El grupo de trabajo de oncología de la Asociación Española de Gastroenterología (AEG) incluye a todos los socios y socias de AEG que comparten su interés por el conocimiento del cáncer gastrointestinal, incluyendo las formas hereditarias y de alto riesgo asociadas a estos tumores. La filosofía del grupo es promover la investigación colaborativa, impulsar las actividades formativas y fomentar la docencia relacionada con esta área de la especialidad de Aparato Digestivo.
Clinical Gastroenterology and Hepatology
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 pan-chromoendoscopy 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.
Keywords: Colonoscopy; Colonoscopy Quality; Colorectal Neoplasms; HNPCC; Hereditary Colorectal Cancer; Hereditary Nonpolyposis Colorectal Cancer; Lynch Syndrome.
Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.
Sánchez A, et al. Clin Gastroenterol Hepatol. 2020 Nov 3: S1542-3565(20)31514-7.