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Lingam G, Shakir T, Kader R, Chand M. Role of artificial intelligence in colorectal cancer. Artif Intell Gastrointest Endosc 2024; 5:90723. [DOI: 10.37126/aige.v5.i2.90723] [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: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/11/2024] Open
Abstract
The sphere of artificial intelligence (AI) is ever expanding. Applications for clinical practice have been emerging over recent years. Although its uptake has been most prominent in endoscopy, this represents only one aspect of holistic patient care. There are a multitude of other potential avenues in which gastrointestinal care may be involved. We aim to review the role of AI in colorectal cancer as a whole. We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer. All trials including qualitative research were included from the year 2000 onwards. Studies were grouped into pre-operative, intra-operative and post-operative aspects. Pre-operatively, the major use is with endoscopic recognition. Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic, Japan Narrow-band Imaging Expert Team, Paris and Kudo. However, novel detection and diagnostic methods have arisen from advances in AI classification. Intra-operatively, adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes. Post-operatively, monitoring and surveillance have taken strides with potential socioeconomic and environmental savings. The uses of AI within the umbrella of colorectal surgery are multiple. We have identified existing technologies which are already augmenting cancer care. The future applications are exciting and could at least match, if not surpass human standards.
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Affiliation(s)
- Gita Lingam
- Department of General Surgery, Princess Alexandra Hospital, Harlow CM20 1QX, United Kingdom
| | - Taner Shakir
- Department of Colorectal Surgery, University College London, London W1W 7TY, United Kingdom
| | - Rawen Kader
- Department of Gastroenterology, University College London, University College London Hospitals Nhs Foundation Trust, London W1B, United Kingdom
| | - Manish Chand
- Gastroenterological Intervention Centre, University College London, London W1W 7TS, United Kingdom
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Dankner L, Quiros JA, Volpert D, Atreja A. Evaluating the use of a customized digital navigation program to optimize bowel preparation in pediatric colonsocopy. Front Pediatr 2023; 11:1271222. [PMID: 37876520 PMCID: PMC10591091 DOI: 10.3389/fped.2023.1271222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Adequate bowel preparation is essential for optimal colonoscopy diagnosis and/or intervention. However, suboptimal bowel preparation occurs in as many as 1 in 3 pediatric colonoscopies, leading to missed diagnoses, procedural complications, wasted resources, and increased costs. We aimed to evaluate the effect of an automated Pediatric Colonoscopy Digital Navigation Program (PC-DNP) on the quality of colonoscopy preparation among pediatric patients. Methods The PC-DNP sent patients timely weight-based bowel preparation instructions, video and text-based educational modules, logistical information, and appointment reminders prior to their scheduled diagnostic and/or therapeutic colonoscopies. Physician reported bowel preparation quality among patients/caregivers who were prescribed the PC-DNP were compared to bowel preparation quality of a historical sample of patients/caregivers who received standard care instructions. Results We found that the PC-DNP group had significantly higher bowel preparation quality than the standard care group. Conclusions These results demonstrated that automated DNPs may be easily implemented into the pediatric gastroenterologists' practice and may help streamline and improve bowel preparation in pediatric patients.
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Affiliation(s)
- Lauren Dankner
- Division of Pediatric Gastroenterology, Valley Hospital, Ridgewood, NJ, United States
| | - Jose Antonio Quiros
- Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Diana Volpert
- Division of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashish Atreja
- Chief Information and Digital Health Officer, UC Davis Medical Center, Sacramento, CA, United States
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Cervena K, Siskova A, Jungwirth J, Volarić M, Kral J, Kohout P, Levy M, Vymetalkova V. MALAT1 in Liquid Biopsy: The Diagnostic and Prognostic Promise for Colorectal Cancer and Adenomas? Int J Gen Med 2023; 16:3517-3531. [PMID: 37601809 PMCID: PMC10439781 DOI: 10.2147/ijgm.s420127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction The development of colorectal cancer (CRC) is a multistep process accompanied by the accumulation of mutations that start from specific precancerous lesion - colorectal adenomas (CA). CRC incidence and mortality can be reduced by the early identification of these neoplasm. Colonoscopy is the most widely used screening method for CRC identification. Nowadays, clinical research interest is shifting to the use of liquid biopsy that may help with the early diagnosis of CA and CRC. In our previous study, we identified long non-coding RNA MALAT1 gene amplification associated with the development of CA. Methods This study aimed to describe the potential of MALAT1 expression levels in the adenoma tissue of patients used in the previous study by real-time qPCR. Furthermore, we analysed the plasma samples of an independent group of patients with CA (n=97), CRC (n=101), and cancer-free individuals (CFI, n=48). Results There was no difference in the MALAT1 expression level between CA patients with or without MALAT1 amplification. However, the plasma MALAT1 expression levels were significantly upregulated in patients with CRC and CA compared to CFI (for both p<0.001). Moreover, a correlation between MALAT1 expression and histological types of adenomas was identified- high-CRC-risk adenomas also displayed the highest MALAT1 expression levels. Furthermore, in CRC patients, MALAT1 levels were associated with a response to therapy. Conclusion MALAT1 expression levels could serve as a promising circulating biomarker for early CA and CRC diagnosis, and even as a predictor of therapy response in CRC patients.
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Affiliation(s)
- Klara Cervena
- Institute of Experimental Medicine, Czech Academy of Sciences, Prague, 142 00, Czech Republic
- Institute of Biology and Medical Genetics, 1 Medical Faculty, Charles University, Prague, 128 00, Czech Republic
| | - Anna Siskova
- Institute of Experimental Medicine, Czech Academy of Sciences, Prague, 142 00, Czech Republic
- Institute of Biology and Medical Genetics, 1 Medical Faculty, Charles University, Prague, 128 00, Czech Republic
| | - Jiri Jungwirth
- Institute of Physiology, 1st Faculty of Medicine Charles University, Prague, 121 08, Czech Republic
- Department of Surgery, Weiden Clinic, Weiden in der Oberpfalz, 92637, Germany
| | - Marin Volarić
- Laboratory for Non-Coding DNA, Ruđer Bošković Institute, Zagreb, 10000, Croatia
| | - Jan Kral
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, 140 21, Czech Republic
| | - Pavel Kohout
- Department of Internal Medicine, 3rd Faculty of Medicine Charles University and Faculty Thomayer Hospital Prague, Prague, 140 00, Czech Republic
| | - Miroslav Levy
- Department of Surgery, First Faculty of Medicine, Charles University and Thomayer Hospital Prague, Prague, 140 59, Czech Republic
| | - Veronika Vymetalkova
- Institute of Experimental Medicine, Czech Academy of Sciences, Prague, 142 00, Czech Republic
- Institute of Biology and Medical Genetics, 1 Medical Faculty, Charles University, Prague, 128 00, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, 323 00, Czech Republic
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Sui Y, Zheng Y, Wang Q, Lv J, Wang H, Wen Q, Wang Z, Wang G, Jia H, Cao F, Wang N, Hao J, Zhang Y, Wu X, Chen H, Lu J, Chen X. Comparison of missed adenomas in deep-sedated and unsedated colonoscopy: A multicenter retrospective study. Eur J Intern Med 2023; 110:48-53. [PMID: 36710136 DOI: 10.1016/j.ejim.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Deep-sedated colonoscopy with propofol is widely used in China. However, its impact on quality metrics remains controversial. We aimed to investigate the effects of deep-sedated colonoscopy on missed adenomas, specifically in each colorectal segment. METHODS Data of 3710 individuals from seven hospitals in China who underwent an initial colonoscopy with or without propofol sedation and a second colonoscopy without sedation within six months for surveillance or polypectomy by endoscopist of the same level between October 2020 and September 2021 were retrospectively analyzed. RESULTS A total of 1113 missed adenomas in 3710 patients were evaluated. The adenoma miss rate (AMR) was significantly higher in deep-sedated colonoscopy than in unsedated colonoscop [19.14% (578/3020) vs. 16.15% (535/3313), P < 0.05]. The risk of missing adenomas in deep-sedated colonoscopy was 1.229 times higher than in unsedated colonoscopy (OR, 1.229; 95% CI: 1.080-1.399). AMRs of the splenic flexure (26.02% [96/369] vs. 16.04% [47/293], P < 0.05) and descending colon (20.86% [102/489] vs. 13.37% [54/404], P < 0.05) were significantly higher in deep-sedated colonoscopy than in unsedated colonoscopy when performed by middle-level endoscopists rather than high-level endoscopists (P < 0.05). CONCLUSIONS AMR was higher in deep-sedated colonoscopy than in unsedated colonoscopy. Furthermore, adenomas in the splenic flexure and descending colon were more frequently missed in deep-sedated colonoscopy than in unsedated colonoscopy, particularly when performed by less experienced endoscopists.
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Affiliation(s)
- Yue Sui
- Shanxi Medical University, 030000, China
| | | | - Qing Wang
- Shanxi Medical University, 030000, China.
| | - Jieping Lv
- The First Hospital of Shanxi Medical University, 03000, China.
| | - Hongjin Wang
- The Second People's Hospital of Datong, 037000, China
| | - Qing Wen
- The Second People's Hospital of Datong, 037000, China.
| | - Zhenzhen Wang
- The Second People's Hospital of Datong, 037000, China
| | - Guanfeng Wang
- The Second People's Hospital of Datong, 037000, China.
| | - Hui Jia
- Ordos Mongolian Medical Hospital, 017000, China.
| | - Fengzhen Cao
- Kangning Physical Examination Center, 017000, China
| | - Naping Wang
- The First Hospital of Shanxi Medical University, Yanhu District Branch, 044000, China
| | - Junlian Hao
- Xiaoyi Traditional Chinese Medicine Hospital, 033000, China.
| | - Yiping Zhang
- Datong Shoujia Digestive Disease Hospital, 037000, China.
| | - Xiaopeng Wu
- Lvliang Traditional Chinese Medicine Hospital, 033000, China.
| | - Haihua Chen
- The First Hospital of Shanxi Medical University, 03000, China.
| | - Junhui Lu
- Shanxi Medical University, 030000, China
| | - Xing Chen
- The First Hospital of Shanxi Medical University, 03000, China.
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Comparison of adenoma detection in different colorectal segments between deep-sedated and unsedated colonoscopy. Sci Rep 2022; 12:15356. [PMID: 36097050 PMCID: PMC9468171 DOI: 10.1038/s41598-022-19468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
To investigate if deep-sedated colonoscopy affects adenoma detection in certain colorectal segment. Review of colonoscopy reports, electronic images and medical records of individuals underwent screening colonoscopy with or without propofol sedation between October 2020 and March 2021 from seven hospitals in China. A total of 4500 individuals were analyzed. There was no significant difference in ADR between deep-sedated colonoscopy and unsedated colonoscopy [45.4% vs. 46.3%, P > 0.05]. The APP of deep-sedated colonoscopy was lower than unsedated colonoscopy (1.76 ± 0.81 vs. 2.00 ± 1.30, P < 0.05). Both average number of adenomas and luminal distention score of splenic flexure and descending colon were lower in deep-sedated colonoscopy (P < 0.05), and average number of adenomas was positively correlated with an improved distension score in splenic flexure and descending colon (splenic flexure r = 0.031, P < 0.05; descending colon r = 0.312, P < 0.05). Linear regression model showed deep-sedated colonoscopy significantly affected luminal distention of splenic flexure and descending colon as well as average number of adenomas detected in splenic flexure (P < 0.05). Deep-sedated colonoscopy decreased adenoma detection in splenic flexure and the luminal distention of splenic flexure and descending colon compared with unsedated colonoscopy.
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Sui Y, Chen X, Ma T, Lu J, Xiao T, Wang Z, Wen Q, Wang G, Jia H, Cao F, Wu X, Zhang Y, Hao J, Wang N. Comparison of three sedation models for same-day painless bidirectional endoscopy: A multicenter randomized controlled trial. J Gastroenterol Hepatol 2022; 37:1603-1609. [PMID: 35618650 PMCID: PMC9543240 DOI: 10.1111/jgh.15901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM We investigated the most beneficial propofol sedation model for same-day painless bidirectional endoscopy (BDE). METHODS Asymptomatic participants scheduled for same-day painless BDE examination from October 2020 to September 2021 were randomized to three groups: sedated esophagogastroduodenoscopy followed by unsedated colonoscopy (Group A); sedated esophagogastroduodenoscopy followed by sedated colonoscopy (Group B); and sedated esophagogastroduodenoscopy followed by sedated insertion colonoscopy (Group C). Patient discomfort, colonoscopy performance, doses of propofol, cardiovascular stress, anesthesia resuscitation, and sedation-related adverse events were evaluated. RESULTS A total of 3200 participants were analyzed. Baseline demographics, patient discomfort, cecal intubation rate, adenoma detection rate and sedation-related adverse events were similar in the three groups. Propofol dose was the lowest in Group A (137.65 ± 36.865 mg) compared with Group B (177.71 ± 40.112 mg, P < 0.05) and Group C (161.63 ± 31.789 mg, P < 0.05). Decline in vital signs was most obvious in Group B during the procedure (P < 0.05). Recovery time was the shortest in Group A (5.01 ± 1.404 min) compared with Group B (9.51 ± 2.870 min, P < 0.05) and Group C (5.83 ± 2.594 min, P < 0.05); discharge time was the shortest in Group A (3.53 ± 1.685 min) compared with Group B (11.29 ± 5.172 min, P < 0.05) and Group C (6.47 ± 2.338 min, P < 0.05). Adenomas per positive patient of Group A (2.29 ± 1.055) and Group C (2.28 ± 0.931) were more than that in Group B (2.11 ± 0.946, P < 0.05). CONCLUSIONS Sedated esophagogastroduodenoscopy followed by unsedated colonoscopy is the superior model for same-day painless BDE with the benefits of satisfactory patient comfort, reduced sedation dose, less cardiovascular stress, faster recovery, shorter discharge time and high colonoscopy quality.
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Affiliation(s)
- Yue Sui
- Shanxi Medical UniversityTaiyuanChina
| | - Xing Chen
- Shanxi Medical UniversityTaiyuanChina,The First Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Ting Ma
- Shanxi Medical UniversityTaiyuanChina
| | - Junhui Lu
- Shanxi Medical UniversityTaiyuanChina
| | - Tao Xiao
- Shanxi Cancer HospitalTaiyuanChina
| | | | - Qing Wen
- The Second People's Hospital of DatongDatongChina
| | | | - Hui Jia
- Erdos Kangning Physical Examination CenterErdosChina
| | - Fengzhen Cao
- Erdos Kangning Physical Examination CenterErdosChina
| | - Xiaopeng Wu
- Lvliang Traditional Chinese Medicine HospitalLvliangChina
| | - Yiping Zhang
- Datong Shoujia Digestive Disease HospitalDatongChina
| | - Junlian Hao
- Xiaoyi Traditional Chinese Medicine HospitalXiaoyiChina
| | - Naping Wang
- The First Hospital of Shanxi Medical UniversityYunchengChina
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Liang F, Wang S, Zhang K, Liu TJ, Li JN. Development of artificial intelligence technology in diagnosis, treatment, and prognosis of colorectal cancer. World J Gastrointest Oncol 2022; 14:124-152. [PMID: 35116107 PMCID: PMC8790413 DOI: 10.4251/wjgo.v14.i1.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/19/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) technology has made leaps and bounds since its invention. AI technology can be subdivided into many technologies such as machine learning and deep learning. The application scope and prospect of different technologies are also totally different. Currently, AI technologies play a pivotal role in the highly complex and wide-ranging medical field, such as medical image recognition, biotechnology, auxiliary diagnosis, drug research and development, and nutrition. Colorectal cancer (CRC) is a common gastrointestinal cancer that has a high mortality, posing a serious threat to human health. Many CRCs are caused by the malignant transformation of colorectal polyps. Therefore, early diagnosis and treatment are crucial to CRC prognosis. The methods of diagnosing CRC are divided into imaging diagnosis, endoscopy, and pathology diagnosis. Treatment methods are divided into endoscopic treatment, surgical treatment, and drug treatment. AI technology is in the weak era and does not have communication capabilities. Therefore, the current AI technology is mainly used for image recognition and auxiliary analysis without in-depth communication with patients. This article reviews the application of AI in the diagnosis, treatment, and prognosis of CRC and provides the prospects for the broader application of AI in CRC.
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Affiliation(s)
- Feng Liang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Shu Wang
- Department of Radiotherapy, Jilin University Second Hospital, Changchun 130041, Jilin Province, China
| | - Kai Zhang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Tong-Jun Liu
- Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jian-Nan Li
- Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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Aminnejad R, Hormati A, Shafiee H, Alemi F, Hormati M, Saeidi M, Ahmadpour S, Sabouri SM, Aghaali M. Comparing the efficacy and safety of Dexmedetomidine/Ketamine with Propofol/Fentanyl for sedation in colonoscopy patients: A double-blinded randomized clinical trial. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:724-731. [PMID: 34620069 DOI: 10.2174/1871527320666211006141406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In this double-blinded randomized clinical trial, we aimed to compare the safety and efficacy of a combination of dexmedetomidine and ketamine [DK] with propofol and fentanyl [PF] for sedation in colonoscopy patients. METHODS In this study, 64 patients who underwent colonoscopy were randomized into two groups: 1) A, which received PF, and 2) B, which received DK for sedation. Among 64 patients, 31 patients were included in PF, and 33 patients were included in the DK group. Both groups were similar in terms of demographics. Patients' sedation score (based on Ramsay sedation scale) and vital signs were recorded at 2, 5, 10, and 15 minutes. Complications including apnea, hypotension, hypoxia, nausea, and vomiting, along with gastroenterologist satisfaction and patients' pain score (based on Wong-Baker faces pain assessment scale), were recorded by a checklist. Data were analyzed by SPSS v.18 software, using chi-square, independent t-tests, and repeated measures analysis with p<0.05 as the criterion for significant differences. RESULTS The mean score of sedation was 4.82±0.49 in the DK group and 5.22±0.45 in the PF group [p value=0.001]. Serious complications, including hypotension [p value=0.005] and apnea [p value=0.10] were significantly higher in the PF group. Satisfaction of gastroenterologist [p value= 0.400] and patients' pain score [p value = 0.900] were similar among groups. CONCLUSION Combination of DK provides sufficient sedation with fewer complications in comparison with PF in colonoscopy patients.
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Affiliation(s)
- Reza Aminnejad
- Department of Anesthesiology, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom. Iran
| | - Ahmad Hormati
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran. Iran
| | | | - Faezeh Alemi
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom. Iran
| | | | | | - Sajjad Ahmadpour
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom. Iran
| | - Seyed Mahdi Sabouri
- Department of Family and Community Medicine, School of Medicine, Qom University of Medical Sciences, Qom. Iran
| | - Mohammad Aghaali
- Department of Family and Community Medicine, School of Medicine, Qom University of Medical Sciences, Qom. Iran
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Strong Reduction of Colorectal Cancer Incidence and Mortality After Screening Colonoscopy: Prospective Cohort Study From Germany. Am J Gastroenterol 2021; 116:967-975. [PMID: 33929378 DOI: 10.14309/ajg.0000000000001146] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION A claimed advantage of colonoscopy over sigmoidoscopy in colorectal cancer (CRC) screening is prevention of CRC not only in the distal colon and rectum but also in the proximal colon. We aimed to assess the association of screening colonoscopy use with overall and site-specific CRC incidence and associated mortality. METHODS Information on use of screening colonoscopy as well as potential confounding factors was obtained at baseline in 2000-2002, updated at 2-, 5-, 8-, and 17-year follow-up from 9,207 participants aged 50-75 years without history of CRC in a statewide cohort study in Saarland, Germany. Covariate-adjusted associations of screening colonoscopy with CRC incidence and mortality, which were obtained through record linkage with the Saarland Cancer Registry and mortality statistics up to 2018, were assessed by Cox proportional hazards models with time-varying exposure information. RESULTS During a median follow-up of 17.2 years, 268 participants were diagnosed with CRC and 98 died from CRC. Screening colonoscopy was associated with strongly reduced CRC incidence (adjusted hazard ratio [aHR] 0.44, 95% confidence interval [CI] 0.33-0.57) and mortality (aHR 0.34, 95% CI 0.21-0.53), with stronger reduction for distal (aHRs 0.36, 95% CI 0.25-0.51, and 0.33, 95% CI 0.19-0.59, respectively) than for proximal cancer (aHRs 0.69, 95% CI 0.42-1.13, and 0.62, 95% CI 0.26-1.45, respectively). Nevertheless, strong reduction of mortality from proximal cancer was also observed within 10 years after screening colonoscopy (aHR 0.31, 95% CI 0.10-0.96). DISCUSSION In this large prospective cohort study from Germany, screening colonoscopy was associated with strong reduction in CRC incidence and mortality.
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