Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines
Sang Hyun ParkKwang Il HongHoon Cheol ParkYoung Sun KimGene Hyun BokKyung Ho KimDong Suk ShinJae Yong HanYoung Kwan KimYeun Jong ChoiSoo Hoon EunByung Hoon LimKyeong Kun Kwack
5
Citation
18
Reference
10
Related Paper
Citation Trend
Abstract:
There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines.The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas.Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion).More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.Keywords:
Fecal occult blood
The usefulness of high definition colonoscopy plus i-scan (HD+i-SCAN) for average-risk colorectal cancer screening has not been fully assessed. The detection rate of adenomas and other measurements such as the number of adenomas per colonoscopy and the flat adenoma detection rate have been recognized as markers of colonoscopy quality. The aim of the present study was to compare the diagnostic performance of an HD+i-SCAN with that of standard resolution white-light colonoscope.This is a retrospective analysis of a prospectively collected screening colonoscopy database. A comparative analysis of the diagnostic yield of an HD+i-SCAN or standard resolution colonoscopy for average-risk colorectal screening was conducted.During the period of study, 155/163 (95.1%) patients met the inclusion criteria. The mean age was 56.9 years. Sixty of 155 (39%) colonoscopies were performed using a HD+i-SCAN. Adenoma-detection-rates during the withdrawal of the standard resolution versus HD+i-SCAN colonoscopies were 29.5% and 30% (p = n.s.). Adenoma/colonoscopy values for standard resolution versus HD+i-SCAN colonoscopies were 0.46 (SD = 0.9) and 0.72 (SD = 1.3) (p = n.s.). A greater number of flat adenomas were detected in the HD+i-SCAN group (6/60 versus 2/95) (p < .05). Likewise, serrated adenomas/polyps per colonoscopy were also higher in the HD+i-SCAN group.A HD+i-SCAN colonoscopy increases the flat adenoma detection rate and serrated adenomas/polyps per colonoscopy compared to a standard colonoscopy in average-risk screening population. HD+i-SCAN is a simple, available procedure that can be helpful, even for experienced providers. The performance of HD+i-SCAN and substantial prevalence of flat lesions in our average-risk screening cohort support its usefulness in improving the efficacy of screening colonoscopies.
Withdrawal time
Cite
Citations (5)
To evaluate gastroenterologists' use of esophagogastroduodenoscopy (EGD) for positive fecal occult blood test (FOBT).Colonoscopy is recommended when an FOBT performed for colorectal cancer screening is positive. Guidelines suggest no further evaluation if anemia and gastrointestinal (GI) symptoms are absent.Online surveys included 4 vignettes: positive FOBT in average-risk adults 50 years of age or older with/without iron-deficiency anemia and with/without upper GI symptoms. For each scenario, respondents were asked if they would perform colonoscopy only, EGD only, colonoscopy+EGD on same day, or colonoscopy followed by EGD on different day if colonoscopy was negative.Surveys were returned by 778 (11%) of 7094 potential responders. In patients without anemia or upper GI symptoms, 65% performed colonoscopy only; 35% added EGD (9% same day, 25% different day). EGD was added in 91% with anemia, 96% with symptoms, and 100% with anemia+symptoms. In patients with positive FOBT alone (no symptoms or anemia), multivariate analysis revealed fear of litigation as the primary factor associated with adding EGD to colonoscopy (odds ratio=4.1; 95% confidence interval, 2.3-7.3). When EGD+colonoscopy were planned for positive FOBT, private practice was associated with performing EGD on a different day (odds ratio=6.3; 95% confidence interval, 2.9-13.5 for private versus academic setting).One third of gastroenterologists perform EGD in addition to colonoscopy for a positive FOBT alone. Fear of litigation is the most important factor in deciding whether to add EGD to colonoscopy. When both procedures are planned, they are more likely to be performed on different days in a private practice setting than in an academic setting.
Fecal occult blood
Esophagogastroduodenoscopy
Cite
Citations (4)
Abstract BACKGROUND: Professional society guidelines recommend follow‐up colonoscopy for patients with resected colonic adenomas. However, adherence to guideline recommendations in routine clinical practice has not been well characterized. METHODS: The authors used a population‐based sample of Medicare beneficiaries to identify all patients aged ≥70 years who had a claim for colonoscopy with polypectomy or hot biopsy during the period from 2001 to 2004. Medicare claims through 2009 identified colonoscopy within the following 5 years as well as fecal occult blood testing, sigmoidoscopy, and barium enema. RESULTS: In total, 12,771 patients were included. At 5 years, 45.7% of patients underwent another colonoscopy, and 32.3% of procedures included a polypectomy. The rates of fecal occult blood testing, flexible sigmoidoscopy, and barium enema at 5 years were 54%, 3.8%, and 2.9%, respectively. There was a marked decrease in repeat colonoscopy at 1 year, 3 years, and 5 years with more recent years of index procedures. Other predictors of undergoing repeat colonoscopy were younger age, African American race, and a colonoscopy before the index examination. There was no association with physician specialty. The decreasing use of colonoscopy with time was maintained in a multivariable analysis. CONCLUSIONS: In a sample of elderly Medicare beneficiaries, there was under use of follow‐up colonoscopy at 5 years after polypectomy, and <50% of patients received a repeat examination. In particular, the use of this procedure decreased over the 4‐year study period. Coupled with other data indicating the overuse of follow‐up colonoscopy in patients without polyps, there appeared to be significant discordance between guidelines and actual practice. Cancer 2013. © 2013 American Cancer Society.
Fecal occult blood
Sigmoidoscopy
Polypectomy
Barium enema
Cite
Citations (41)
Colorectal Polyp
Withdrawal time
Bowel preparation
Colorectal adenoma
Cite
Citations (118)
Colorectal cancer (CRC) is preventable through screening, with colonoscopy and fecal occult blood testing comprising the two most commonly used screening tests. Given the differences in complexity, risk, and cost, it is important to understand these tests' comparative effectiveness.The CONFIRM Study is a large, pragmatic, multicenter, randomized, parallel group trial to compare screening with colonoscopy vs. the annual fecal immunochemical test (FIT) in 50,000 average risk individuals. CONFIRM examines whether screening colonoscopy will be superior to a FIT-based screening program in the prevention of CRC mortality measured over 10 years. Eligible individuals 50-75 years of age and due for CRC screening are recruited from 46 Veterans Affairs (VA) medical centers. Participants are randomized to either colonoscopy or annual FIT. Results of colonoscopy are managed as per usual care and study participants are assessed for complications. Participants testing FIT positive are referred for colonoscopy. Participants are surveyed annually to determine if they have undergone colonoscopy or been diagnosed with CRC. The primary endpoint is CRC mortality. The secondary endpoints are (1) CRC incidence (2) complications of screening colonoscopy, and (3) the association between colonoscopists' characteristics and neoplasia detection, complications and post-colonoscopy CRC. CONFIRM leverages several key characteristics of the VA's integrated healthcare system, including a shared medical record with national databases, electronic CRC screening reminders, and a robust national research infrastructure with experience in conducting large-scale clinical trials. When completed, CONFIRM will be the largest intervention trial conducted within the VA (ClinicalTrials.gov identifier: NCT01239082).
Fecal occult blood
Veterans Affairs
Clinical endpoint
Cite
Citations (101)
Fecal occult blood
Occult
Cite
Citations (45)
Fecal occult blood
Cite
Citations (36)
One of the most critical factors determining survival in terms of colorectal cancers is diagnosis and treatment at an early stage. Diagnosis at an early stage is possible with screening programs carried out within preventive health services. In this study, we aimed to compare the results of patients who underwent colonoscopy due to fecal occult blood test (FOBT) positivity with those over 50 years of age who underwent colonoscopy with other complaints and to reveal whether FOBT test is still essential for screening programs.This study included patients who underwent colonoscopy between January 2016 and December 2021. Patients were analyzed in two groups according to colonoscopy reasons: group I (FOBT-positive) and group II (other reasons).A total of 3393 patients were included in the study. The patients were divided into two groups for evaluation. Patients who underwent colonoscopy for FOBT positivity (Group I) and patients over 50 years of age who underwent colonoscopy for other reasons (Group II). When the colonoscopy findings were compared between the groups' inflammatory bowel diseases (p=0,03) were higher in group I, while normal colonoscopy (p=0,03) was found to be more common in group II. Polyps, malignancy, diverticulosis, and perianal diseases seem similar between the groups statistically.FOBT can still be used in colorectal screening because it is inexpensive, widely available, has more participation due to non-invasiveness, and can be applied outside of clinical settings.
Fecal occult blood
Diverticulosis
Occult
Cite
Citations (1)
AIM: Inadequate bowel preparation is associated with reduced adenoma detection. We sought to determine whether the adenoma miss rate during colonoscopy with inadequate preparation is significantly greater than the adenoma miss rate reported with tandem colonoscopy. METHODS: We reviewed records of all patients at our tertiary care center with an inadequately cleansed index colonoscopy between 2/1/2009-2/28/2010, who underwent repeat colonoscopy within 18 months. The primary endpoint was the overall adenoma miss rate. A two-sided test with alpha 0.05 had 80% power to distinguish an adenoma miss rate of about 33% compared to 22% reported with tandem colonoscopy. 910 patients had inadequate cleansing, and 127 met inclusion criteria including repeat colonoscopy within 18 months. RESULTS: The overall adenoma miss rate was significantly greater than reported with tandem colonoscopy (52% vs. 22%, p=0.001). Miss rates were higher for all adenoma size categories (57% vs. 26% for 1 year (OR=11.0, 95% CI: 5.81 to 20.9). CONCLUSION: The adenoma miss rate during colonoscopy with inadequate preparation is significantly higher than reported with tandem colonoscopy. Our findings support performing early repeat colonoscopy after inadequate preparation. © 2013 ACT. All rights reserved.
Bowel preparation
Insertion time
Clinical endpoint
Cite
Citations (2)
Fecal occult blood
Occult
Cite
Citations (20)