Adverse events of colonoscopy in a colorectal cancer screening program with fecal immunochemical testing: a population-based observational study

Denis, Bernard; Gendre, Isabelle; Weber, Sarah; Perrin, Philippe

doi:10.1055/a-1324-2763

Cited by 11 publications

(12 citation statements)

References 28 publications

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“…The adverse events (AEs) from treatments have not been analyzed. We reported elsewhere the AEs of colonoscopies performed in our CRC screening program with FIT 25 . In any case, the higher morbidity and mortality of surgery over endoscopy is well demonstrated 10 11 14 .…”

Section: Discussionmentioning

confidence: 99%

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study

et al. 2021

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Background and study aims The aim of this study was to analyze presentation, management, and outcomes of large polyps (LPs; ≥ 20 mm) detected in a colorectal cancer (CRC) screening program using a quantitative fecal immunochemical test (FIT). Patients and methods This was a retrospective community- and population-based observational study of all LPs detected in patients aged 50 to 74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening program organized in Alsace (France). Results Among 13,633 FIT-positive colonoscopies, 1256 LPs (8.5 % malignant and 51.8 % nonpedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). The sensitivity of optical diagnosis of malignancy was 54 % for nonpedunculated and 27 % for pedunculated T1 CRCs. The endoscopic resection rate was 82.7 % (95 % confidence interval [CI] 80.3–84.9) for benign LPs (70.2 % [95 % CI 66.4–74.1]) nonpedunculated, 95.2 % [95 % CI 93.4–97.1] pedunculated), varying from 0 to 100 % depending on the endoscopist. It was correlated with cecal intubation (Pearson r = 0.49, P < 0.01) and adenoma detection rates (r = 0.25, P = 0.01). Most endoscopists did not refer patients to more experienced endoscopists, and as a result, 60 % to 90 % of 183 surgeries for benign LPs were unwarranted. Endoscopic resection was curative for 4.3 % (95 % CI 0.9–12.0) of nonpedunculated and 37.8 % (95 % CI 22.5–55.2) of pedunculated T1 CRCs. Overall, 22 endoscopic submucosal dissections had to be performed to avoid one surgery. Conclusions Compared with current recommendations, there is tremendous room for improvement in community endoscopy practices in the diagnosis and management of LPs. Detection and polypectomy competencies are correlated and highly variable among endoscopists. Endoscopic resection is curative for 83 % of benign LPs and 16 % of T1 CRCs.

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Section: Discussionmentioning

confidence: 99%

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study

et al. 2021

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“…A total of 13,592,454 patients across 31 studies underwent CRC screening using either gFOBT or FIT. Seventeen studies (3,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) reported on outcomes in patients using gFOBT and 14 studies (39,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55) reported on FIT. Overall, 771,730 colonoscopies were performed in patients with an abnormal FIT (571,971) or positive gFOBT (199,759).…”

Section: Resultsmentioning

confidence: 99%

Colonoscopy related adverse events in patients with abnormal stool-based tests – A systematic review of literature and meta-analysis of outcomes

et al. 2021

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INTRODUCTION:Colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT) and guaiac-based fecal occult blood (gFOBT) are associated with a substantial reduction in CRC incidence and mortality. We conducted a systematic review and comprehensive meta-analysis to evaluate colonoscopy-related adverse events in individuals with a positive FIT or gFOBT.METHODS:A systematic and detailed search was run in January 2021, with the assistance of a medical librarian for studies reporting on colonoscopy-related adverse events as part of organized CRC screening programs. Meta-analysis was performed using the random-effects model, and the results were expressed for pooled proportions along with relevant 95% confidence intervals (CIs).RESULTS:A total of 771,730 colonoscopies were performed in patients undergoing CRC screening using either gFOBT or FIT across 31 studies. The overall pooled incidence of severe adverse events in the entire patient cohort was 0.42% (CI 0.20–0.64); I2 = 38.76%. In patients with abnormal gFOBT, the incidence was 0.2% (CI 0.1–0.3); I2 = 24.6%, and in patients with a positive FIT, it was 0.4% (CI 0.2–0.7); I2 = 48.89%. The overall pooled incidence of perforation, bleeding, and death was 0.13% (CI 0.09–0.21); I2 = 22.84%, 0.3% (CI 0.2–0.4); I2 = 35.58%, and 0.01% (CI 0.00–0.01); I2 = 33.21%, respectively.DISCUSSION:Our analysis shows that in colonoscopies performed after abnormal stool-based testing, the overall risk of severe adverse events, perforation, bleeding, and death is minimal.

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“…22 Adverse events of colonoscopy were significantly more frequent in our FIT CRC screening programme than usually estimated. 33 Accreditation for CRC screening could be seen as equivalent to double reading of mammograms for breast cancer screening; that is, as a way to offer the best possible chances to screened individuals.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopy may be weak link in organised colorectal cancer screening programme with faecal immunochemical test

Denis

Gendre²

2021

J Med Screen

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Objective To evaluate the quality of colonoscopies performed after a positive faecal immunochemical test in the French colorectal cancer screening programme. Methods Retrospective analysis of all colonoscopies performed between 2015 and 2019 after a positive quantitative faecal immunochemical test in the population-based colorectal cancer screening programme organised in Alsace, part of the French programme. The following indicators were evaluated: annual colonoscopy volume, caecal intubation rate, adenoma detection rate, proximal serrated lesion detection rate and proportion of patients referred directly to surgery for benign polyp management. Endoscopists who performed <30 faecal immunochemical test positive colonoscopies were non-assessable. Results Overall, 13,455 faecal immunochemical test-positive colonoscopies performed by 116 community gastroenterologists were included, 13,067 of them by 80 assessable endoscopists. The overall caecal intubation, adenoma detection and proximal serrated lesion detection rates were 97.9%, 57.6% and 7.6%, respectively. They were <90%, <45% and <1% for 1.3%, 12.5% and 6.3% of the endoscopists, respectively. Overall, 1028 (7.9%) individuals were examined by 13 low-performing endoscopists and 328 (2.4%) individuals by 33 low-volume non-assessable endoscopists. Among 9133 individuals harbouring polyps, 155 (1.7%) had unwarranted surgery for a benign polyp. Overall, 1487 individuals (11.1%; 95% confidence interval 10.5–11.6) were not given the best possible chances, whereas 5545 individuals (41.2%; 95% confidence interval 40.4–42.0) were offered the best possible chances by 37 endoscopists. Conclusions At programme level, the key performance indicators evaluated largely exceeded the target standards. At individual level, at least one in nine individuals was not given the best possible chances during faecal immunochemical test-positive colonoscopies by a minority of poor-performing and/or low-volume endoscopists.

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Adverse events of colonoscopy in a colorectal cancer screening program with fecal immunochemical testing: a population-based observational study

Cited by 11 publications

References 28 publications

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study

Colonoscopy related adverse events in patients with abnormal stool-based tests – A systematic review of literature and meta-analysis of outcomes

Colonoscopy may be weak link in organised colorectal cancer screening programme with faecal immunochemical test

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