Quality of colonoscopy is associated with adenoma detection and post-colonoscopy colorectal cancer prevention in Lynch syndrome
Ariadna Sánchez 1 , Victorine H Roos 2 , Matilde Navarro 3 , Marta Pineda 3 , Berta Caballol 1 , Lorena Moreno 1 , Sabela Carballal 1 , Lorena Rodríguez-Alonso 4 , Teresa Ramon Y Cajal 5 , Gemma Llort 6 , Virginia Piñol 7 , Adria Lopez Fernandez 8 , Inmaculada Salces 9 , Maria Dolores Picó 10 , Laura Rivas 11 , Luis Bujanda 12 , Marta Garzon 13 , Angeles Pizarro 13 , Eva Martinez de Castro 14 , Maria Jesus López-Arias 14 , Carmen Poves 15 , Catalina Garau 16 , Daniel Rodriguez-Alcalde 17 , Maite Herraiz 18 , Cristina Alvarez-Urrutia 19 , Andres Dacal 20 , Marta Carrillo-Palau 21 , Lucia Cid 22 , Marta Ponce 23 , Eva Barreiro-Alonso 24 , Esteban Saperas 25 , Elena Aguirre 26 , Cristina Romero 6 , Barbara Bastiaansen 2 , Maribel Gonzalez-Acosta 3 , Blai Morales-Romero 1 , Teresa Ocaña 1 , Liseth Rivero-Sánchez 1 , Gerhard Jung 1 , Xavier Bessa 19 , Joaquin Cubiella 11 , Rodrigo Jover 27 , Francisco Rodríguez-Moranta 4 , Judith Balmaña 8 , Joan Brunet 28 , Antoni Castells 1 , Evelien Dekker 2 , Gabriel Capella 3 , Miquel Serra-Burriel 29 , Leticia Moreira 1 , Maria Pellise 1 , Francesc Balaguer 30
Background and aims: Colonoscopy reduces colorectal (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of post-colonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on operator skill and 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 colorectal cancer 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 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 (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 in a time interval of less than 3-year (OR=0.35; 95%CI: 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for 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 less than 3 years are associated with reduction of PCCRC incidence. In Lynch syndrome, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
CITA DEL ARTÍCULO Clin Gastroenterol Hepatol. 2020 Nov 3;S1542-3565(20)31514-7. doi: 10.1016/j.cgh.2020.11.002