Introduction

Due to long waiting lists and limited resources, referring patients for colonoscopy requires assessment of both need (indication) as well as urgency of performing the procedure. Symptomatic patients are usually perceived as more urgent when compared to asymptomatic individuals sent for screening.

Aims & Methods

Our aim was to explore if indication for colonoscopy had any association with colon cancer or colon polyp incidence, size and number. We hypothesised that patients with most common symptoms (rectal bleeding, change in bowel movements, abdominal pain) were more likely to have pathological colonoscopy findings when compared to asymptomatic individuals sent for screening or due to positive faecal occult blood test (FOBT).
We performed a retrospective analysis of prospectively collected data included 7701 colonoscopies performed between January 2017 and December 2021 in Sestre Milosrdnice University hospital, Zagreb, Croatia. We included patients undergoing first-time colonoscopy due to history of either rectal bleeding, change in bowel movements or abdominal pain, as well as asymptomatic individuals without family history screened with colonoscopy (with or without positive guaiac-based FOBT). Exclusion criteria were all other indications for colonoscopy and a repeated procedure. Final dataset included 2321 patients. Statistical analysis was done in Python 3.2 with statsmodels module for creating logistic regression models to analyse relationships within data.

Results

Mean age in the cohort was 59 +\- 15 years, with 56.8% being female. When comparing symptomatic to asymptomatic individuals, adenomas were found in 30.1% vs. 40.6% and carcinomas in 4.0% vs. 4.2% respectively.
After adjusting for age and sex there was however no significant difference between these two groups regarding polyps or carcinoma findings. For polyp detection OR was 0.61 (95% CI 0.41- 1.09); for polyp size >2cm OR 0.68 (95% CI 0.38-1.2) and for carcinoma detection 1.15 (95% CI 0.56 -2.33). Age was the only factor that was consistently associated with pathological colonoscopy findings, as follows: for every year of age odds of finding an adenoma increased by 1.027 (95% CI 1.021-1.033), having >5 adenomas increased by 1.04 (95% CI 1.016-1.065), and finding a carcinoma by 1.057 (95% CI 1.039-1.075). None of the investigated factors were associated with polyp size.

Conclusion

Presence of most common symptoms/causes for sending patients to colonoscopy does not seem to increase the odds of pathological findings and therefore should not raise the urgency of performing the endoscopy. Increasing age is the only consistent risk factor for colonic neoplasia in these patients.

Introduction

The European Society of Gastrointestinal Endoscopy (ESGE) recommends colorectal cancer (CRC) screening for individuals at average risk, aged 50-75 years. However, recent trends indicate an increasing incidence of colorectal neoplasms among younger individuals.

Aims & Methods

The primary aim of this cross-sectional study is to record the prevalence of polyps, adenomas, and advanced neoplasia (high-grade dysplasia and CRC) in individuals up to 49 years old, and secondarily to identify predictors of neoplasia and high-grade dysplasia. The data were collected retrospectively through the hospital’s electronic database. All serial colonoscopies, with cecum intubation, from 1/1/2018 until 31/12/2024 were included. Endoscopies in patients with diagnosed familial polyposis syndromes, inflammatory bowel disease and those with poor bowel preparation were excluded. Patients’ demographics, CRC family history and the recorded polyps' size, location, Paris classification, and pathology reports were collected. SPSS 23 (IBM, Armonk, NY, USA) was used for the statistical analysis.

Results

Table. Polyps, adenomas and advanced adenomas by age groups
	<25 (n=36)	25-29 (n=31)	30-34 (n=61)	35-39 (n=76)	40-44 (n=146)	45-49 (n=218)	Total (n=568)	P
Polyps, n (%)	0 (0)	2 (6.5)	6 (9.8)	20 (26.3)	52 (35.6)	86 (39.4)	166 (29.2)	<0.001
Adenoma, n (%)	0 (0)	1 (3.2)	2 (3.3)	9 (11.8)	21 (14.4)	36 (16.5)	68 (12.1)	0.006
Advanced adenoma, n (%)	0 (0)	1 (3.2)	0 (0)	3 (3.9)	4 (2.8)	12 (5.6)	20 (3.5)	0.266

A total of 568 colonoscopies were included, involving 306 male patients (53.8%), with a median age of 42 years (IQR: 36-46). Of these, 71 patients (12.5%) had a family history of CRC. At least one polyp was identified in 166 patients (29.2%), with adenomas observed in 68 patients (12.1%) and advanced neoplasia in 20 patients (3.5%), including 3 patients (0.5%) diagnosed with CRC (Table). Advanced adenomas were more frequently detected in colonoscopies performed due to visible blood in stools (8.5%) and as follow-up after diverticulitis (7.1%). In multivariate analysis, in which age, family history of CRC, and bowel preparation quality were included as variables, the presence of adenomas and advanced adenomas was significantly associated with age (adenoma OR = 1.08; 95% CI: 1.04-1.13 and advanced adenoma OR = 1.08; 95% CI: 1.00-1.18).
In total 271 polyps were identified. Ninety-four were adenomas of which 74 had low-grade dysplasia and 20 high-grade dysplasia or cancer. Sixteen of 177 not-adenomatous polyps were found to be serrated and 2 of those had low-grade dysplasia. “Large” polyps [≥10mm] had a higher probability of being adenomas (71.4%) compared to “small” [5-9mm] (26.2%) and “diminutive” [<5mm] (24.4%), Chi square P<0.001. Regarding the Paris classification Ip and Isp presented a higher probability to be adenomas (87.5% and 86.4% respectively) in contrast to Is and 0-IIa (35.6% and 12.2% respectively), Chi square P<0.001.
The resected adenomas were also categorized according to the type of reported dysplasia to identify predictors of high-grade dysplasia. High-grade dysplasia was present in 42.5% of large polyps compared to 4.5% of small and 6.2% of diminutive (Chi square P<0.001). High-grade dysplasia was also present in a higher frequency in polyps resected from the “left” colon (26.2%) compared to the “right” (10.3%) and in 0-IIa (66.7%) and Ip (38.1%) compared to Isp (21.1%) and Is (12.5%) polyps according to the Paris classification, but not in a statistically significant degree (Chi square P<0.010).

Conclusion

Despite the relatively small sample size of our study, initiation of screening at a younger age should be considered to be lowered, since adenoma and advanced adenoma were identified in 15% and 4.3% of individuals aged 35-49.

Disclosure

GB: Advisor/lecturer for Janssen, Pfizer, Takeda, Abbvie, MSD, Mylan, Genesis Pharma, Adacyte Therapeutics, Amgen, Ferring, Cooper; Funding (Grants/Honoraria): Pfizer, Takeda, Abbvie, Aenorasis; Research/Clinical Trials: Abbvie, Takeda.

Introduction

It remains unknown whether gastric histopathology is associated with the occurrence of colorectal diseases.

Aims & Methods

Aims：We aimed to clarify the association between gastric histopathology and colorectal diseases, especially colorectal polyps (CP). On this basis, we established risk prediction models for different colorectal diseases.
Methods: A retrospective cross-sectional study was conducted on 2540 patients who underwent gastroscopy and colonoscopy simultaneously in The Affiliated Wuxi People's Hospital of Nanjing Medical University from January 1, 2021 to August 31, 2023. Basic demographic data, previous medical history, clinical symptoms, important laboratory indicators, and gastric histopathology classification were collected for univariate and multivariate analysis. The nomogram model was constructed with R language while its calibration was tested by Hosmer-Lemeshow, its discrimination was evaluated by Area Under the ROC Curve (AUC), and its clinical efficacy was evaluated by Decision Curve Analysis (DCA).

Results

1: According to the results of colonoscopy, patients were divided into Normal group (N=601); Non-adenomatous polyp group (N=576); Adenomatous polyp group (N=1116); Inflammatory bowel disease group (N=149) and Colorectal cancer group (N=98). The average age of the five groups was (55.04±13.95) years, (58.74±11.58) years, (61.83±10.19) years, (50.48±16.64) years, and (66.10±10.80) years, respectively. The CRC group had the largest proportion of males, accounting for 59.2% (n=58).
2: The results of gastroscopy were divided into: Normal; NAG (non-atrophic gastritis); AG or IM (atrophic gastritis/intestinal metaplasia); Gastric polyps; Esophageal cancer; and SC-patho (pathological gastric cancer). The association between indicators and colonoscopy results was analyzed to establish risk prediction models for different colorectal diseases. We found that gastric histopathology was significantly correlated with NAP and AP; for clinical symptoms, abdominal pain was significantly correlated with colorectal diseases, and the contribution ranking was: NAP>IBD>CRC>AP; hematochezia was significantly correlated with IBD; for clinical indicators, anemia was significantly correlated with AP, and CEA was significantly correlated with CRC; for previous medical history, previous colonoscopy examination was significantly correlated with colorectal diseases, and the contribution ranking was: NAP>CRC>AP>IBD; history of hypertension and rheumatism disease were significantly correlated with NAP; history of chronic kidney disease and rheumatism disease were significantly correlated with AP; history of chronic kidney disease and gastrointestinal tumor were significantly correlated with CRC; history of hypertension and thyroid nodules were significantly correlated with IBD; for demographic indicators, age was significantly correlated with NAP, AP, and CRC; while BMI was significantly correlated with IDB.
3: Using R language to establish the nomogram prediction model, we could find that: all the prediction models had good discrimination, and the AUC of the CRC model reached 0.885. Through the calibration curve, we could find that all prediction models has strong consistency, among which the AP model has the highest consistency and the smallest absolute error value of 0.007.

Conclusion

The nomogram prediction model has good discrimination and calibration, and has good clinical value for predicting the occurrence probability of different colorectal diseases.

Introduction

Aims & Methods

Results

Conclusion

Introduction

Fewer adenomas are detected at colonoscopy in women compared to men. Failure to detect adenomas and sessile serrated polyps is associated with an increased risk of post-colonoscopy colorectal cancer (PCCRC).There are differences between men and women that may influence different diagnostic yields by colonoscopy. Different attitudes towards the procedure may account for a lower attendance rate for colonoscopy in women. Colonoscopy can be technically more difficult in women than men, and women have an increased need of analgesia and sedation. Men and women have a different probability of complete examinations. A considerable variation in colonoscopy quality among different endoscopists has been observed in two randomized controlled clinical screening trials: the Nordic-European Initiative on Colorectal Cancer (NordICC) trial (1) and the SCREESCO (Screening of Swedish Colons) trial (2, 3). Endoscopist performance may affect male and female patients differently given the more technically challenging procedure in women. In previous studies, the adenoma detection rate tends has been higher in men while high-grade sessile serrated polyps, in particular those found in right colon, are more frequent in women , and the risk for post-colonoscopy CRC (PCCRC) within three years was lower in men (6.9%) than in women (7.6%) in Sweden and in England (7.0% vs 8.0%).

Aims & Methods

Aims: The aim of this study was to investigate whether this was in part due to the greater difficulty of conducting colonoscopy in women, with the difference being more apparent in colonoscopies conducted by less skilled endoscopists.
Methods: Cross-sectional exploratory analysis of data on 16,551 individuals undergoing a primary colonoscopy (PCOL group) or colonoscopy after positive fecal immunochemical test (FIT group) within the randomized controlled trial SCREESCO, Screening of Swedish Colons. Endoscopist skill (low or high) was determined based on each endoscopist’s adenoma detection rate in all first-time colonoscopies performed in SCREESCO. Colonoscopy yield was assessed by gender in each study group and by endoscopist adenoma skill. Effect modification of the gender difference by endoscopist adenoma detection rate (a measure of endoscopist skill) on colonoscopy yield was assessed by use of multiplicative interaction tests.

Results

​Most endoscopists performed equally many colonoscopies in men and women (median 52% men) and the adenoma detection rate was higher in male patients (median: 32.6%) compared to female patients (median: 22.9%). There were no signs of effect modification of the risk ratio of any finding (men vs women) by endoscopist skill in the PCOL group (p=0.33) and the FIT group (p=0.3). The proportion of incomplete index colonoscopies was lower in men than in women in both groups and there was no effect modification by endoscopist skill in neither the PCOL group (p=0.41) nor the FIT group (p=0.96).

Conclusion

Endoscopist skill affected yield similarly for men and women in both the PCOL group and the FIT group, both regarding diagnostic yield and caecal intubation rate. Differences in endoscopist adenoma detection rate in male and female patients suggest that quality indicators should be assessed by patient gender.

References

1. Bretthauer M, Kaminski MF, Loberg M, Zauber AG, Regula J, Kuipers EJ, et al. Population-Based Colonoscopy Screening for Colorectal Cancer: A Randomized Clinical Trial. JAMA Intern Med. 2016;176(7):894-902
2. Forsberg A, Westerberg M, Metcalfe C, Steele R, Blom J, Engstrand L, et al. Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(6):513-21.
3. Sekiguchi M, Westerber M, Ekbom A, Hultcrantz R, Forsberg A. Endoscopist Characteristics and Polyp Detection in Colonoscopy: Cross-Sectional Analyses of Screening of Swedish Colons. Gastroenterology. 2023;164(2):293-295.e4

Disclosure

No disclosores to report

Introduction

Early detection of colon adenomas and polyps lowers the risk of colorectal cancer development. Quality indicators for screening or diagnostic colonoscopy encompass the adenoma detection rate (ADR), polyp detection rate (PDR), and cecal intubation rate (CIR). Previous research on ADR, PDR, and CIR in groups of patients who were deeply sedated with propofol versus those who underwent colonoscopy without sedation is undetermined.

Aims & Methods

The objective of this study was to analyze the effects of deep sedation versus no sedation on ADR, PDR, and CIR in a population of elderly patients.

This was a retrospective cohort study that included adult patients over the age of 60, presenting for a first screening or diagnostic colonoscopy performed in the period from January 2017 to September 2023 at our clinical center. The exclusion criteria were emergency colonoscopies, inflammatory bowel diseases, intent therapeutic colonoscopies, and bowel preparation quality (based on the Boston Bowel Preparation Score, BBPS) of less than 6. Participants’ characteristics were assessed using descriptive statistics. Normal distribution was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were analyzed using Mann–Whitney test and categorical variables using Chi-square or Fisher exact test. Binary logistic regression was conducted to identify significant predictors of the outcomes. Two-tailed tests were conducted, and statistical significance was considered when p <0.05.

Results

Among 2034 patients (46.4% female; mean age: 70 years) deep sedation was performed in 622 patients (30.6%). Total PDR was 51.65%, ADR was 33.3%, and CIR was 94.25%. Patients' characteristics are shown in table 1.
After adjusting for confounders (age, gender, BMI, BBPS for PDR/ADR and age, gender, BMI, BBPS, previous abdominal/pelvic operation, diverticulosis for CIR) no significant difference was shown in PDR, ADR and CIR between no-sedation and deep sedation groups. Higher BMI (B = .041, p < .01) and male gender (B = .36, p = .02) were independent predictors for ADR.

	No-sedation (N=1412)	Deep sedation with propofol (N=622)
Age*	70 (65-76)	68 (64-73)
Female gender *	655 (46,4%)	359 (57,7%)
BMI	27 (24,3 - 30,5)	27,1 (23,7 - 29,9)
BBPS	9 (6-9)	9 (6-9)
PDR	731 (51,8%)	320 (51,5%)
ADR	472 (33,5%)	202 (32,5%)
CIR	1316 (93,2%)	593 (95,3%)
Abdominal/pelvic operation	488 (34,6%)	186 (29,9)
Diverticulosis *	523 (37,1%)	272 (43,8%)

Table 1; Patient s' characteristics, BMI; Body mass index, BBPS; Boston bowel preparation scale, PDR; Polyp detection rate, ADR; Adenoma detection rate, CIR; Cecal intubation rate, *gender χ2(3, N =2034)=27,37, p<0.01, *diverticulosis χ2(1, N =2031)=8,14, p<0.01, *age U=367989, z=-5,78; p<0,01, PDR: χ2(1, N =2033)=0,01, p=.92, ADR: χ2(1, N =2031)=0,17, p=.68

Conclusion

In our mixed cohort of elderly patients undergoing screening and diagnostic colonoscopies, propofol-induced deep sedation did not enhance ADR, PDR, or CIR. Further research is needed to determine the impact of deep sedation on colonoscopy quality parameters in elderly patients.