Introduction

Colonoscopy plays a key role in colorectal cancer (CRC) screening. It is effective in reducing morbidity and mortality from CRC, which continues to be diagnosed at advanced stages in Ukraine. This research evaluates the challenges faced by endoscopists in Ukraine and suggests solutions to improve screening colonoscopy in Ukraine.

Aims & Methods

Semi-structured interviews were conducted with Ukrainian endoscopists regarding screening colonoscopy. Interview questions were first pilot-tested by a Ukrainian endoscopist and refined by a qualitative expert. Sampling continued until data saturation was achieved. The interviews were recorded and transcribed. Rapid qualitative analysis was conducted. Two researchers independently coded the data and identified common themes. Interviews were conducted in Ukrainian and translated into English.

Results

Six endoscopists were interviewed. Six themes were developed: quality of endoscopy training; equipment and consumables; performance measures recording; cooperation with National Health Services of Ukraine (NHSU); collaboration with specialists in related fields and recommendations for improving quality of colonoscopy in Ukraine.
Most endoscopists cite poor quality of endoscopy training, insufficient provision of equipment and consumables, problems with collaboration between specialists. The top recommendations they cite for improvement of screening colonoscopy include equipment upgrade and consumables provision, the importance of structured training and coordination between related specialists. The most representative quotes for each theme are shown in Table 1.

Conclusion

These results summarize challenges and suggest solutions to improve screening colonoscopy in Ukraine, emphasizing the importance of structured training,equipment and consumables provision, сooperation with specialists in related fields, and the development of funding programs. These results are important in establishing an effective country specific screening program.

Introduction

Screening colonoscopy is effective in preventing colorectal cancer by removing precancerous lesions. Incomplete examinations are associated with a higher risk of post-colonoscopy colorectal cancer. Therefore, the minimum standard for cecal intubation rate is >90%, and the target standard >95%. However, little is known about the distribution of reasons for incomplete colonoscopy in colorectal cancer screening programs.

Aims & Methods

Based on data from the Austrian quality assurance program for screening colonoscopy, we analyzed the reasons for incomplete colonoscopies. We further investigated whether the use of sedation and the adenoma detection rate (ADR) are associated with lower rates of complete examination.

Results

489,800 screening colonoscopies were analyzed within the Austrian quality assurance program. Of these, 2.9% (n=14,325) were incomplete. 59,7% of those patients were female and 40.3% male. 85.4% of patients with an incomplete vs. 91.2% with a complete examination were sedated (p<0.001). The reasons for not reaching the cecum were insufficient bowel preparation in 23.3% (n=3335), pain in 23% (n=3291), stenosis in 11.7% (n=1674), complications in 1.6% (n=227), and other factors in 40.5% (n=5798). 69% of incomplete colonoscopies were performed by endoscopists with an ADR lower than 25% and 31% with an ADR over 25%. 54.6% of complete examinations were done by endoscopists with an ADR lower than 25% and 45.4% with an ADR over 25% (p<0.001).

Conclusion

The target standard of the cecal intubation rate has been achieved (97.1%). Incomplete colonoscopies were more often in female (84.4%) compared to male (40.3%), performed in unsedated patients and by endoscopists with an ADR <25%. The most common reason for not reaching the cecum was categorized as other factors (40.5%), this category is not well defined and requires further investigation.

Introduction

Colorectal cancer incidence is increasing worldwide. Nowadays it is the third most diagnosed cancer¹. Screening colonoscopy is the gold standard for prevention and often treatment, both economically and efficiently. Hellenic Society of Gastroenterology recommends that screening colonoscopy should starts by 50 years old for average risk population¹. There are limited data about participation in screening colonoscopy in general population in Greece and the existing ones shows discouraging participation rates^2,3.

Aims & Methods

The aim of this study was to determinate general population’s knowledge about screening colonoscopy in Greece. We created a digital, anonymous questionnaire at Google Forms platform and transferred it via social media in general population that lives in Greece.

Results

In total 711 individuals answered the survey. 65.8% of them(468/711) were woman. 61.5% (437/711) were under 40 years old, 19.7% (140/711) were between 40 and 50 years old and 18.3% (130/711) were between 50 and 75 years old. 40.2% (286/711) did not know if there is an appropriate age for the first screening colonoscopy. 39% (277/711) answered that they thought an appropriate age is at 50 years old, 26.7% (190/711) at 45 years old and 8.2% (58/711) answered that they thought there is not an appropriate age for a screening colonoscopy. Regarding the performance of screening colonoscopy 363 out of 711 (51.1%) are willing to perform it in the future, 20.1% (143/711) answered that they do not know or do not answer the question,11% (78/711) are not willing to perform it and 2.1% (15/711) are not willing to perform it, because they think it is not necessary for preventing colorectal cancer.

Conclusion

Our study confirms that there is lack of information in general population and unwillingness to screen for colorectal cancer in Greece. General population tends to be uninformed and unwilling about screening colonoscopy¹. Despite the effectiveness of colonoscopy there is not an organized screening program in Greece. Individuals are usually self-referred for screening and usually later than the appropriate age and after symptoms occure¹. Primary health care providers should be well informed and correctly advise individuals about colorectal cancer screening and its privilege, options, and alarm symptoms⁴.

References

1. Viazis N, Tzouvala M, Theodoropoulou A, Giouleme O, Thomopoulos K, Christodoulou DK, Michopoulos S, Soufleris K, Koutroubakis I, Karamanolis G, Papatheodoridis G, Giotis I, Paspatis G, Mantzaris GJ. Comparison of the Uptake of Screening Colonoscopy between Physicians and the General Population in Greece. Dig Dis. 2020;38(1):23-30. doi: 10.1159/000501266. Epub 2019 Jul 9. PMID: 31288225.
2. Kamposioras K, Mauri D, Golfinopoulos V, Ferentinos G, Zacharias G, Xilomenos A, Polyzos NP, Bristianou M, Chasioti D, Milousis A, Vittoraki A, Koukourakis G, Chatziioannou I, Papadopoulos P. Colorectal cancer screening coverage in Greece. PACMeR 02.01 study collaboration. Int J Colorectal Dis. 2007 May;22(5):475-81. doi: 10.1007/s00384-006-0186-6. Epub 2006 Aug 29. PMID: 16941174.
3. Cardoso R, Guo F, Heisser T, Hoffmeister M, Brenner H. Utilisation of Colorectal Cancer Screening Tests in European Countries by Type of Screening Offer: Results from the European Health Interview Survey. Cancers (Basel). 2020 May 29;12(6):1409. doi: 10.3390/cancers12061409. PMID: 32486077; PMCID: PMC7352919.
4. Mastrokostas A, Gavana M, Gkrizioti M, Smyrnakis E, Cholongitas E, Benos A, Haidich AB. Discrepancies and misconceptions of perceived colorectal cancer screening barriers between primary health professionals and unscreened population. A comparative study in Greece. J BUON. 2018 Dec;23(7):67-76. PMID: 30722114.

Introduction

In Germany, screening colonoscopy has been offered to all adults aged 55 or older since 2002. In parallel to screening colonoscopy, fecal occult blood testing is offered (Guaiac test until 2017, fecal immunochemical test afterwards) and, in addition, there is a high use of diagnostic colonoscopies. In view of this context, we aimed to quantify the effectiveness of screening colonoscopy in reducing colorectal cancer (CRC) incidence in Germany in men and women aged 55–69 years.

Aims & Methods

Using a German claims database (GePaRD, 20% population coverage) we included persons at average CRC risk aged 55–69 years and without a colonoscopy, polypectomy or fecal occult blood test before baseline. We emulated a target trial with two arms: Colonoscopy screening vs. no colonoscopy screening at baseline. We estimated adjusted cumulative CRC incidence over 11 years of follow-up stratified by sex (at the time of the conference, 14-year follow-up data will be available).

Results

Overall, we included 99,101 men (women: 99,288) in the screening arm and 583,861 men (women: 664,052) in the control arm. In men, the adjusted 11-year CRC risk was 1.89% in the screening group and 2.85% in the control group resulting in a relative risk of 0.66 (95% CI: 0.63–0.73). In women, the adjusted 11-year CRC risk was 1.31% in the screening group and 1.96% in the control group resulting in a relative risk of 0.67 (95% CI: 0.63–0.73).

Conclusion

Our study shows that screening colonoscopy in Germany is effective in preventing CRC both in men and women. In the interpretation of the strength of the effect (~33% incidence reduction), the high background prevalence of diagnostic colonoscopy should be considered. As previously shown, screening colonoscopy accounts for less than half of the overall 10-year prevalence of colonoscopy in persons aged 55-69 years in Germany.

Introduction

Currently, gastric cancer screening is only cost-effective in countries with high incidence. Colorectal cancer screening is an effective method for the reduction of CRC incidence and receives high attendance rates. Integrated screening, where gastroscopy is performed in conjunction with colonoscopy, could help reduce the gastric cancer screening procedure burden in countries with low or intermediate incidence. However, there is a lack of population-based studies providing data on groups at high risk for mortality from gastric malignancies that might benefit from this approach.

Aims & Methods

In this retrospective analysis of a colorectal cancer screening program database, we used Cox proportional hazards model to identify an association of high-risk and low-risk finding (polyps ≥ 10mm or with high-grade dysplasia vs <10 mm and no high-grade dysplasia or advanced adenoma vs non-advanced adenoma) with time to death from
upper gastrointestinal (esophageal and gastric) cancer. To quantify the burden of deaths from upper GI cancer in screening participants with high-risk or low-risk polyps in relation to the general population, we calculated standardized mortality ratios.

Results

We included 331,284 CRC high-quality screening colonoscopies in our study. The median follow-up time was 5.04 years (95% CI 5.03-5.07). 4.4% of participants had polyps ≥10 mm or with HGD and 7.7% had advanced adenomas. At the end of the study period, 296 deaths of upper GI cancer had occurred, corresponding to a rate of 10.29 deaths per 100,000 person years in women and 26.61 deaths per 100,000 person years in men. In participants with non-advanced adenomas, hazards for upper GI cancer death were similar compared to participants with advanced adenomas (HR 1.37, 95% CI 1.01-1.72 and HR 1.35, 95% CI 0.94-1.95) when taking participants with a negative colonoscopy as the reference. However, in participants with polyps ≥10 mm or HGD, hazards for upper GI cancer death were higher (HR 1.70, 95% CI 1.07-1.66). Participants with polyps <10 mm and no HGD experienced significantly fewer deaths from upper GI cancer than the general population (SMR 0.71, 95% CI 0.61-0.83, p<0.001), however, participants with high-risk polyps had an upper GI cancer mortality which was similar to that of the population (SMR 0.90, 95% CI 0.60-1.29, p = 0.6).

Conclusion

CRC screening participants with polyps <10 mm and no HGD have a lower risk for mortality from upper gastrointestinal cancers compared to participants with polyps >10 mm and HGD or the general population. In these participants, additional upper GI screening efforts might not be useful. However, future studies will demonstrate whether integrated screening with additional gastroscopy is effective in CRC screening participants with large or highly dysplastic polyps.

Introduction

In colorectal cancer (CRC) screening programs utilizing colonoscopy, patient satisfaction plays a pivotal role in persistent adherence, thus influencing the program's long-term efficacy. Our study aimed to evaluate patient satisfaction following endoscopic procedures within the Hungarian population-based CRC screening program (EFOP-1.8.1-VEKOP-15-2016-00001) on a national scale.

Aims & Methods

Our study aimed to evaluate patient satisfaction following endoscopic procedures within the Hungarian population-based CRC screening program (EFOP-1.8.1-VEKOP-15-2016-00001) on a national scale. The survey evaluated data from the anonymous, standardized self-administered questionnaire devised and distributed by the Hungarian National Centre for Public Health and Pharmacy between January 2020 and November 2023. The questionnaire predominantly comprised closed-ended questions. Patient satisfaction was assessed quantitatively by a 5-point scale. Categorical variables were reported as event rates and relative frequencies, and continuous variables as means with standard deviation. Fisher’s exact test was used to analyze categorical data.

Results

A total of 4083 questionnaires were evaluated, with a slight male predominance (55.71%) and with 41.96% of patients under 61 years of age. Questionnaire completed by 19.76% of colonoscopy patients (0.46% in 2020, 33.69% in 2021, 27.70% in 2022 and 22.71% in 2023). Respondents were evenly split between county centers/large cities, small towns and villages, but Budapest was under-represented (31.55%, 32.92%, 32.32% and 2.94% respectively). There was considerable variation in the willingness of endoscopic units to cooperate, so that no data at all were available from 4 counties. Sedation was used in 60.40% of patients (analgesia 55.57%, general anesthesia 4.82%), but 493 patients did not answer this question. Patients rated the quality of the colonoscopy units, competence of endoscopy staff and the overall satisfaction with exam execution as 4.68±0.58, 4.89±0.42 and 4.47±0.77 respectively. They were equally satisfied with the communication of the doctor (4.87±0.41) and the staff (4.87±0.44). Only 1.67% of patients reported that they would prefer to be switched to another doctor in case of a future screening, and the question remained unanswered in 5.44% of cases. Lack of rest room was complained by 9.09% of patients, where it was available, it was rated 4.68±0.67 points, however 7.67% of patients didn't respond to this question. In 33.70% of the cases, colonoscopy was considered to be substantially unpleasant and painful, giving an overall score of 3.85±1.06. Procedure-related pain and discomfort were rated as significantly less severe in men (p <0.001) and in patients over 61 years of age (p=0.001), as well as in patients who received detailed information from the endoscopist immediately before the endoscopy (p<0.001) and who received sedation (p<0.001). The detailed information provided by the endoscopist (p<0.001), the sedation (p<0.001) and the mild pain experienced during the examination (p<0.001) had a positive influence on patients' overall satisfaction with the colonoscopy.

Conclusion

This is the first large-volume patient satisfaction survey among patients invited to CRC screening program in Hungary. Positive patient feedback indicates high quality of care. Overall satisfaction can be further improved by modulation of procedure-related pain, rate of sedation and quality of postprocedural rest, as well as the quality of information delivered by endoscopists prior to procedures.