Introduction

There is no evidence on the best surveillance strategy in individuals with high-risk lesions (sessile adenomas ≥20mm and/or number of adenomas ≥10). The Catalan Society of Digestology recommends a surveillance colonoscopy per year for this group.

Aims & Methods

The aim was to evaluate the findings of this colonoscopy in order to assess its usefulness.
Retrospective analysis of the surveillance colonoscopy per year performed in individuals with high-risk lesions from the 3rd, 4th and 5th rounds of the program of population screening Ciutat Vella-Sant Martí of Barcelona.

Results

179 individuals were identified, of which 12 were excluded due to lack of data. 40.1% were women and 61.7% were over 60 years old. Among the total of 167 individuals, 87 (52.1%) met criteria for size, 63 (37.7%) for multiplicity and 17 (10.2%) met both. Lesions ≥20 mm were resected in fragments in 46.2% of cases. In 67 cases, more than one baseline colonoscopy was required (46.9%), to review the polypectomy base for fragmented lesions or to complete the polypectomy. 143 (85.6%) individuals underwent surveillance colonoscopy (mean time: 14.7±7.2 months). No predictors of non-surveillance in the year were found. Colonoscopy at one year was normal in 54 (37.8%) cases, non-advanced lesions (adenomas/serrated) in 66 (46.2%) cases, advanced lesions in 22 (15.4%) cases and one case was detected of CRC (0.7%). Globally, the prevalence of advanced neoplasia (AN) was 16.1%. The presence of AN was not associated with age, sex, round, or basal faecal hemoglobin, but with multiplicity (23.1% vs 6.7, p<0.05, in multiplicity group vs lesion group ≥ 20mm, respectively), regardless of the number of baseline colonoscopies. In the group of lesions ≥20mm resected in fragment with review colonoscopy at 4-6 months, no cases of AN were detected per year.

Conclusion

The prevalence of AN per year in individuals with high-risk lesions is considerable, and seems associated with basal multiplicity. In individuals with lesions ≥20mm with a normal follow-up colonoscopy, prolonged surveillance could be considered.

Introduction

The indications for colonoscopy are well established, with the primary objective being the detection of neoplasia or lesions that carry a high risk for colorectal cancer, even though benign causes are more commonly encountered. In young adults under 50 years of age, common indications include rectal bleeding and diarrhea. In contrast, individuals aged 50 years and older are screened more broadly due to the increased risk of colorectal cancer, although recent trends show a rising incidence of neoplastic lesions in younger adults as well. ​

Aims & Methods

The aim of our study is to compare the indications and outcomes of colonoscopy between individuals younger and older than 50 years, and to identify which indications are most strongly associated with neoplastic findings.
A retrospective, descriptive, and analytical study was conducted over a period of 3.5 years, involving 1,518 patients. Participants were divided into two groups: Group A included patients under 50 years old, while Group B comprised those aged 50 and above. Epidemiological, clinical, and endoscopic data were compared between the two groups. Patients with a known diagnosis of inflammatory bowel disease (IBD) were excluded from the study. Statistical analysis was carried out using SPSS version 21.0.

Results

Among the patients, 65.1% were over 50 years of age, while 34.9% were under 50. The mean age in group A (under 50) was 37.5 ± 9 years, compared to 64.4 ± 9 years in group B (over 50). Females predominated in the younger group (55.3%), whereas males were more prevalent among older patients (56.3%) (p < 0.001). A personal history of colorectal cancer was more frequent in patients over 50 (10.5% vs. 4.4%; p < 0.001).
Colonoscopy indications varied by age group: constipation was the most common indication in group B (29.1% vs. 22%; p = 0.01), whereas diarrhea predominated in group A (33.3% vs. 19.3%; p < 0.001). Pathological findings on colonoscopy were more frequent in older patients (49.1% in group B vs. 32.9% in group A; p < 0.001).
In patients under 50, the most common pathological findings were colitis or ulcerative colitis (47.9% vs. 11.7%; p < 0.001). In contrast, patients over 50 showed a higher prevalence of polyps (61.5% vs. 41.3%; p < 0.001) and rectocolonic neoplasia (16% vs. 5%; p = 0.002).
Among the colonoscopy indications, constipation in patients under 50 was associated with a higher risk of neoplastic lesions (p = 0.007), while in patients over 50, rectal bleeding and constipation were significantly associated with neoplastic lesions (p < 0.001).

Conclusion

The presence of neoplastic lesions was strongly associated with constipation in individuals under 50 years of age, and with both rectal bleeding and constipation in those over 50. Further studies to better define these indications could help improve the appropriateness of colonoscopy, particularly in younger patients.

Introduction

In colonoscopies with colorectal neoplasia, the endoscopy therapy is recommended. The surveillance (follow-up, FU) colonoscopies follow with the aim to diagnose the recurrent and metachronous lesions. Many guidelines recommend the intervals of such procedures based on the number, size and histopathological phenotype of the resected lesions. In clinical practice, the adherence of the recommendations is variable and selection of the high-risk patients who will benefit from shorter intervals might be helpful. Therefore, detailed study focusing on the development and clinical utilization of the new method combining the clinicopathological phenotype and the mutation burden was started in 2017. The interim results of the clinical phase of the prospective study are described.

Aims & Methods

Patients with colorectal lesions ≥ 10 mm removed by advanced therapeutic methods (en-bloc mucosal resection and submucosal dissection) and followed in interval in year 1, 3 and 5 were included. The therapy and surveillance were performed in one tertiary endoscopy center. The main aim was to assess the metachronous lesions (number, size, locality, histopathology characteristics) in relation with the index colonoscopy findings. Secondary aim was evaluation of the local residual neoplasia (LRN) in the scar after previous therapy.

Results

There were 217 patients included in the study in years 2017 – 2020. Eight of them were excluded because they did not meet the inclusion criteria. Results of the index colonoscopy in 209 patients (130 men, 62,2%; 79 women, 37,8%) were analyzed. 275 index lesions were found, majority of them (238 lesions, 86,5 %, low-grade and high-grade adenomas) were benign and there were 12 (4,4%) intramucosal cancers, two T1 cancers, one T2 cancers and one NET. 21 lesions were hyperplastic or others. Follow-up colonoscopy in one year was performed in 178 patients (82,0%) and in 91 of them (51,1 %) metachronous lesions were found, 120 (64,2%) adenomas, 46 (24,6%) hyperplastic and 21 (11.2%) others, with no cancer. LRN was diagnosed in 5,5% patients. In 122 patients with 3-years FU colonoscopy, 59 (48,4%) had metachronous lesions, mostly adenomas (73; 72,3%), no cancer and one LRN found. 45 patients had 5-years FU colonoscopy so far, 22 of them (48,9%) with metachronous lesions, mostly adenomas (25; 54,3%), no cancer, LRN in one case.

Conclusion

In patients after removal of the high-risk colorectal lesions defined by size ≥ 10 mm, high numbers of metachronous lesions were found in the strict surveillance protocol (years 1, 3, and 5). All the lesions were benign, with no cancer found.

References

Supported by program projects of the Ministry of Health of the Czech Republic with reg. no. NU22-08-00424, MO1012 and Cooperatio.

Introduction

The Hungarian population-based colorectal cancer (CRC) screening program (EFOP-1.8.1-VEKOP-15-2016-00001) was launched in 2019 among asymptomatic individuals between the ages of 50 and 70 with average risk of CRC.

Aims & Methods

Aim of the study was to retrospectively assess the quality indicators and results of screening colonoscopies performed during the initial five-year period of screening program (from 2019 to 2023). Our non-interventional, observational cohort study retrospectively analyzed clinical records of screening colonoscopies which were prospectively collected in the registry of National Public Health Institute. The quality indicators and results of examinations was determined based on cecal intubation rate, polyp, adenoma and cancer detection rates (PDR, ADR, and CDR), proportion of photo-documentation and sedation.

Results

Total of 27,021 colonoscopies were performed during the initial five-year period of CRC screening program. Cecal intubation rate was 92.54%, from which 66.77% of cases were confirmed by cecal image documentations. The causes of incomplete colonoscopies were inadequate bowel cleansing (n=172, 11.48%), anatomical reasons (n=369, 24.63%) and malignant colonic obstruction (n=178, 11.88%), and only in 191 cases (12.75%), the examination had discontinued due to patients’ intolerance. Total of 17,981 patients (66.54%) of participants received some kind of sedation. The result of colonoscopy was non-negative in 80.83% of cases. At least one polyp was found (PDR) in 56.56% (n=15,282) of participants among which the largest polyp was located in rectosigmoid colon in 64.92% of cases and the polyp size was higher than 1 cm in 34.69% of cases. Morphological features of polyps could not be assessed due to inappropriate colonoscopy reports in registry. A total of 36,829 polyps were found, of which 30,494 were removed during the registered examinations, becoming polyp-free 82.15% of patients (polypectomy per colonoscopy 1,13). The ADR was 33.53%, where the most relevant lesion histological types were tubular, tubulovillous, villous and serrated in 67.46%, 22.83%, 3.60% and 2.92% respectively. CRC was found in 5.51% of participants from which the most cancers were located in the sigmoid colon (n=578, 38,82%) and rectum (n=458, 30,76%). The data of registry to description of polyp morphology, usage of advanced imaging assessment, polyp retrieval rate and the image documentation were often missing or inappropriate.

Conclusion

Cecal intubation, polyp and adenoma detection rates of screening colonoscopies of Hungarian CRC screening program are satisfactory according to guideline of European Society of Gastrointestinal Endoscopy, however, the description of polyp morphology, usage of advanced imaging assessment, polyp retrieval rate and the image documentation are inappropriate yet, therefore the evaluation was not possible. The aim for the future is to improve the quality of data input to the register.

Introduction

Several studies have shown that a low quality of colonoscopy reduces its effect in preventing colorectal cancer (CRC), but it is not clear to which extent a low-quality colonoscopy is still effective compared to no colonoscopy. We aimed to compare the 13-year risk of developing CRC between persons with I) a high-quality screening colonoscopy, II) a low-quality screening colonoscopy and III) without a screening colonoscopy.

Aims & Methods

Using observational data from a German claims database (GePaRD; 20% population coverage) we emulated a target trial with three arms: High-quality screening colonoscopy (highQualSC) vs. low-quality screening colonoscopy (lowQualSC) vs. no screening colonoscopy (noSC) at baseline. The quality of baseline colonoscopy was categorized based on the polyp detection rate of the examining physician. We included persons at average CRC risk aged 55–69 years and without a colonoscopy, polypectomy or fecal occult blood test before baseline. We estimated adjusted cumulative CRC incidence over 13 years of follow-up.

Results

Overall, we included 142,960 persons in the highQualSC arm, 62,338 persons in the lowQualSC arm and 124,040 persons in the noSC arm. The adjusted 13-year risk of any CRC was 1.77% in the highQualSC arm, 2.09% in the lowQualSC arm and 2.74% in the noSC arm. Compared to the noSC arm, the adjusted relative risk (aRR) was 0.76 (95% CI: 0.70-0.84) in the lowQualSC arm and 0.65 (95% CI: 0.60-0.69) in the highQualSC arm.

Conclusion

Our study demonstrated that the effect of screening colonoscopy in preventing CRC is substantially lower in persons with a low-quality as compared to a high-quality screening colonoscopy. However, it also showed that attending a low-quality screening colonoscopy still markedly reduces the risk of CRC compared to no screening colonoscopy.