Odds of Incomplete Colonoscopy in Colorectal Cancer Screening Based on Socioeconomic Status

Selected comorbidities increases the likelihood of an incomplete colonoscopy during colorectal cancer screening

OBJECTIVE

The risk of incomplete colonoscopy is associated with demographic factors and general comorbidity. However, focus on specific comorbidities is limited. This study aimed to investigate the association between selected comorbidities and incomplete colonoscopy in colorectal cancer (CRC) screening.

METHODS

This register-based study included 71,973 Danish screening participants, undergoing colonoscopy after positive fecal immunochemical test. The selected comorbidities were divided into hematological disease, endocrine disease (nondiabetes), endocrine disease (diabetes related), upper gastrointestinal (GI) disease, lower GI disease, other diseases of digestive system, hepatobiliary and pancreatic (HBP) disease, CRC, intraabdominal cancer (except CRC), and mental disease. Outcomes were incomplete colonoscopy due to poor bowel preparation and other reasons. Multivariate logistic regression models were applied.

RESULTS

Of 5,428 (7.5%) incomplete colonoscopies, 2,625 (3.6%) were due to poor bowel preparation and 2,803 (3.9%) due to other reasons. Individuals with specific comorbidities were compared to those without, exhibiting varying odds ratios (OR) for incomplete colonoscopy. For poor bowel preparation, ORs were 1.20 (95%CI: 1.04;1.39), 1.43 (95%CI: 1.30;1.56), 1.86 (95%CI: 1.66;2.09), 1.27 (95%CI: 1.12;1.43), and 1.64 (95%CI: 1.47;1.83) for hematological, endocrine (nondiabetes), endocrine (diabetes related), HBP, and mental disease, respectively, and 1.29 (95%CI: 1.09;1.52) for intraabdominal cancer (except CRC). Incomplete colonoscopies due to other reasons showed ORs of 1.24 (95%CI: 1.08;1.43), 1.18 (95%CI: 1.03;1.36), 1.19 (95%CI: 1.05;1.35), and 1.30 (95%CI: 1.15;1.47) for hematological, endocrine (diabetes related), HBP, and mental disease, respectively, and 1.35 (95%CI: 1.15;1.60) for intra-abdominal cancer (except CRC).

CONCLUSION

Participants with specific comorbidities had significantly higher probability of having an incomplete colonoscopy, suggesting that certain comorbidities could be used prospectively as a predictive factor.

Socioeconomic inequalities in interval colorectal cancer are explained by differences in faecal haemoglobin concentration and age: a register-based cohort study

OBJECTIVE

To estimate the risk of interval colorectal cancer (CRC) in faecal immunochemical test (FIT) negative screening participants according to socioeconomic status.

DESIGN

In this register-based study, first round FIT negative (<20 µg hb/g faeces) screening participants (biennial FIT, citizens aged 50-74) were followed to estimate interval CRC risk. Multivariate Cox proportional hazard regression models estimated HRs based on socioeconomic status defined by educational level and income. Models were adjusted for age, sex and FIT concentration.

RESULTS

We identified 829 (0.7‰) interval CRC in 1 160 902 individuals. Interval CRC was more common in lower socioeconomic strata with 0.7‰ for medium-long higher education compared with 1.0‰ for elementary school and 0.4‰ in the highest income quartile compared with 1.2‰ in the lowest. These differences did not translate into significant differences in HR in the multivariate analysis, as they were explained by FIT concentration and age. HR for interval CRC was 7.09 (95% CI) for FIT concentrations 11.9-19.8 µg hb/g faeces, and 3.37 (95% CI) for FIT between 7.2 and 11.8 compared with those <7.2. The HR rose with increasing age ranging from 2.06 (95% CI 1.45 to 2.93) to 7.60 (95% CI 5.63 to 10.25) compared with those under 55 years.

CONCLUSION

Interval CRC risk increased with decreasing income, heavily influenced by lower income individuals more often being older and having increased FIT concentrations. Individualising screening interval based on age and FIT result, may decrease interval CRC rates, reduce the social gradient and thereby increase the screening efficiency.

The optimal use of colon capsule endoscopes in clinical practice

Colon capsule endoscopy (CCE) has been available for nearly two decades but has grappled with being an equal diagnostic alternative to optical colonoscopy (OC). Due to the COVID-19 pandemic, CCE has gained more foothold in clinical practice. In this cutting-edge review, we aim to present the existing knowledge on the pros and cons of CCE and discuss whether the modality is ready for a larger roll-out in clinical settings. We have included clinical trials and reviews with the most significant impact on the current position of CCE in clinical practice and discuss the challenges that persist and how they could be addressed to make CCE a more sustainable imaging modality with an adenoma detection rate equal to OC and a low re-investigation rate by a proper preselection of suitable populations. CCE is embedded with a very low risk of severe complications and can be performed in the patient's home as a pain-free procedure. The diagnostic accuracy is found to be equal to OC. However, a significant drawback is low completion rates eliciting a high re-investigation rate. Furthermore, the bowel preparation before CCE is extensive due to the high demand for clean mucosa. CCE is currently not suitable for large-scale implementation in clinical practice mainly due to high re-investigation rates. By a better preselection before CCE and the implantation of artificial intelligence for picture and video analysis, CCE could be the alternative to OC needed to move away from in-hospital services and relieve long-waiting lists for OC.