Ariadna Sánchez1, Victorine H Roos2, Matilde Navarro3, Marta Pineda3, Berta Caballol1, Lorena Moreno1, Sabela Carballal1, Lorena Rodríguez-Alonso4, Teresa Ramon Y Cajal5, Gemma Llort6, Virginia Piñol7, Adrià López-Fernández8, Inmaculada Salces9, Maria Dolores Picó10, Laura Rivas11, Luis Bujanda12, Marta Garzon13, Angeles Pizarro13, Eva Martinez de Castro14, Maria Jesus López-Arias14, Carmen Poves15, Catalina Garau16, Daniel Rodriguez-Alcalde17, Maite Herraiz18, Cristina Alvarez-Urrutia19, Andres Dacal20, Marta Carrillo-Palau21, Lucia Cid22, Marta Ponce23, Eva Barreiro-Alonso24, Esteban Saperas25, Elena Aguirre26, Cristina Romero6, Barbara Bastiaansen2, Maribel Gonzalez-Acosta3, Blai Morales-Romero1, Teresa Ocaña1, Liseth Rivero-Sánchez1, Gerhard Jung1, Xavier Bessa19, Joaquin Cubiella11, Rodrigo Jover27, Francisco Rodríguez-Moranta4, Judith Balmaña8, Joan Brunet28, Antoni Castells1, Evelien Dekker2, Gabriel Capella3, Miquel Serra-Burriel29, Leticia Moreira1, Maria Pellise1, Francesc Balaguer30. 1. Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. 2. Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands. 3. Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals. 4. Department of Gastroenterology, Hospital Universitari de Bellvitge, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain. 5. Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6. Department of Medical Oncology and Gastroenterology, Parc Tauli Hospital Universitari, Conscorci Sanitari de Terrasa, Sabadell-Terrasa, Spain. 7. Department of Gastroenterology, University of Girona, Hospital Dr Josep Trueta, Girona, Spain. 8. Department of Medical Oncology, Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain. 9. Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain. 10. Department of Gastroenterology, Hospital General Universitario de Elche, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Elche, Spain. 11. Department of Gastroenterology, Complexo Hospitalario Universitario de Orense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Ourense, Spain. 12. Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), San Sebastián, Spain. 13. Department of Gastroenterology, Hospital Virgen del Rocio, Sevilla, Spain. 14. Department of Medical Oncology and Gastroenterology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain. 15. Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain. 16. Department of Gastroenterology, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain. 17. Department of Gastroenterology, Hospital de Móstoles, Móstoles, Spain. 18. Department of Gastroenterology, Clínica Universidad de Navarra, Pamplona, Spain. 19. Department of Gastroenterology, Institut Hospital del Mar d'Investigacions Biomèdiques (IMIM), Hospital del Mar Medical Research Institute, Barcelona Hospital del Mar, Barcelona; Spain. 20. Department of Gastroenterology, Hospital Universitario Lucus Augusti, Lugo, Spain. 21. Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain. 22. Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, Servizo Galego de Saude (SERGAS), Research Group in Digestive Diseases, Instituto de Investigacion Sanitaria Galicia Sur (IISGS), SERGAS-Universidade de Vigo (UVIGO), Vigo, Spain. 23. Department of Gastroenterology, Hospital Universitario de la Fe de Valencia, Valencia, Spain. 24. Department of Gastroenterology, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain. 25. Department of Gastroenterology, Hospital Universitari General de Catalunya, Sant Cugat, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain. 26. Genetic Counseling Unit, Department of Medical Oncology, Hospital Quirónsalud Zaragoza, Zaragoza, Spain. 27. Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain. 28. Hereditary Cancer Program, Catalan Institute of Oncology, Institut d'Investigacio Biomèdica de Giron Dr. Josep Trueta (IDIBGI), Medical Sciences Department, School of Medicine, University of Girona, Hospital Dr Josep Trueta, Girona, Spain. 29. Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain. 30. Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. Electronic address: fprunes@clinic.cat.
Abstract
BACKGROUND & AIMS: Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS. METHODS: We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model. RESULTS: The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%-65.2%) and 7.9% (95% CI, 5.2%-10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06-4.3), complete colonoscopies (20% vs 0%; P = .01), and pan-chromoendoscopy use (OR, 2.14; 95% CI, 1.15-3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03-1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17-3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02-2.33). CONCLUSIONS: Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
BACKGROUND & AIMS: Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS. METHODS: We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model. RESULTS: The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%-65.2%) and 7.9% (95% CI, 5.2%-10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06-4.3), complete colonoscopies (20% vs 0%; P = .01), and pan-chromoendoscopy use (OR, 2.14; 95% CI, 1.15-3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03-1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17-3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02-2.33). CONCLUSIONS: Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
Authors: Britt B S L Houwen; Yark Hazewinkel; María Pellisé; Liseth Rivero-Sánchez; Francesc Balaguer; Raf Bisschops; Sabine Tejpar; Alessandro Repici; D Ramsoekh; Maarten A J M Jacobs; Ramon-Michel M Schreuder; Michal Filip Kaminski; Maria Rupinska; Pradeep Bhandari; Martijn G H van Oijen; Lianne Koens; Barbara A J Bastiaansen; Kristien M Tytgat; Paul Fockens; Jasper L A Vleugels; E Dekker Journal: Gut Date: 2021-03-18 Impact factor: 23.059