Publicaciones científicas

Quality of colonoscopy is associated with adenoma detection and post-colonoscopy colorectal cancer prevention in Lynch syndrome

03-nov-2020 | Revista: Clinical Gastroenterology and Hepatology

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

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