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The impact of endoscopist performance and patient factors on distal adenoma detection and colorectal cancer incidence.
Power, Sharon; Wooldrage, Kate; Saunders, Brian P; Cross, Amanda J.
Afiliación
  • Power S; Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, W2 1NY, UK. s.power18@imperial.ac.uk.
  • Wooldrage K; Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, W2 1NY, UK.
  • Saunders BP; Department of Surgery and Cancer, Imperial College London, London, UK.
  • Cross AJ; Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK.
BMC Gastroenterol ; 24(1): 44, 2024 Jan 23.
Article en En | MEDLINE | ID: mdl-38262960
ABSTRACT

BACKGROUND:

High quality endoscopy is key for detecting and removing precursor lesions to colorectal cancer (CRC). Adenoma detection rates (ADRs) measure endoscopist performance. Improving other components of examinations could increase adenoma detection.

AIMS:

To investigate how endoscopist performance at flexible sigmoidoscopy (FS) affects adenoma detection and CRC incidence.

METHODS:

Among 34,139 participants receiving FS screening by the main endoscopist at one of 13 centres in the UK FS Screening Trial, median follow-up was 17 years. Factors examined included family history of CRC, bowel preparation quality, insertion and withdrawal time, bowel segment reached, patient pain and ADR. Odds ratios (OR) for distal adenoma detection were estimated by logistic regression. Hazard ratios (HR) for distal CRC incidence were estimated by Cox regression.

RESULTS:

At screening, 4,104 participants had distal adenomas detected and 168 participants developed distal CRC during follow-up. In multivariable models, a family history of CRC (yes vs. no OR 1.40, 95%CI 1.21-1.62), good or adequate bowel preparation quality (vs. excellent OR 0.84, 95%CI 0.74-0.95; OR 0.56, 95%CI 0.49-0.65, respectively) and longer insertion and withdrawal times (≥ 4.00 vs. < 2.00 min OR 1.96, 95%CI 1.68-2.29; OR 32.79, 95%CI 28.22-38.11, respectively) were associated with adenoma detection. Being screened by endoscopists with low or intermediate ADRs, compared to high ADRs, was positively associated with CRC incidence (multivariable HR 4.71, 95%CI 2.65-8.38; HR 2.16, 95%CI 1.22-3.81, respectively).

CONCLUSIONS:

Bowel preparation quality and longer insertion and withdrawal time are key for improving distal adenoma detection. Higher ADRs were associated with a lower risk of distal CRC.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Colorrectales / Adenoma Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: BMC Gastroenterol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Colorrectales / Adenoma Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: BMC Gastroenterol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido