Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Clin Gastroenterol Hepatol. 2022 Mar;20(3):611-621.e9. doi: 10.1016/j.cgh.2020.11.002. Epub 2020 Nov 3.
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.
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.
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).
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.
结肠镜检查可降低林奇综合征（LS）患者的结直肠癌（CRC）发病率和死亡率。然而，据报道，结肠镜检查后的结直肠癌（PCCRC）发病率仍然较高。结肠镜检查高度依赖于内镜医生的技能，并且存在质量变异性。我们旨在评估关键结肠镜检查质量指标对 LS 患者腺瘤检出率和 PCCRC 预防的影响。
我们进行了一项多中心研究，纳入了 893 例无既往 CRC 的 LS 携带者，他们正在接受结肠镜检查监测。分析了监测期间新发结直肠腺瘤和所有结肠镜检查的质量指标。我们进行了一项模拟目标试验，比较了第一次和第二次结肠镜检查的结果，以评估结肠镜检查质量指标对腺瘤检出率和 PCCRC 发生率的影响。使用多变量逻辑回归模型进行风险分析。
10 年累积腺瘤和 PCCRC 发生率分别为 60.6%（95%CI，55.5%-65.2%）和 7.9%（95%CI，5.2%-10.6%）。充分的肠道准备（比值比[OR]，2.07；95%CI，1.06-4.3）、完整的结肠镜检查（20%比 0%；P=0.01）和全结肠染色内镜的使用（OR，2.14；95%CI，1.15-3.95）与腺瘤检出率的显著提高相关。当结肠镜检查的间隔时间小于 3 年时，PCCRC 的风险显著降低（OR，0.35；95%CI，0.14-0.97）。我们观察到，先前进行过完整检查（OR，0.16；95%CI，0.03-1.28）、充分的肠道准备（OR，0.64；95%CI，0.17-3.24）或先前使用高清结肠镜检查（OR，0.37；95%CI，0.02-2.33）与 PCCRC 风险的降低呈一致但无统计学意义。
充分的肠道准备和染色内镜使用的完整结肠镜检查与腺瘤检出率的提高相关，而间隔时间小于 3 年与 PCCRC 发生率的降低相关。在 LS 中，高质量的结肠镜检查监测对于 CRC 的预防至关重要。
