Performance of additional colonoscopies and yield of neoplasms within 3 years after screening colonoscopy: a historical cohort study

 

 Buy Article Permissions and Reprints

Background and study aims: After screening colonoscopy, additional colonoscopies may be required for adenoma surveillance or diagnostic reasons. The aim of the present study was to explore their utilization and findings in routine practice.

Patients and methods: The study comprised an historical cohort of individuals participating in colonoscopy screening in 2006. Utilization and yield of neoplasms of additional colonoscopies performed in these individuals by the same physician ( < 6 months and 6 – 36 months after screening) between 2006 and 2009 were assessed using data of a colonoscopy quality assurance program in Bavaria, Germany. Screening including polypectomy, and short-term follow-up colonoscopy was assumed to have been completed within ≤ 6 months. Multivariate logistic regression was used to identify predictors of additional colonoscopy and advanced neoplasms (high risk adenoma or colorectal cancer [CRC]) among those with additional colonoscopy during the period of 6 – 36 months after screening.

Results: A total of 51 301 individuals undergoing screening colonoscopy were included. Of these, 10.1 % (95 % confidence interval [CI] 9.8 % – 10.3 %) had an additional colonoscopy performed by the same physician between 6 and 36 months after screening. The percentages of those with additional colonoscopy were 5.7 % (95 %CI 5.5 % – 5.9 %), 18.6 % (95 %CI 17.8 % – 19.4 %), and 33.7 % (95 %CI 32.2 % – 35.2 %) after negative screening, low risk adenoma at screening, and high risk adenoma at screening, respectively. The overall findings were negative colonoscopy, low risk adenoma, high risk adenoma, and CRC in 68.6 % (95 %CI 67.3 % – 69.8 %), 24.1 % (95 %CI 23.0 % – 25.3 %), 6.7 % (95 %CI 6.0 % – 7.4 %), and 0.6 % (95 %CI 0.4 % – 0.8 %), respectively. Younger age, male sex, screen-detected adenomas, inflammatory bowel disease, and early repeat colonoscopy within 6 months were predictors of additional colonoscopy. Older age, male sex, screen-detected adenomas, and surveillance indications were associated with increased risk of advanced neoplasms at post-screening colonoscopy.

Conclusion: The results indicate frequent utilization of additional colonoscopies along with substantial adenoma yield in the first 3 years after screening colonoscopy.

• References

• 1 Heitman SJ, Ronksley PE, Hilsden RJ et al. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7: 1272-1278
  CrossrefPubMedSearch in Google Scholar
• 2 Ferlitsch M, Reinhart K, Pramhas S et al. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA 2011; 306: 1352-1358
  CrossrefPubMedSearch in Google Scholar
• 3 Pox CP, Altenhofen L, Brenner H et al. Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 2012; 142: 1460-1467.e1462
  CrossrefPubMedSearch in Google Scholar
• 4 Arditi C, Gonvers JJ, Burnand B et al. Appropriateness of colonoscopy in Europe (EPAGE II). Surveillance after polypectomy and after resection of colorectal cancer. Endoscopy 2009; 41: 209-217
  Thieme ConnectPubMedSearch in Google Scholar
• 5 Schmiegel W, Pox C, Reinacher-Schick A et al. S3 guidelines for colorectal carcinoma. Results of an evidence-based consensus conference on February 6/7, 2004 and June 8/9, 2007 (for the topics IV, VI and VII). Z Gastroenterol 2010; 48: 65-136
  Thieme ConnectPubMedSearch in Google Scholar
• 6 Winawer SJ, Zauber AG, Fletcher RH et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology 2006; 130: 1872-1885
  CrossrefPubMedSearch in Google Scholar
• 7 Atkin WS, Valori R, Kuipers EJ et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Colonoscopic surveillance following adenoma removal. Endoscopy 2012; 44: SE151-SE163
  Thieme ConnectPubMedSearch in Google Scholar
• 8 Saini SD, Kim HM, Schoenfeld P. Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review. Gastrointest Endosc 2006; 64: 614-626
  CrossrefPubMedSearch in Google Scholar
• 9 Pox C, Schmiegel W. Colorectal screening in Germany. Z Gastroenterol 2008; 46: 31-32
  Thieme ConnectPubMedSearch in Google Scholar
• 10 Heldwein W, Dollhopf M, Rösch T et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 2005; 37: 1116-1122
  Thieme ConnectPubMedSearch in Google Scholar
• 11 Adler A, Roll S, Marowski B et al. Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective, multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1). Dis Colon Rectum 2007; 50: 1628-1638
  CrossrefPubMedSearch in Google Scholar
• 12 Brenner H, Hoffmeister M, Stegmaier C et al. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies. Gut 2007; 56: 1585-1589
  CrossrefPubMedSearch in Google Scholar
• 13 Sieverding M, Matterne U, Ciccarello L. Gender differences in FOBT use: evidence from a large German survey. Z Gastroenterol 2008; 46: 47-51
  Thieme ConnectPubMedSearch in Google Scholar
• 14 Crispin A, Birkner B, Munte A et al. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy 2009; 41: 1018-1025
  Thieme ConnectPubMedSearch in Google Scholar
• 15 Fröhlich E, Müller R, Leiss O. [Effect of quality assessment assurance in 2002 (before starting the German colorectal cancer screening programme by colonoscopy) on the quality of reprocessing of flexible endoscopes – a nationwide analysis]. Z Gastroenterol 2009; 47: 1137-1144
  Thieme ConnectPubMedSearch in Google Scholar
• 16 Brenner H, Hoffmeister M, Arndt V et al. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 2010; 102: 89-95
  CrossrefPubMedSearch in Google Scholar
• 17 Ziegler M, Schubring-Giese B, Bühner M et al. Attitude to secondary prevention and concerns about colonoscopy are independent predictors of acceptance of screening colonoscopy. Digestion 2010; 81: 120-126
  CrossrefPubMedSearch in Google Scholar
• 18 Stock C, Ihle P, Schubert I et al. Colonoscopy and fecal occult blood test use in Germany: results from a large insurance-based cohort. Endoscopy 2011; 43: 771-781
  Thieme ConnectPubMedSearch in Google Scholar
• 19 Stock C, Brenner H. Utilization of lower gastrointestinal endoscopy and fecal occult blood test in 11 European countries: evidence from the Survey of Health, Aging and Retirement in Europe (SHARE). Endoscopy 2010; 42: 546-556
  Thieme ConnectPubMedSearch in Google Scholar
• 20 Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit [Bavarian Health and Food Safety Authority]. Gesundheitsberichterstattung: Ausgaben und Finanzierung. Available from: http://www.lgl.bayern.de/gesundheit/ (Accessed: 18 December 2012)
  PubMed
• 21 Mansmann U, Crispin A, Henschel V et al. Epidemiology and quality control of 245 000 outpatient colonoscopies. Dtsch Arztebl Int 2008; 105: 434-440
  PubMedSearch in Google Scholar
• 22 Kolligs FT, Crispin A, Munte A et al. Risk of advanced colorectal neoplasia according to age and gender. PLoS ONE 2011; 6: e20076
  CrossrefPubMedSearch in Google Scholar
• 23 Schmiegel W, Pox C, Adler G et al. [S3-guidelines conference “colorectal carcinoma” 2004]. Z Gastroenterol 2004; 42: 1129-1177
  Thieme ConnectPubMedSearch in Google Scholar
• 24 Schmiegel W, Reinacher-Schick A, Arnold D et al. [Update S3-guideline “colorectal cancer” 2008]. Z Gastroenterol 2008; 46: 799-840
  Thieme ConnectPubMedSearch in Google Scholar
• 25 Lieberman DA, De Garmo PL, Fleischer DE et al. Patterns of endoscopy use in the United States. Gastroenterology 2000; 118: 619-624
  CrossrefPubMedSearch in Google Scholar
• 26 Mysliwiec PA, Brown ML, Klabunde CN et al. Are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med 2004; 141: 264-271
  CrossrefPubMedSearch in Google Scholar
• 27 Laiyemo AO, Pinsky PF, Marcus PM et al. Utilization and yield of surveillance colonoscopy in the continued follow-up study of the polyp prevention trial. Clin Gastroenterol Hepatol 2009; 7: 562-567
  CrossrefPubMedSearch in Google Scholar
• 28 Schoen RE, Pinsky PF, Weissfeld JL et al. Utilization of surveillance colonoscopy in community practice. Gastroenterology 2010; 138: 73-81
  CrossrefPubMedSearch in Google Scholar
• 29 Ko CW, Dominitz JA, Green P et al. Utilization and predictors of early repeat colonoscopy in Medicare beneficiaries. Am J Gastroenterol 2010; 105: 2670-2679
  CrossrefPubMedSearch in Google Scholar
• 30 Lee TJW, Rutter MD, Blanks RG et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut 2012; 61: 1050-1057
  CrossrefPubMedSearch in Google Scholar
• 31 Adelstein BA, Macaskill P, Chan SF et al. Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review. BMC Gastroenterol 2011; 11: 65
  CrossrefPubMedSearch in Google Scholar
• 32 Saini SD, Schoenfeld P, Vijan S. Surveillance colonoscopy is cost-effective for patients with adenomas who are at high risk of colorectal cancer. Gastroenterology 2010; 138: 2292-2299
  CrossrefPubMedSearch in Google Scholar
• 33 Adler A, Wegscheider K, Lieberman D et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12 134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut 2013; 62: 236-241
  CrossrefPubMedSearch in Google Scholar
• 34 Razum O, Altenhöner T, Breckenkamp J et al. Social epidemiology after the German reunification: east vs. west or poor vs. rich?. Int J Public Health 2008; 53: 13-22
  CrossrefPubMedSearch in Google Scholar

• Supplementary Material