The Diagnostic Yield of Colonoscopy Stratified by Indications

Abstract

Introduction Danish centers reserve longer time for screening colonoscopies and allocate the most experienced endoscopists to these cases. The objective of this study is to determine the diagnostic yield in colonoscopies for different indications to improve planning of colonoscopy activity and allocation of the highly skilled endoscopists. Methods Nine hundred and ninety-nine randomly collected patients from a prospectively maintained database were grouped in defined referral indication groups. Five groups were compared in respect of the detection rate of adenomas and cancers. Results Two hundred and eighty-nine of 1098 colonoscopies in 999 patients showed significant neoplastic findings, resulting in 591 adenoma resections. Eighty-five percent were treated with a snare resection, and 15% with endoscopic mucosa resection (EMR). Positive findings in the indication groups were (1) symptoms, 25%; (2) positive screening, 17%; (3) previous resection of adenomas, 45%; (4) previous resection of colorectal cancer, 15%; and (5) surveillance of patients with high-risk family history of cancer, 35%. Conclusion The majority of adenomas found during colonoscopy can be treated with simple techniques. If individualized time slots are considered, the adenoma follow-up colonoscopies are likely to be the most time-consuming group with more than twice the number of adenomas detected as compared to other indications.

ScotCap – A large observational cohort study

“…Most colonoscopy is performed under sedation, but despite a drive to increase the quality of colonoscopy, 8%–20% of procedures will be incomplete and patients find the procedure uncomfortable [ 2 , 3 , 4 ]. The diagnostic yield of colonoscopy in the symptomatic population is low, with 46%–75% of patients having a normal examination [ 3 , 5 ]. Colonoscopy has a low complication rate (a 4–5 in 10,000 chance of perforation) [ 3 , 6 ].…”

“…of patients having a normal examination [3,5]. Colonoscopy has a low complication rate (a 4-5 in 10,000 chance of perforation) [3,6].…”

Colonoscopy Indication Algorithm Performance Across Diverse Health Care Systems in the PROSPR Consortium

“…Colonoscopy is also commonly used for diagnostic reasons in patients with gastrointestinal-related symptoms, such as iron-deficiency anemia [6], and for CRC surveillance in patients at elevated risk due to personal history of CRC or colorectal adenomas [7]. Diagnostic and surveillance colonoscopies tend to have different CRC and adenoma yields [89] and greater risks of adverse events [1011], than screening colonoscopies. Also, because the vast majority of individuals diagnosed with CRC after presentation with symptoms undergo a colonoscopy as part of their diagnostic process, failure to accurately determine exam indication can lead to biased estimates of the benefit of colonoscopy [1213].…”