Colonoscopist Performance and Colorectal Cancer Risk After Adenoma Removal to Stratify Surveillance: Two Nationwide Observational Studies

Wieszczy, Paulina; Waldmann, Elisabeth; Løberg, Magnus; Reguła, Jarosław; Rupiński, Maciej; Bugajski, Marek; Gray, Kathryn P.; Kalager, Mette; Ferlitsch, Monika; Bretthauer, Michael

doi:10.1053/j.gastro.2020.10.009

Cited by 43 publications

(31 citation statements)

References 26 publications

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“…However, we suspect that the number of symptomatic interval cancers was quite small for both groups given the relatively high ADR of the participating endoscopists. 27 Seventh, the retrospective design also precludes a detailed analysis of the extent to which differential exposure to risk factors for polyp recurrence other than age, sex, and socioeconomic status may have influenced our results. 28,29 Lastly, we relied on the subjective judgment of multiple endoscopists to provide data about polyp size, thereby raising the possibility of misclassification for ACN defined by size alone.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Metachronous Advanced Colorectal Neoplasia in Black and White Patients at a Safety Net Hospital

Rebello

Schroy²,

Leszcynski³

et al. 2022

Gastro Hep Advances

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BACKGROUND AND AIMS: Current postpolypectomy surveillance guidelines are based primarily on data from non-Hispanic Whites (NHWs); thus, generalizability to non-Hispanic Blacks (NHBs) remains unknown. Hence, the primary objective of this study was to assess the validity of these guidelines for NHBs by comparing the prevalence of metachronous advanced colorectal neoplasia (ACN) between NHWs and NHBs undergoing surveillance colonoscopy. METHODS: This was a retrospective cross-sectional study of NHWs (N ¼ 1500) and NHBs (N ¼ 1260) aged 40-75 years who underwent surveillance colonoscopy at an academic safety net hospital between 2007 and 2017. The primary outcome measure was the prevalence of metachronous ACN, defined as an advanced adenoma, advanced sessile polyp, or invasive cancer. Multivariate logistic regression was used to measure associations between race/ ethnicity and ACN prevalence after adjustment for potential confounding factors. RESULTS: Overall, the prevalence of metachronous ACN was similar for NHBs and NHWs (6.8% vs 7.4%, respectively; P ¼ .60). The prevalence of metachronous cancers (0.2% vs 0.1%; P ¼ .48), advanced adenomas (2.8% vs 3.8%; P ¼ .14), advanced serrated polyps (3.5% vs 3.3%; P ¼ .82), and large hyperplastic polyps !10 mm (0.2% vs 0.6%, P ¼ .24) were also similar between the 2 groups. Moreover, race was not a determinant of metachronous ACN after adjustment for age, sex, education, type of insurance, indication (screen/ surveillance) for baseline colonoscopy, surveillance interval, and findings at baseline colonoscopy (adjusted odds ratio, 0.96; 95% confidence interval, 0.70-1.30; P ¼ .78). CONCLUSION: Our study finds no significant difference in the prevalence of metachronous ACN between NHWs and NHBs undergoing appropriate postpolypectomy surveillance at an urban safety net hospital, suggesting that current guidelines are appropriate for both NHWs and NHBs.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Metachronous Advanced Colorectal Neoplasia in Black and White Patients at a Safety Net Hospital

Rebello

Schroy²,

Leszcynski³

et al. 2022

Gastro Hep Advances

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“…CRC detection during surveillance depends not only on the characteristics of the polyps but also on the endoscopist’s technical ability. A recently published Polish study reveals that long-term risk of CRC is increased (HR 2.69, 95% CI: 1.62–4.47) if baseline colonoscopy is performed by low-performing endoscopists (adenoma detection rate <20%) [ 25 ]. In this sense, Spanish CRC screening programs initiate surveillance after a complete evaluation of colonic mucosa and resection of colonic lesions.…”

Section: Discussionmentioning

confidence: 99%

Polyprev: Randomized, Multicenter, Controlled Trial Comparing Fecal Immunochemical Test with Endoscopic Surveillance after Advanced Adenoma Resection in Colorectal Cancer Screening Programs: A Study Protocol

et al. 2021

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Colorectal cancer (CRC) screening programs have been implemented to reduce the burden of the disease. When an advanced colonic lesion is detected, clinical practice guidelines recommend endoscopic surveillance with different intervals between explorations. Endoscopic surveillance is producing a considerable increase in the number of colonoscopies, with a limited effect on the CRC incidence. Instead, participation in CRC screening programs based on the fecal immunochemical test (FIT) could be a non-inferior alternative to endoscopic surveillance to reduce 10-year CRC incidence. Based on this hypothesis, we have designed a multicenter and randomized clinical trial within the Spanish population CRC screening programs to compare FIT surveillance with endoscopic surveillance. We will include individuals aged from 50 to 65 years with complete colonoscopy and advanced lesions resected within the CRC screening programs. Patients will be randomly allocated to perform an annual FIT and colonoscopy if fecal hemoglobin concentration is ≥10 µg/g, or to perform endoscopic surveillance. On the basis of the non-superior CRC incidence, we will recruit 1894 patients in each arm. The main endpoint is 10-year CRC incidence and the secondary endpoints are diagnostic yield, participation, adverse effects, mortality and cost-effectiveness. Our results may modify the clinical practice after advanced colonic resection in CRC screening programs.

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“…CRC detection during surveillance depends not only on the characteristics of the polyps but also on the endoscopist’s technical ability. A recently published Polish study revealed that long-term risk of CRC is increased (HR 2.69, 95%CI: 1.62-4.47) if baseline colonoscopy is performed by low-performing endoscopists (adenoma detection rate < 20%)[ 64 ].…”

Section: Fit In Surveillance After Adenoma Resectionmentioning

confidence: 99%

Faecal immunochemical test outside colorectal cancer screening?

Vieito¹,

Puga²,

Fernández-de-Castro³

et al. 2021

WJG

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Faecal immunochemical tests (FITs) are the most widely colorectal cancer (CRC) diagnostic biomarker available. Many population screening programmes are based on this biomarker, with the goal of reducing CRC mortality. Moreover, in recent years, a large amount of evidence has been produced on the use of FIT to detect CRC in patients with abdominal symptoms in primary healthcare as well as in surveillance after adenoma resection. The aim of this review is to highlight the available evidence on these two topics. We will summarize the evidence on diagnostic yield in symptomatic patients with CRC and significant colonic lesion and the different options to use this (thresholds, brands, number of determinations, prediction models and combinations). We will include recommendations on FIT strategies in primary healthcare proposed by regulatory bodies and scientific societies and their potential effects on healthcare resources and CRC prognosis. Finally, we will show information regarding FIT-based surveillance as an alternative to endoscopic surveillance after high-risk polyp resection. To conclude, due to the coronavirus disease 2019 pandemic, FIT-based strategies have become extremely relevant since they enable a reduction of colonoscopy demand and access to the healthcare system by selecting individuals with the highest risk of CRC.

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Colonoscopist Performance and Colorectal Cancer Risk After Adenoma Removal to Stratify Surveillance: Two Nationwide Observational Studies

Cited by 43 publications

References 26 publications

Prevalence of Metachronous Advanced Colorectal Neoplasia in Black and White Patients at a Safety Net Hospital

Prevalence of Metachronous Advanced Colorectal Neoplasia in Black and White Patients at a Safety Net Hospital

Polyprev: Randomized, Multicenter, Controlled Trial Comparing Fecal Immunochemical Test with Endoscopic Surveillance after Advanced Adenoma Resection in Colorectal Cancer Screening Programs: A Study Protocol

Faecal immunochemical test outside colorectal cancer screening?

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