Appropriateness of colonoscopy in Europe (EPAGE II) – Screening for colorectal cancer

Abstract

Original article 200Introduction ! Cancer of the colon and rectum (colorectal cancer [CRC]) is one of the most common cancers diagnosed in Western countries and is a major cause of cancer-associated morbidity and mortality [1,2]. In Europe, the annual age-standardized incidence of CRC is 35 and 55 per 100 000 in women and in men respectively [1]. The age distribution of CRC shows a predominance in patients > 50 years with less than 10 % of patients being younger than 50 years [3]. The mean age at diagnosis was found to range from 65 to 71.5 years [4]. CRC is the second major cause of cancer mortality in both women and men. While the survival rate for early-stage cancers is high, the survival rate for those diagnosed with widespread cancer is low. About 75 % of all new cases of CRC occur in asymptomatic individuals with no known predisposing factor for the disease except age (≥ 50 years old; average risk) [5]. The remaining cases occur in individuals with a family history of CRC or adenomatous polyps, or with a family history of hereditary nonpolyposis colorectal cancer (HNPCC), or with familial adenomatous polyposis (FAP) or attenuated FAP. Screening, which refers to the search for colorectal lesions in asymptomatic patients with no personal history of CRC or adenomas, appears to be the best option available to reduce CRC morbidity and mortality by early detection of CRC in individuals ≥ 50 years old. However, there is debate about the best screening method and about whether colonoscopy should be recommended for CRC screening. In April 2008, a multidisciplinary European expert panel was convened in Montreux, Switzerland, to discuss and develop criteria for the appropriate use of colonoscopy. This article presents the literature review on screening for CRC in asymptomatic individuals that was provided to Background and study aims: To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. Methods: A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances. Results: Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonos-

Noninvasive Screening Tests for Colorectal Cancer

“…Guidelines from the European Union recommend annual or biennial screening with high-sensitivity fecal occult blood tests (gFOBTs) or the newer fecal immunochemical tests (FITs) [1,2], while guidelines from North America and eastern Asia recommend any of several screening tests including sigmoidoscopy, colonoscopy, double-contrast barium enema, CT colonography, and fecal DNA in addition to FOBTs and FITs [3,4,5,6]. German guidelines recommend a FOBT annually and colonoscopy every 10 years.…”

Appropriateness of colonoscopy in Cocody teaching hospital center in 2010: A prospective study using criteria established by the European panel on the appropriateness of gastrointestinal endoscopy (EPAGE)

“…Indications most often associated with the appropriateness of colonoscopy were rectal bleeding [24], assessment of iron deficiency anemia [24]; surveillance after resection of polyps or colorectal cancer [25] and colorectal cancer screening [26]. The patients in our study were younger compared with those of these studies and there was no indication of colorectal cancer screening or surveillance after resection of colorectal cancer.…”

The relationship between proximal and distal colonic adenomas

“…Although it is the most expensive method, patients who undergo colonoscopic screening and present no colonic lesions can delay repeating this screening test for at least 10 years [19,20]. In contrast, the advantages of PS over colonoscopy include the fact that it requires less bowel preparation and can be performed without sedation by paramedical personnel.…”