Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths

Zauber, Ann G.; Winawer, Sidney J.; O’Brien, Michael; Lansdorp–Vogelaar, Iris; Ballegooijen, Marjolein van; Hankey, Benjamin F.; Shi, Wei; Bond, John H.; Schapiro, Melvin; Panish, Joel F.; Stewart, Edward T.; Waye, Jerome D.

doi:10.1056/nejmoa1100370

Cited by 2,685 publications

(1,754 citation statements)

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“…Most of the decline in CRC incidence has been attributed to increased rates of screening through colonoscopy and sigmoidoscopy, although changes in risk factors and better treatments likely contributed to the decline. 1,4,18 These types of screening, which includes the removal of adenomatous polyps, have been shown to reduce both CRC incidence and mortality. 18 Despite evidence of its effectiveness, Hispanic men are less likely than white men to undergo endoscopic screening, and Hispanic men in California are no exception.…”

Section: Rates Among Hispanics Did Not Decline Until 2008 (Table 2)mentioning

confidence: 99%

“…1,4,18 These types of screening, which includes the removal of adenomatous polyps, have been shown to reduce both CRC incidence and mortality. 18 Despite evidence of its effectiveness, Hispanic men are less likely than white men to undergo endoscopic screening, and Hispanic men in California are no exception. [19][20][21] Data from the California Health Interview Survey show lower screening compliance among recent immigrants (48%) and respondents who spoke limited English (44%).…”

Section: Rates Among Hispanics Did Not Decline Until 2008 (Table 2)mentioning

confidence: 99%

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Colorectal Cancer Trends in California and the Need for Greater Screening of Hispanic Men

Martinsen

Morris

Pinheiro

et al. 2016

American Journal of Preventive Medicine

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Section: Rates Among Hispanics Did Not Decline Until 2008 (Table 2)mentioning

confidence: 99%

Section: Rates Among Hispanics Did Not Decline Until 2008 (Table 2)mentioning

confidence: 99%

Colorectal Cancer Trends in California and the Need for Greater Screening of Hispanic Men

Martinsen

Morris

Pinheiro

et al. 2016

American Journal of Preventive Medicine

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“…Colonoscopy has been shown to reduce colorectal cancer (CRC) morbidity and mortality,1, 2, 3 but the procedure requires high‐quality bowel preparation. Many standard bowel preparations consist of large volumes of poorly palatable laxatives which many patients are unable to tolerate due to nausea, vomiting, bloating, and headache.…”

Section: Introductionmentioning

confidence: 99%

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

et al. 2017

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Background and AimBowel preparations with polyethylene glycol (PEG) and clear fluids are often poorly tolerated. We compared an innovative low‐residue White Diet and low‐volume, split‐dose Picosalax with the standard preparation at our institution of day‐before clear fluids and combination PEG plus sodium picosulfate/magnesium citrate (SPMC).MethodsAdults undergoing morning colonoscopy were randomized to either the White Diet and split‐dose, two sachets of Picosalax (WD/PICO) or day‐before clear fluids and 1‐L PEG plus two sachets of SPMC (CF/PEG + SPMC). The primary endpoint was successful bowel preparation defined by an Ottawa bowel preparation score ≤ 6. An intention‐to‐treat analysis with a predefined non‐inferiority margin of 15% was used to compare efficacy.ResultsA total of 250 patients were randomized (125 WD/PICO and 125 CF/PEG + SPMC). WD/PICO was non‐inferior to CF/PEG + SPMC for successful bowel preparation by intention‐to‐treat analysis (58% WD/PICO vs 62% CF/PEG + SPMC, 95%CI: −14.2 to 6.2%) and per‐protocol analysis (64% WD/PICO vs 65% CF/PEG + SPMC, 95%CI: −11.3 to 9.4%). Patients in the WD/PICO group reported greater satisfaction with the diet (P < 0.001), greater ease of following the diet (P < 0.001), and improved experience compared with prior colonoscopy (P < 0.0001), less bloating (P = 0.02), less weakness (P = 0.046), less hunger (P < 0.0001), and less interference with daily activities (P = 0.001). Procedure/withdrawal times and adenoma detection rates were similar between groups.ConclusionBowel preparation with the White Diet and low‐volume, split‐dose Picosalax was preferred and better tolerated without detriment to bowel preparation success compared with clear fluids and combination PEG plus SPMC for morning colonoscopy.

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“…Despite its efficacy, only 20-38 % of the population is adherent to CRC screening guidelines [2,3]. Colonoscopy at present is estimated to decrease CRC-related mortality by 53 %, with further decrements expected if a greater proportion of individuals received age-appropriate screening [4]. Given limited healthcare resources, information that enables practitioners to focus interventions on populations most likely to be non-adherent to screening colonoscopy is valuable.…”

mentioning

confidence: 99%

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Rogers

Keswani

2015

Dig Dis Sci

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Although colorectal cancer (CRC) remains the second leading cause of cancer-related mortality in the USA, its incidence and mortality have decreased in men and women since 1997, a reduction attributed, in part, to the increased use of CRC screening modalities [1]. Colonoscopy, regarded by most expert advisory groups as the mainstay of CRC screening, is the only modality that both detects and removes neoplastic polyps from the entire colon. Despite its efficacy, only 20-38 % of the population is adherent to CRC screening guidelines [2,3]. Colonoscopy at present is estimated to decrease CRC-related mortality by 53 %, with further decrements expected if a greater proportion of individuals received age-appropriate screening [4]. Given limited healthcare resources, information that enables practitioners to focus interventions on populations most likely to be non-adherent to screening colonoscopy is valuable.Multiple patient factors influence adherence to CRC screening [5,6]. Demographic factors associated with lower rates of screening include female gender, younger age, low income or educational attainment, recent immigrant status, lack of health insurance, and persons of African-American or Hispanic descent [5]. Health factors associated with non-adherence include multiple medical comorbidities and decreased primary care utilization [6]. Nevertheless, little is known about how adherence differs among patients who are undergoing surveillance colonoscopy indicated for a history of colorectal polyps or are undergoing screening colonoscopy.In this issue of Digestive Diseases and Sciences, Greenspan et al. [7] report the results of a prospective study comparing rates of adherence to screening and surveillance colonoscopy in a population of 617 patients seeking care at an urban, tertiary medical center. Of multiple demographic factors studied in patients scheduled to undergo colonoscopy, patients scheduled for screening colonoscopy were significantly less likely to undergo their procedures than those scheduled for surveillance of adenomatous polyps (RR 5.42,). This intuitive finding represents a new, easily identifiable factor toward which patient adherence efforts can be directed.While univariate analysis indicated that female gender and the presence of medical comorbidities (represented by clopidogrel use and a history of congestive heart failure) were associated with an increased risk of non-adherence, these were not significant according to multivariable logistic regression analysis, consistent with prior studies [8]. The single factor associated with non-adherence and repeated procedure cancellations according to multivariable analysis, was indication for colonoscopy [7]. Although patients with a prior history of adenomatous polyps are at high risk of the development of adenomas or carcinoma (20-50 %) at subsequent surveillance colonoscopy, the risk of adenoma or carcinoma in asymptomatic patients undergoing screening colonoscopy can also be as high as 50 % [9]. Thus, it is appropriate to direct efforts toward ensuri...

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Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths

Cited by 2,685 publications

References 51 publications

Colorectal Cancer Trends in California and the Need for Greater Screening of Hispanic Men

Colorectal Cancer Trends in California and the Need for Greater Screening of Hispanic Men

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

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