1
|
Jiao YF, Cheng ZY, Gao Y, Yu CT, Jiang HS, Wang TL, Deng Y, Lin H, Wang TJ, Wang W, Wan R, Li ZS, Xin L, Wang LW. Development, quality, and influencing factors of colonoscopy in China: results from the national census in 2013 and 2020. Front Oncol 2023; 13:1276520. [PMID: 37810978 PMCID: PMC10556871 DOI: 10.3389/fonc.2023.1276520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background and Aim With the increasing burden of colorectal cancer (CRC), the practice of colonoscopy is gaining attention worldwide. However, it exhibits distinct trends between developing and developed countries. This study aims to explore its development and identify influencing factors in China. Methods The Chinese Digestive Endoscopy Censuses were conducted twice in mainland China under the supervision of health authorities. Information regarding the practice of colonoscopy was collected through a structured online questionnaire. The authenticity of the data was evaluated through logical tests, and a random selection of endoscopic reports underwent manual validation by Quality Control Centers. Potential factors associated with colonoscopy were analyzed using real-world information. Results From 2012 to 2019, the number of hospitals that performed colonoscopy increased from 3,210 to 6,325 (1.97-fold), and the volume increased from 5.83 to 12.92 million (2.21-fold). The utilization rate rose from 436.0 to 914.8 per 100,000 inhabitants (2.10-fold). However, there was an exacerbation of regional inequality in the adequacy of colonoscopy. Regions with higher incidence of CRC, higher gross domestic product per capita, more average numbers of endoscopists and tertiary hospitals tended to provide more accessible colonoscopy (P<0.001). Nationwide, the cecal intubation rate improved from 83.9% to 94.4% and the unadjusted adenoma detection rate (ADR) improved from 16.3% to 18.1%. Overall, hospital grading, educational background of endoscopists, economic income, and colonoscopy volume were observed as the significantly positive factors affecting ADR (P<0.05), but not the incidence of CRC or the number of endoscopists. Conclusions Tremendous progress in colonoscopy has been made in China, but some issues needed timely reflection. Our findings provide timely evidence for better colonoscopy strategies and measures, such as quality control and medical education of endoscopists.
Collapse
Affiliation(s)
- Yun-Fei Jiao
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Zhi-Yuan Cheng
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ye Gao
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Chu-Ting Yu
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Hui-Shan Jiang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Ting-Lu Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Ying Deng
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Han Lin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Tian-Jiao Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Wei Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Rong Wan
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Luo-Wei Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| |
Collapse
|
2
|
Samnani S, Khan R, Heitman SJ, Hilsden RJ, Byrne MF, Grover SC, Forbes N. Optimizing adenoma detection in screening-related colonoscopy. Expert Rev Gastroenterol Hepatol 2023:1-14. [PMID: 37158052 DOI: 10.1080/17474124.2023.2212159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Screening-related colonoscopy is a vital component of screening initiatives to both diagnose and prevent colorectal cancer (CRC), with prevention being reliant upon early and accurate detection of pre-malignant lesions. Several strategies, techniques, and interventions exist to optimize endoscopists' adenoma detection rates (ADR). AREAS COVERED This narrative review provides an overview of the importance of ADR and other colonoscopy quality indicators. It then summarizes the available evidence regarding the effectiveness of the following domains in terms of improving ADR: endoscopist factors, pre-procedural parameters, peri-procedural parameters, intra-procedural strategies and techniques, antispasmodics, distal attachment devices, enhanced colonoscopy technologies, enhanced optics, and artificial intelligence. These summaries are based on an electronic search of the databases Embase, Pubmed, and Cochrane performed on December 12, 2022. EXPERT OPINION Given the prevalence and associated morbidity and mortality of CRC, the quality of screening-related colonoscopy quality is appropriately prioritized by patients, endoscopists, units, and payers alike. Endoscopists performing colonoscopy should be up to date regarding available strategies, techniques, and interventions to optimize their performance.
Collapse
Affiliation(s)
- Sunil Samnani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert J Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael F Byrne
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
3
|
Denis B, Gendre I. Colonoscopy may be weak link in organised colorectal cancer screening programme with faecal immunochemical test. J Med Screen 2021; 29:84-91. [PMID: 34866481 DOI: 10.1177/09691413211061118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the quality of colonoscopies performed after a positive faecal immunochemical test in the French colorectal cancer screening programme. METHODS Retrospective analysis of all colonoscopies performed between 2015 and 2019 after a positive quantitative faecal immunochemical test in the population-based colorectal cancer screening programme organised in Alsace, part of the French programme. The following indicators were evaluated: annual colonoscopy volume, caecal intubation rate, adenoma detection rate, proximal serrated lesion detection rate and proportion of patients referred directly to surgery for benign polyp management. Endoscopists who performed <30 faecal immunochemical test positive colonoscopies were non-assessable. RESULTS Overall, 13,455 faecal immunochemical test-positive colonoscopies performed by 116 community gastroenterologists were included, 13,067 of them by 80 assessable endoscopists. The overall caecal intubation, adenoma detection and proximal serrated lesion detection rates were 97.9%, 57.6% and 7.6%, respectively. They were <90%, <45% and <1% for 1.3%, 12.5% and 6.3% of the endoscopists, respectively. Overall, 1028 (7.9%) individuals were examined by 13 low-performing endoscopists and 328 (2.4%) individuals by 33 low-volume non-assessable endoscopists. Among 9133 individuals harbouring polyps, 155 (1.7%) had unwarranted surgery for a benign polyp. Overall, 1487 individuals (11.1%; 95% confidence interval 10.5-11.6) were not given the best possible chances, whereas 5545 individuals (41.2%; 95% confidence interval 40.4-42.0) were offered the best possible chances by 37 endoscopists. CONCLUSIONS At programme level, the key performance indicators evaluated largely exceeded the target standards. At individual level, at least one in nine individuals was not given the best possible chances during faecal immunochemical test-positive colonoscopies by a minority of poor-performing and/or low-volume endoscopists.
Collapse
Affiliation(s)
- Bernard Denis
- Service d'hépato-gastroentérologie, Hôpital Pasteur, France.,ADECA Alsace, France
| | | |
Collapse
|
4
|
Abstract
Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.
Collapse
Affiliation(s)
- Andrea Laghi
- a Department of Radiological Sciences, Oncology and Pathology , Sapienza - University of Rome, ICOT Hospital , Latina , Italy
| |
Collapse
|
7
|
The relationship between proximal and distal colonic adenomas: is screening sigmoidoscopy enough in the presence of a changing epidemiology? Eur J Gastroenterol Hepatol 2013; 25:973-80. [PMID: 23571611 DOI: 10.1097/meg.0b013e3283614b57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Because the relationship between distal and proximal colonic findings remains uncertain, controversy exists over whether proctosigmoidoscopy or colonoscopy is more suitable for colorectal cancer (CRC) screening. We aim to describe the distribution and characteristics of polyps removed in colonoscopy screening. PATIENTS AND METHODS A prospective registry of a colonoscopy-based CRC screening program was developed on asymptomatic individuals over 50 years. All polyps were removed and characterized. Polyp size and histology were noted. Adenomas were considered advanced if they measured greater than 10 mm or were tubulovillous, villous, or malignant. The prevalence of advanced proximal polyps was determined and patients were categorized according to their family history of CRC. RESULTS A total of 696 individuals (418 women), aged 57.7 ± 10.3 years, were examined; 45.8% presented a colonic lesion, being adenomatous polyps in 32.7% individuals. Among these, 24.7% were advanced adenomas. Three patients (0.6%) presented invasive CRC. There were no significant differences with respect to sex and family history of CRC between patients with or without adenomas. Adenomas were more prevalent in individuals aged at least 65, irrespective of location (P<0.001). In 65.1% of individuals with adenomatous polyps in the right colon, there were no synchronous adenomas in the left colon (P<0.001). More adenomas were also present in the right colon of patients with no family history of CRC (P<0.001). CONCLUSION Most patients with adenomatous polyps in the right colon showed no synchronic adenomas on the left side. Lesions on the right side would have gone undetected if the individuals undergoing CRC screening had been explored with proctosigmoidoscopy.
Collapse
|
8
|
Day LW, Bhuket T, Inadomi JM, Yee HF. Diversity of endoscopy center operations and practice variation across California's safety-net hospital system: a statewide survey. BMC Res Notes 2013; 6:233. [PMID: 23767938 PMCID: PMC3693938 DOI: 10.1186/1756-0500-6-233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/11/2013] [Indexed: 02/07/2023] Open
Abstract
Background Little is known about endoscopic services provided or operational practice variation within California public hospital endoscopy centers. Methods A survey was distributed to all 18 California public hospitals with endoscopy centers to assess operational practices. Results Eight of 18 hospitals responded to the survey. Six of the eight responding hospitals used a closed access system for patient referrals. Mean wait time for an endoscopic procedure was 42.4 ± 37.7 days (N = 8) with a mean procedure no-show/cancellation rate of 14.5 ± 8.0% (N = 7). All responding public hospitals performed colonoscopy, esophagogastroduodenoscopy, PEG tube placement, and endoscopic retrograde cholangiopancreatography (ERCP) with two hospitals performing endoscopic ultrasound. There was significant practice variation in the documentation of endoscopic quality and performance measurements among the responding hospitals. Multiple methods were used to communicate pathology results to patients: GI clinic visit (6/8), primary physician (4/8), telephone (2/8) or letter (1/8). Conclusion Our study highlights the diversity and practice variations of endoscopy center operations at California public hospitals and serves as a catalyst for future collaborations among safety-net hospitals.
Collapse
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
| | | | | | | |
Collapse
|