Position and yield of colonoscopy within the faecal occult bleeding test (FOBT) based screening program

Czech version

Authors: J. Špičák ¹; P. Štirand ¹; P. Drastich ¹; M. Beneš ¹; T. Hucl ¹; P. Wohl ¹; V. Nosek ³; Š. Suchánek ²; M. Řehoř ³; O. Urban ⁴; M. Zavoral ²
Authors‘ workplace: Klinika hepatogastroenterologie, IKEM, Praha2Interní klinika, ÚVN Praha3Endoskopické oddělení, Nemocnice Jablonec nad Nisou4Interní oddělení, Vítkovická nemocnice, a. s., Ostrava ¹
Published in: Gastroent Hepatol 2011; 65(4): 181-188
Category: Endoscopy: Original Article

Overview

Introduction, aim of the study: Colorectal carcinoma is one of the most serious malignancies. Screening may reduce its incidence as well as mortality by up to tens of percents. Each region should optimise screening with respect to the specific conditions. This prospective multicenter study aimed to provide an overview of colorectal neoplasia detection and assess the potential of colonoscopy and the screening program.

Results:
We assessed 3,400 subsequent colonoscopies performed between 2009 and 2010. In four centres the caecum and the terminal ileum were reached in 89 to 93% and in 73 to 87% of patients, respectively. Both values were significantly higher than during the 2005/2006 study. The incidence of advanced neoplasia in the age categories up to 40, 40–45, 45–50 and over 50 years was 0.9%, 4.4%, 12% and 38.1%, respectively. The most frequent location of advanced neoplasia was the rectosigmoid followed by the colon ascendens and the caecum. Only slightly over 50% of advanced neoplasia were potentially within the reach of a sigmoidoscope. In the group aged > 40 years, we assessed 2,126 colonoscopies. 564 (26.5%) were indicated within the screening. Women involved in the screening accounted for 43.4%; the incidence of advanced neoplasia was 15.5% in women and 19.1% in men. In the screened patients with positive family history, the incidence of advanced neoplasia equalled 4.3%, while it was 32.6% in the other patients. Within the screening, the incidence of advanced neoplasia was 21.2% after positive FOBT, 13.1% in primary colonoscopies and 7.4% after negative FOBT. The average age at the time of screening colonoscopies was 50 years, 58 years with diagnostic colonoscopies, 45 years with positive family history screening and 52 years with negative family history screening.

Conclusion:
The ratio of screening colonoscopies and symptomatic indications was approximately 1 to 4 in patients aged > 40 years and did not change in 4 years. The ability to reach the caecum as well as the terminal ileum increased. The detection of colorectal carcinoma and its precursors was extraordinarily high in all the subgroups. A relatively high proportion of advanced neoplasia was localised beyond the potential reach of the sigmoidoscope. Male patients prevail in the screening and there is a high proportion of patients with positive family history. The low yield of screening with positive family history can be explained by significantly lower age. They probably come for the examination earlier as they are informed about the risk.

Key words:
colorectal cancer – screening – colonoscopy – faecal occult blood test (FOBT) – family history

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