Outcomes of patients with delayed surveillance colonoscopy

Abstract

Background: Surveillance colonoscopy has been shown to be an effective tool for prevention of colorectal cancer (CRC) in high-risk populations, if adhered to.Aim: To discover the sequelae of late surveillance in a cohort of patient's overdue for colonoscopy. Methods:We conducted a retrospective cohort study on all patients from the Bay of Plenty District Health Board region, New Zealand, placed on the colonoscopy surveillance waitlist from 2006 onwards who had their procedure completed between 1 November 2016 and 31 January 2018. Patients with overdue surveillance, defined as done later than 90 days after the recommended due date, were compared with patients who were done either early or on time.Results: A total of 786 patients was recorded as overdue for surveillance colonoscopy and 386 were completed early or on time. The median time overdue was 22 months. Three (0.4%) cases of CRC were found in overdue patients compared with four (1%) cases for those done on time (adjusted P = 0.24). There were 86 (11%) advanced adenomas (AA) in patients overdue compared with 27 (7%) in those not overdue (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.0-2.5; P = 0.04). Surveillance of 180 high-risk post-polypectomy patients identified 2 CRC and 8/43 AA in those overdue compared with no CRC and 9/137 AA (18.6% vs 6.6%; OR 1.79; 95% CI 1.07-2.0; unadjusted P = 0.03) in those done on time. Conclusion:While overdue surveillance is not predictive of increased CRC, it is associated with an increase in expected number of AA, particularly in patients having surveillance for previous high-risk polypectomy.Abbreviations: AA, advanced adenoma; CI, confidence Interval; CRC, colorectal cancer; FHx, family history; HNPCC, herediatry non-polyposis colorectal cancer (in this paper, HNPCC refers to patients who fulfilled the Amsterdam criteria, although a proportion also had confirmed germline mutation in one of the DNA mismatch repair genes (Lynch syndrome

Older Age at First Screening Colonoscopy is Associated With an Increased Risk of Colorectal Adenomas and Cancer

“…The results of our study will help clarify for clinicians and patients the risk of colonoscopy delay. A recent study has shown that a 1-year delay in surveillance colonoscopy in patients with a prior history of polyps was associated with a 19% increase in the risk of advanced adenomas, 32 which is even greater than that in our study likely reflecting the at-risk patient population of the study. Prior literature has also described increased disease progression and mortality associated with delays in diagnostic colonoscopy after positive fecal screening tests 33–35 .…”

“…The risk in high-risk patients such as those with a family history of CRC remains unclear although it would be expected to be even greater. 32 Furthermore, it is possible that some of the participants may have had symptoms or clinical indications that may have led to the colonoscopy that could not be found by chart review. We were also unable to identify the causes of the delay in performing the initial screening colonoscopy, so studies assessing barriers or causes of the delay are warranted.…”

Faecal immunochemical test mitigates risk of delayed colonoscopy in people with elevated risk of colorectal neoplasia

“…Strict adherence to these surveillance recommendations is at times variable due to patient reticence or service delivery factors 5 . Currently, pressures on medical services during the COVID‐19 pandemic and resultant delays to surveillance colonoscopies also have the potential to increase the risk of developing advanced preinvasive lesions, or CRC and related death 6–9 …”

“…5 Currently, pressures on medical services during the COVID-19 pandemic and resultant delays to surveillance colonoscopies also have the potential to increase the risk of developing advanced preinvasive lesions, or CRC and related death. [6][7][8][9] The consequences of delays in surveillance colonoscopy procedures of elevated-risk patients have not been widely investigated. Observations in other patient cohorts have demonstrated that a 2to 6-month delay in colonoscopy in symptomatic patients can increase the odds of advanced neoplasia 7 and can lead to significantly higher mortality rates and loss of life years, 10 while in faecal immunochemical test (FIT)-based screening populations, an increased risk of advanced CRC is related to a delay in colonoscopy beyond 4-6 months, and mortality from CRC increases with more than a 12-month delay.…”

“…[6][7][8][9] The consequences of delays in surveillance colonoscopy procedures of elevated-risk patients have not been widely investigated. Observations in other patient cohorts have demonstrated that a 2to 6-month delay in colonoscopy in symptomatic patients can increase the odds of advanced neoplasia 7 and can lead to significantly higher mortality rates and loss of life years, 10 while in faecal immunochemical test (FIT)-based screening populations, an increased risk of advanced CRC is related to a delay in colonoscopy beyond 4-6 months, and mortality from CRC increases with more than a 12-month delay. 11 However, these studies investigating the effect of delayed colonoscopy on advanced neoplasia are limited by small sample sizes, 7 unadjusted statistical analysis, 7 or failure to distinguish between screening, symptomatic, and asymptomatic patients.…”