at 6 months. In 41/119 (34.5%) cases, the PCP did not recommend colonoscopy, most commonly due to a normal colonoscopy prior to the positive FIT (19, 46.3%). There were 41/119 patients (34.5%) that declined colonoscopy despite the patient navigator and the PCP order. Male sex and younger age were significant predictors of follow-up (aOR = 2.91, 95%CI, 1.18-7.13; aOR = 0.92, 95%CI, 0.87-0.99). CONCLUSIONS After implementation of patient navigation, diagnostic colonoscopy was completed for 31.1% of patients with a positive FIT result. However, navigation also highlighted persistent multilevel barriers to follow-up. Future work will develop targeted solutions for these barriers to further increase FIT follow-up rates in our health system.
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Affiliation(s)
- Vivy T Cusumano
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Anthony Myint
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Edgar Corona
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Liu Yang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer Bocek
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA
| | - Antonio G Lopez
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA
| | - Marcela Zhou Huang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA
| | - Naveen Raja
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA
| | - Anna Dermenchyan
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lily Roh
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Faculty Practice Group and Office of Population Health and Accountable Care, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria Han
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel Croymans
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.,Quality Program, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Folasade P May
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA. .,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Cancer Prevention Control Research, UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA. .,Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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8
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Jung YS, Lee J, Moon CM. Risk of colorectal cancer in patients with positive results of fecal immunochemical test performed within 5 years since the last colonoscopy. Korean J Intern Med 2021; 36:1083-1091. [PMID: 34134468 PMCID: PMC8435487 DOI: 10.3904/kjim.2020.525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/AIMS Annual fecal immunochemical tests (FITs) are often repeated within the recommended colonoscopy surveillance intervals. However, it remains unclear whether interval FITs are useful. To answer this question, we assessed the risk of colorectal cancer (CRC) according to the interval from the last colonoscopy to an FIT. METHODS Using the Korean National Cancer Screening Program database, we collected data on patients who underwent FITs in 2011. Patients with positive FIT results were classified into three groups according to their previous colonoscopy interval: 0.5 to 5 years (group 1), 5 to 10 years (group 2), and ≥ 10 years or no colonoscopy (group 3). CRC incidence was defined as CRC diagnosed within 1 year after an FIT. RESULTS Among 177,660 patients with positive FIT results, the incidence of CRC in groups 1, 2, and 3 was 0.72% (n = 214/29,575), 1.28% (n = 116/9,083), and 3.88% (n = 5,387/139,002), respectively. The age- and sex-adjusted risk for CRC was higher in groups 2 (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.43 to 2.25) and 3 (OR, 5.56; 95% CI, 4.85 to 6.38) than in group 1. Among patients who did and did not undergo a polypectomy during the previous colonoscopy, those in group 2 had a higher rate of CRC than those in group 1 (without polypectomy: 1.15% vs. 0.63%; OR, 1.79; 95% CI, 1.37 to 2.34) (with polypectomy: 2.37% vs. 0.93 %; OR, 2.30; 95% CI, 1.44 to 3.69). CONCLUSION In patients with positive FIT results who had undergone a colonoscopy within the past 5 years, the risk of CRC is very low, regardless of whether a polypectomy was performed, suggesting that interval FITs are not useful.
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Affiliation(s)
- Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jinhee Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon,
Korea
| | - Chang Mo Moon
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul,
Korea
- Inflammation-Cancer Microenvironment Research Center, Ewha Womans University College of Medicine, Seoul,
Korea
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9
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Amankulov J, Kaidarova D, Zholdybay Z, Zagurovskaya M, Baltabekov N, Gabdullina M, Ainakulova A, Toleshbayev D, Panina A, Satbayeva E, Kalieva Z. Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan. Clin Endosc 2021; 55:101-112. [PMID: 34265195 PMCID: PMC8831409 DOI: 10.5946/ce.2021.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background/Aims The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.
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Affiliation(s)
- Jandos Amankulov
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Dilyara Kaidarova
- Department of Medical Oncology, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Zhamilya Zholdybay
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Marianna Zagurovskaya
- Department of Radiology, Medical College at the University of Kentucky, Lexington, KY, USA
| | - Nurlan Baltabekov
- Department of Medical Oncology, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Madina Gabdullina
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Akmaral Ainakulova
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Dias Toleshbayev
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Alexandra Panina
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Elvira Satbayeva
- Center of Morphological Diagnostics, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Zhansaya Kalieva
- Department of Endoscopy, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
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10
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Ebner DW, Eckmann JD, Burger KN, Mahoney DW, Bering J, Kahn A, Rodriguez EA, Prichard DO, Wallace MB, Kane SV, Finney Rutten LJ, Gurudu SR, Kisiel JB. Detection of Postcolonoscopy Colorectal Neoplasia by Multi-target Stool DNA. Clin Transl Gastroenterol 2021; 12:e00375. [PMID: 34140458 PMCID: PMC8216679 DOI: 10.14309/ctg.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Significant variability between colonoscopy operators contributes to postcolonoscopy colorectal cancers (CRCs). We aimed to estimate postcolonoscopy colorectal neoplasia (CRN) detection by multi-target stool DNA (mt-sDNA), which has not previously been studied for this purpose. METHODS In a retrospective cohort of patients with +mt-sDNA and completed follow-up colonoscopy, positive predictive value (PPV) for endpoints of any CRN, advanced adenoma, right-sided neoplasia, sessile serrated polyps (SSP), and CRC were stratified by the time since previous colonoscopy (0-9, 10, and ≥11 years). mt-sDNA PPV at ≤9 years from previous average-risk screening colonoscopy was used to estimate CRN missed at previous screening colonoscopy. RESULTS Among the 850 studied patients with +mt-sDNA after a previous negative screening colonoscopy, any CRN was found in 535 (PPV 63%). Among 107 average-risk patients having +mt-sDNA ≤9 years after last negative colonoscopy, any CRN was found in 67 (PPV 63%), advanced neoplasia in 16 (PPV 15%), right-sided CRN in 48 (PPV 46%), and SSP in 20 (PPV 19%). These rates were similar to those in 47 additional average risk persons with previous incomplete colonoscopy and in an additional 68 persons at increased CRC risk. One CRC (stage I) was found in an average risk patient who was mt-sDNA positive 6 years after negative screening colonoscopy. DISCUSSION The high PPV of mt-sDNA 0-9 years after a negative screening colonoscopy suggests that lesions were likely missed on previous examination or may have arisen de novo. mt-sDNA as an interval test after negative screening colonoscopy warrants further study.
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Affiliation(s)
- Derek W. Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason D. Eckmann
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelli N. Burger
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W. Mahoney
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie Bering
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Allon Kahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Eduardo A. Rodriguez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - David O. Prichard
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic Health System, La Crosse, Wisconsin, USA
| | - Michael B. Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sunanda V. Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Suryakanth R. Gurudu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - John B. Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Making FIT Count: Maximizing Appropriate Use of the Fecal Immunochemical Test for Colorectal Cancer Screening Programs. J Gen Intern Med 2020; 35:1870-1874. [PMID: 32128688 PMCID: PMC7280423 DOI: 10.1007/s11606-020-05728-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) remains one of the most common and deadly malignancies despite advancements in screening, diagnostic capabilities, and treatment. The ability to detect and remove precancerous and cancerous lesions via screening has altered the epidemiology of the disease, decreasing incidence, mortality, and late-stage disease presentation. The fecal immunochemical test (FIT) is a screening test that aims to detect human hemoglobin in the stool. FIT is the most common CRC screening modality worldwide and second most common in the United States. Its use in screening programs has been shown to increase screening uptake and improve CRC outcomes. However, FIT-based screening programs vary widely in quality and effectiveness. In health systems with high-quality FIT screening programs, only superior FIT formats are used, providers order FIT appropriately, annual patient participation is high, and diagnostic follow-up after an abnormal result is achieved in a timely manner. Proper utilization of FIT involves multiple steps beyond provider recommendation of the test. In this commentary, we aim to highlight ongoing challenges in FIT screening and suggest interventions to maximize FIT effectiveness. Through active engagement of patients and providers, health systems can use FIT to help optimize CRC screening rates and improve CRC outcomes.
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12
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Cusumano VT, Corona E, Partida D, Yang L, Yu C, May FP. Patients without colonoscopic follow-up after abnormal fecal immunochemical tests are often unaware of the abnormal result and report several barriers to colonoscopy. BMC Gastroenterol 2020; 20:115. [PMID: 32306919 PMCID: PMC7168865 DOI: 10.1186/s12876-020-01262-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 04/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background The fecal immunochemical test (FIT) is the second most commonly used colorectal cancer (CRC) screening modality in the United States; yet, follow-up of abnormal FIT results with diagnostic colonoscopy is underutilized. Our objective was to determine patient-reported barriers to diagnostic colonoscopy following abnormal FIT in an academic healthcare setting. Methods We included patients age 50–75 with an abnormal FIT result between 1/1/2015 and 10/31/2017 and no documented follow-up diagnostic colonoscopy. We abstracted demographic data from the electronic health record (EHR). Study personnel conducted telephone surveys with patients to confirm colonoscopy completion and elicit data on notification of FIT results and barriers to colonoscopy. We also provided brief verbal education about diagnostic colonoscopy. We calculated frequencies of demographic data and survey responses and compared survey responses by interest in colonoscopy after education. Results We surveyed 67 patients. Fifty-one were aware of the abnormal FIT result, and a majority learned of the abnormal FIT result by direct communication with providers (19, 37.3%) or EHR messaging (11, 21.6%). Overall, fifty-three patients (79.1%) confirmed lack of colonoscopy, citing provider-related (19, 35.8%), patient-related (16, 30.2%), system-related (1, 1.9%), or multifactorial (17, 32.1%) reasons. Lack of knowledge of FIT result (14, 26.4%) was most common. After brief education, 20 (37.7%) patients requested colonoscopy. Conclusion Patients with an abnormal FIT reported various multi-level barriers to diagnostic colonoscopy after abnormal FIT, including knowledge of FIT results. When provided with brief education, participants expressed interest in diagnostic colonoscopy. Future efforts will evaluate interventions to improve colonoscopy follow-up.
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Affiliation(s)
- Vivy T Cusumano
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Edgar Corona
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Diana Partida
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Liu Yang
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christine Yu
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Gastroenterology, Southern California Permanente Medical Group, Los Angeles, California, USA
| | - Folasade P May
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. .,Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. .,UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, Los Angeles, California, USA. .,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
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13
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Kawamura T, Inoue T, Shinomiya R, Sakai H, Amamiya K, Sakiyama N, Shirakawa A, Okada Y, Sanada K, Nakase K, Mandai K, Suzuki A, Kamaguchi M, Morita A, Nishioji K, Tanaka K, Uno K, Yokota I, Kobayashi M, Yasuda K. Significance of fecal hemoglobin concentration for predicting risk of colorectal cancer after colonoscopy. JGH OPEN 2020; 4:898-902. [PMID: 33102761 PMCID: PMC7578332 DOI: 10.1002/jgh3.12346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
Background and Aim As the significance of the quantitative fecal immunochemical test (FIT) in patients who previously underwent a colonoscopy is unknown, this study aimed at investigating the association between fecal hemoglobin concentration and the risk of colorectal cancer (CRC). Methods and Results We retrospectively analyzed FIT-positive patients who underwent a colonoscopy through our opportunistic annual screening program from April 2010 to March 2017 at the Kyoto Second Red Cross Hospital. We stratified them into no colonoscopy and past colonoscopy (>5 years or ≤5 years) groups based on whether they had a history of undergoing a colonoscopy and analyzed the correlation between fecal hemoglobin concentration and advanced neoplasia or invasive cancer detection in each group. We analyzed 1248 patients with positive FIT results. There were 748 (59.9%), 198 (15.9%), and 302 (24.2%) patients in the no colonoscopy, past colonoscopy (>5 years), and past colonoscopy (≤5 years) groups, respectively. In the no colonoscopy group, the advanced neoplasia detection rate significantly increased with the fecal hemoglobin concentration (P < 0.001). However, no significant trend was observed in the past colonoscopy (both >5 years and ≤5 years) group (P = 0.982). No invasive cancer was detected in the past colonoscopy (≤5 years) group. Conclusion The risk of CRC might be low even if fecal hemoglobin concentration was high, especially in those who underwent colonoscopy within 5 years.
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Affiliation(s)
- Takuji Kawamura
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Takato Inoue
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Ryo Shinomiya
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Hiroaki Sakai
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Kana Amamiya
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Naokuni Sakiyama
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Atsushi Shirakawa
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Yusuke Okada
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Kasumi Sanada
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Kojiro Nakase
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Koichiro Mandai
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Azumi Suzuki
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Mai Kamaguchi
- Department of Health Care Kyoto Second Red Cross Hospital Kyoto Japan
| | - Atsushi Morita
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Kenichi Nishioji
- Department of Health Care Kyoto Second Red Cross Hospital Kyoto Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Koji Uno
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Masao Kobayashi
- Department of Health Care Kyoto Second Red Cross Hospital Kyoto Japan
| | - Kenjiro Yasuda
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
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14
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Anderson R, Burr NE, Valori R. Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology 2020; 158:1287-1299.e2. [PMID: 31926170 DOI: 10.1053/j.gastro.2019.12.031] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 12/07/2019] [Accepted: 12/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Postcolonoscopy colorectal cancer (PCCRC) is CRC diagnosed after a colonoscopy in which no cancer was found. A consensus article from the World Endoscopy Organization (WEO) proposed an approach for investigating and categorizing PCCRCs detected within 4 years of a colonoscopy. We aimed to identify cases of PCCRC and the factors that cause them, test the WEO system of categorization, quantify the proportion of avoidable PCCRCs, and propose a target rate for PCCRCs detected within 3 years of a colonoscopy that did not detect CRC. METHODS We performed a retrospective analysis of 107 PCCRCs identified at a single medical center in England from January 1, 2010, through December 31, 2017 using coding and endoscopy data. For each case, we reviewed clinical, pathology, radiology, and endoscopy findings. Using the WEO recommendations, we performed a root-cause analysis of each case, categorizing lesions as follows: possible missed lesion, prior examination adequate; possible missed lesion, prior examination inadequate; detected lesion, not resected; or likely incomplete resection of previously identified lesion. We determined whether PCCRCs could be attributed to the colonoscopist for technical or decision-making reasons, and whether the PCCRC was avoidable or unavoidable, based on the WEO categorization and size of tumor. The endoscopy reporting system provided performance data for individual endoscopists. RESULTS Of the PCCRCs identified, 43% were in high-risk patients (those with inflammatory bowel disease, previous CRC, previous multiple large polyps, or hereditary cancer syndromes) and 66% were located distal to the hepatic flexure. There was no correlation between postcolonoscopy colorectal tumor size and time to diagnosis after index colonoscopy. Bowel preparation was poor in 19% of index colonoscopies, and only 36% of complete colonoscopies had adequate photodocumentation of completion. Development of 73% of PCCRCs was determined to be affected by technical endoscopic factors, 17% of PCCRCs by administrative factors (follow-up procedures delayed/not booked by administrative staff), and 27% of PCCRCs by decision-making factors. Twenty-seven percent of PCCRCs were categorized as possible missed lesion, prior examination adequate; 58% as possible missed lesion, prior examination inadequate; 8% as detected lesion, not resected; and 7% as incomplete resection of previously observed lesion; 89% were deemed to be avoidable. CONCLUSIONS In a retrospective analysis of PCCRCs, using the WEO system of categorization, we found 43% to occur in high-risk patients; this might be reduced with more vigilant surveillance. Measures are needed to reduce technical, decision-making, and administrative factors. We found that 89% of PCCRCs may be avoidable. If half of avoidable PCCRCs could be prevented, the target rate of 2% for the PCCRC-3y (cancer diagnosed between 6 and 36 months after index colonoscopy) benchmark would be achievable.
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Affiliation(s)
- Rebecca Anderson
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Nicholas E Burr
- The Mid Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Wakefield, United Kingdom; Cancer Epidemiology Group, Institute of Cancer & Pathology and Institute of Data Analytics, University of Leeds, United Kingdom
| | - Roland Valori
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom.
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15
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Kawamura T, Uno K. Should we perform repeated colonoscopy for fecal immunochemistry test-positive, average-risk patients after a recent colonoscopy with negative results? Gastrointest Endosc 2019; 90:319. [PMID: 31327342 DOI: 10.1016/j.gie.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Koji Uno
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
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