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Möllers T, Schwab M, Gildein L, Hoffmeister M, Albert J, Brenner H, Jäger S. Second-generation colon capsule endoscopy for detection of colorectal polyps: Systematic review and meta-analysis of clinical trials. Endosc Int Open 2021; 9:E562-E571. [PMID: 33860073 PMCID: PMC8041571 DOI: 10.1055/a-1353-4849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Adherence to colorectal cancer (CRC) screening is still unsatisfactory in many countries, thereby limiting prevention of CRC. Colon capsule endoscopy (CCE), a minimally invasive procedure, could be an alternative to fecal immunochemical tests or optical colonoscopy for CRC screening, and might increase adherence in CRC screening. This systematic review and meta-analysis evaluates the diagnostic accuracy of CCE compared to optical colonoscopy (OC) as the gold standard, adequacy of bowel preparation regimes and the patient perspective on diagnostic measures. Methods We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Register for Clinical Trials. Pooled estimates for sensitivity, specificity and the diagnostic odds ratio with their respective 95 % confidence intervals (CI) were calculated for studies providing sufficient data. Results Of 840 initially identified studies, 13 were included in the systematic review and up to 9 in the meta-analysis. The pooled sensitivities and specificities for polyps ≥ 6 mm were 87 % (95 % CI: 83 %-90 %) and 87 % (95 % CI: 76 %-93 %) in 8 studies, respectively. For polyps ≥ 10 mm, the pooled estimates for sensitivities and specificities were 87 % (95 % CI: 83 %-90 %) and 95 % (95 % CI: 92 %-97 %) in 9 studies, respectively. A patients' perspective was assessed in 31 % (n = 4) of studies, and no preference of CCE over OC was reported. Bowel preparation was adequate in 61 % to 92 % of CCE exams. Conclusions CCE provides high diagnostic accuracy in an adequately cleaned large bowel. Conclusive findings on patient perspectives require further studies to increase acceptance/adherence of CCE for CRC screening.
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Affiliation(s)
- Tobias Möllers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Clinical Pharmacogenomics and Cancer, Stuttgart, Germany,Department of Clinical Pharmacology, University Hospitals Tubingen, Tubingen, Germany,Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany,German Cancer Consortium, Partner Site Tubingen, Tubingen, Germany
| | - Lisa Gildein
- Department of Gastroenterology and Hepatology, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany
| | - Jörg Albert
- Department of Gastroenterology and Hepatology, Robert Bosch Hospital, Stuttgart, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany,Division of Preventive Oncology, National Center for Tumor Diseases, Heidelberg, Germany,German Cancer Consortium, Heidelberg, Germany
| | - Simon Jäger
- Dr. Margarete Fischer Bosch Institute of Clinical Pharmacology, Clinical Pharmacogenomics and Cancer, Stuttgart, Germany,Department of Clinical Pharmacology, University Hospitals Tubingen, Tubingen, Germany
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Yakubu M, Meggetto O, Lai Y, Peirson L, Walker M, Lofters A. Impact of postal correspondence letters on participation in cancer screening: a rapid review. Prev Med 2021; 145:106404. [PMID: 33388326 DOI: 10.1016/j.ypmed.2020.106404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/20/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023]
Abstract
The purpose of this rapid review was to identify and synthesize evidence on the impact of postal correspondence letters on participation in cancer screening and to determine whether impact varied by cancer site or inclusion of the participant's physician's name within the letter (i.e., physician-linked). PubMed and the Cochrane Database of Systematic Reviews were searched for English-language systematic reviews and randomized controlled trials (RCTs) published up until October 2019. One reviewer completed citation screening and data extraction with 30% verification by a second reviewer. Systematic reviews and RCTs were appraised using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 and Cochrane Risk of Bias 2.0 tools, respectively, by one reviewer with complete verification by a second reviewer. Findings from systematic reviews and RCTs were examined separately and presented narratively. Six systematic reviews and 18 RCTs of generally low quality were included. Evidence generally demonstrated a positive impact of a letter as compared to no letter or usual practice on screening participation. This finding was consistent for breast cancer and cervical screening participation but inconsistent for colorectal cancer screening participation. Studies comparing physician-linked letters to no letters or usual practice reported similar effect estimates as those examining letters in general. Limited and inconsistent evidence was identified on the impact of physician-linked letters as compared to non-physician-linked letters on screening participation. Evidence identified in this rapid review, and other contextual and implementation considerations, may be useful for jurisdictions considering how to promote cancer screening participation.
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Affiliation(s)
- Mafo Yakubu
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada
| | - Olivia Meggetto
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada.
| | - Yonda Lai
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada
| | - Leslea Peirson
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada
| | - Meghan Walker
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Aisha Lofters
- Ontario Health (Cancer Care Ontario), Prevention and Cancer Control, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada; IC/ES, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada
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Veldhuijzen G, Klemt-Kropp M, Terhaar Sive Droste JS, van Balkom B, van Esch AAJ, Drenth JPH. Computer-based patient education is non-inferior to nurse counselling prior to colonoscopy: a multicenter randomized controlled trial. Endoscopy 2021; 53:254-263. [PMID: 32702759 DOI: 10.1055/a-1225-8708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Optimal patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We developed computer-based education (CBE) supported by video and 3 D animations. We hypothesized that CBE could replace nurse counselling without loss of bowel preparation quality during colonoscopy. METHODS We conducted a prospective, multicenter, endoscopist-blinded, non-inferiority randomized controlled trial. The primary outcome was adequate bowel preparation, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were: sickness absence for outpatient clinic visits; patient anxiety/satisfaction scores; and information recall. We included patients in four endoscopy units (rural, urban, and tertiary). RESULTS We screened 1035 eligible patients and randomized 845. After evaluation, 684 were included in the intention-to-treat (ITT) group. Subsequently, 497 patients were included in the per-protocol analysis, 217 in the nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among the groups. On per-protocol analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse-counselled patients (94.0 %; 204/217), with a difference of -0.8 % (95 % confidence interval [CI] -5.1 % to 3.5 %). Non-inferiority was confirmed in the ITT population. Sickness absence was significantly more frequent in nurse-counselled patients (28.0 % vs. 4.8 %). In CBE patients, 21.5 % needed additional information, with 3.0 % needing an extra outpatient visit. CONCLUSION CBE is non-inferior to nurse counselling in terms of bowel preparation during colonoscopy, with lower patient sickness leave. CBE may serve as an efficient educational tool to inform patients before colonoscopy in routine clinical practice.
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Affiliation(s)
- Govert Veldhuijzen
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Michael Klemt-Kropp
- Department of Gastroenterology and Hepatology, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - Bas van Balkom
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands
| | - Aura A J van Esch
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Seoane A, Font X, Pérez JC, Pérez R, Enriquez CF, Parrilla M, Riu F, Dedeu JM, Barranco LE, Duran X, Ibáñez IA, Álvarez MA. Evaluation of an educational telephone intervention strategy to improve non-screening colonoscopy attendance: A randomized controlled trial. World J Gastroenterol 2020; 26:7568-7583. [PMID: 33384555 PMCID: PMC7754547 DOI: 10.3748/wjg.v26.i47.7568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes. Within these programmes, educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement, and because of its huge clinical and economic impact, they have been widely implemented. However, outside of this population programmes, educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.
AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.
METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018. The intervention group (IG) received a telephone intervention, while the control group (CG) did not. Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment. The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy. The impact on patient compliance with preparedness protocols related to bowel cleansing, anti-thrombotic management, and sedation scheduling was also evaluated. A second call was conducted to assess patient satisfaction. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed.
RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively. Six hundred thirteen (83%) patients were contacted in the IG. The non-attendance rate was lower in the IG, both in the ITT analysis (IG 8.4% vs CG 14.3%, P < 0.001) and in the PP analysis (4.4% vs 14.3%, P < 0.001). In a multivariable analysis, belonging to the control group increased the risk of non-attendance in both, the ITT analysis (OR 1.81, 95%CI: 1.27 to 2.58, P = 0.001) and the PP analysis (OR 3.56, 95%CI: 2.25 to 5.64, P < 0.001). There was also a significant difference in compliance with preparedness protocols [bowel cleansing: IG 61.7% vs CG 52.6% (P = 0.001), antithrombotic management: IG 92.5% vs CG 62.8% (P = 0.001), and sedation scheduling: IG 78.8% vs CG 0% (P ≤ 0.001)]. We observed a net benefit of €55600/year after the intervention. The information given before the procedure was rated as excellent by 26% (CG) and 51% (IG) of patients, P ≤ 0.001.
CONCLUSION Educational telephone nurse intervention improves attendance, protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact, which supports its imple-mentation and maintenance over time.
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Affiliation(s)
- Agustín Seoane
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Xènia Font
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Juan C Pérez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Rocío Pérez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Carlos F Enriquez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Miriam Parrilla
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Faust Riu
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Josep M Dedeu
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona 08003, Spain
| | - Luis E Barranco
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Xavier Duran
- Consulting Service on Methodology for Biomedical Research, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Inés A Ibáñez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
| | - Marco A Álvarez
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona 08003, Spain
- Colorectal Cancer Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona 08003, Spain
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