Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome
Por:
Sanchez, A, Roos, VH, Navarro, M, Pineda, M, Caballol, B, Moreno, L, Carballal, S, Rodriguez-Alonso, L, Cajal, TRY, Llort, G, Pinol, V, Lopez-Fernandez, A, Salces, I, Pico, MD, Rivas, L, Bujanda, L, Garzon, M, Pizarro, A, de Castro, EM, Lopez-Arias, MJ, Poves, C, Garau, C, Rodriguez-Alcalde, D, Herraiz, M, Alvarez-Urrutia, C, Dacal, A, Carrillo-Palau, M, Cid, L, Ponce, M, Barreiro-Alonso, E, Saperas, E, Aguirre, E, Romero, C, Bastiaansen, B, Gonzalez-Acosta, M, Morales-Romero, B, Ocana, T, Rivero-Sanchez, L, Jung, G, Bessa, X, Cubiella, J, Jover, R, Rodriguez-Moranta, F, Balmana, J, Brunet, J, Castells, A, Dekker, E, Capella, G, Serra-Burriel, M, Moreira, L, Pellise, M, Balaguer, F
Publicada:
1 mar 2022
Resumen:
BACKGROUND & AIMS: Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS.
METHODS: We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model.
RESULTS: The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%-65.2%) and 7.9% (95% CI, 5.2%-10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06-4.3), complete colonoscopies (20% vs 0%; P = .01), and panchromoendoscopy use (OR, 2.14; 95% CI, 1.15-3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03-1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17-3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02-2.33).
CONCLUSIONS: Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
Filiaciones:
Sanchez, A:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Roos, VH:
Univ Amsterdam, Amsterdam Univ Med Ctr, Canc Ctr Amsterdam, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
Navarro, M:
Hosp Duran & Reynals, Inst Invest Biomed Bellvitge IDIBELL, Oncobell Program, Hereditary Canc Program, Barcelona, Spain
Pineda, M:
Hosp Duran & Reynals, Inst Invest Biomed Bellvitge IDIBELL, Oncobell Program, Hereditary Canc Program, Barcelona, Spain
Caballol, B:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Moreno, L:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Carballal, S:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Rodriguez-Alonso, L:
Hosp Univ Bellvitge, Dept Gastroenterol, Catalan Inst Oncol, Barcelona, Spain
Cajal, TRY:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Llort, G:
Parc Tauli Hosp Univ, Dept Med Oncol & Gastroenterol, Conscorci Sanitari Terrasa, Sabadell Terrasa, Spain
Pinol, V:
Univ Girona, Hosp Dr Josep Trueta, Dept Gastroenterol, Girona, Girona, Spain
Lopez-Fernandez, A:
Vall Hebron Inst Oncol, Dept Med Oncol, Hereditary Canc Genet Grp, Barcelona, Spain
Salces, I:
Hosp 12 Octubre, Dept Gastroenterol, Madrid, Spain
Pico, MD:
Hosp Gen Univ Elche, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Dept Gastroenterol, Elche, Spain
Rivas, L:
Complexo Hosp Univ Orense, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Sanitaria Galicia Sur, Dept Gastroenterol, Orense, Spain
Bujanda, L:
Univ Basque Country, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Biodonostia Hlth Res Inst, Dept Gastroenterol,Euskal Herriko Unibertsitatea, San Sebastian, Spain
Garzon, M:
Hosp Virgen Rocio, Dept Gastroenterol, Seville, Spain
Pizarro, A:
Hosp Virgen Rocio, Dept Gastroenterol, Seville, Spain
de Castro, EM:
Hosp Univ Marques Valdecilla, Inst Invest Sanitaria Valdecilla IDIVAL, Dept Med Oncol & Gastroenterol, Santander, Spain
Lopez-Arias, MJ:
Hosp Univ Marques Valdecilla, Inst Invest Sanitaria Valdecilla IDIVAL, Dept Med Oncol & Gastroenterol, Santander, Spain
Poves, C:
Hosp Clin San Carlos, Dept Gastroenterol, Madrid, Spain
Garau, C:
Hosp Univ Son Llatzer, Dept Gastroenterol, Palma De Mallorca, Spain
Rodriguez-Alcalde, D:
Hosp Mostoles, Dept Gastroenterol, Mostoles, Spain
Herraiz, M:
Clin Univ Navarra, Dept Gastroenterol, Pamplona, Spain
Alvarez-Urrutia, C:
Barcelona Hosp Mar, Inst Hosp Mar Invest Biomed IMIM, Hosp Mar Med Res Inst, Dept Gastroenterol, Barcelona, Spain
Dacal, A:
Hosp Univ Lucus Augusti, Dept Gastroenterol, Lugo, Spain
Carrillo-Palau, M:
Hosp Univ Canarias, Dept Gastroenterol, Tenerife, Spain
Cid, L:
SERGAS Univ Vigo UVIGO, Inst Invest Sanitaria Galicia Sur IISGS, Serv Galego Saude SERGAS,Res Grp Digest Dis, Dept Gastroenterol,Xerencia Xest Integrada Vigo, Vigo, Spain
Ponce, M:
Hosp Univ Fe Valencia, Dept Gastroenterol, Valencia, Spain
Barreiro-Alonso, E:
Hosp Univ Cent Asturias, Inst Invest Sanitaria Principado Asturias, Dept Gastroenterol, Oviedo, Spain
Saperas, E:
Univ Int Catalunya, Hosp Univ Gen Catalunya, Sch Med, Dept Gastroenterol, Barcelona, Spain
Aguirre, E:
Hosp Quironsalud Zaragoza, Dept Med Oncol, Genet Counseling Unit, Zaragoza, Spain
Romero, C:
Parc Tauli Hosp Univ, Dept Med Oncol & Gastroenterol, Conscorci Sanitari Terrasa, Sabadell Terrasa, Spain
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Bastiaansen, B:
Univ Amsterdam, Amsterdam Univ Med Ctr, Canc Ctr Amsterdam, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
Gonzalez-Acosta, M:
Hosp Duran & Reynals, Inst Invest Biomed Bellvitge IDIBELL, Oncobell Program, Hereditary Canc Program, Barcelona, Spain
Morales-Romero, B:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Ocana, T:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Rivero-Sanchez, L:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Jung, G:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Bessa, X:
Barcelona Hosp Mar, Inst Hosp Mar Invest Biomed IMIM, Hosp Mar Med Res Inst, Dept Gastroenterol, Barcelona, Spain
Cubiella, J:
Complexo Hosp Univ Orense, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Sanitaria Galicia Sur, Dept Gastroenterol, Orense, Spain
Jover, R:
Hosp Gen Univ Alicante, Inst Invest Biomed ISABIAL, Dept Gastroenterol, Alicante, Spain
Rodriguez-Moranta, F:
Hosp Univ Bellvitge, Dept Gastroenterol, Catalan Inst Oncol, Barcelona, Spain
Balmana, J:
Vall Hebron Inst Oncol, Dept Med Oncol, Hereditary Canc Genet Grp, Barcelona, Spain
Brunet, J:
Univ Girona, Hosp Dr Josep Trueta, Sch Med,Inst Invest Biomed Giron Dr Josep Trueta, Catalan Inst Oncol,Hereditary Canc Program,Med Sc, Girona, Spain
Castells, A:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Dekker, E:
Univ Amsterdam, Amsterdam Univ Med Ctr, Canc Ctr Amsterdam, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
Capella, G:
Hosp Duran & Reynals, Inst Invest Biomed Bellvitge IDIBELL, Oncobell Program, Hereditary Canc Program, Barcelona, Spain
Serra-Burriel, M:
Univ Pompeu Fabra, Ctr Res Hlth & Econ, Barcelona, Spain
Moreira, L:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Pellise, M:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
Balaguer, F:
Univ Barcelona, Hosp Clin Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Invest Biomed August Pi I Sunyer,Dept Gastro, Barcelona, Spain
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