Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
School of Medicine, University College Dublin, Dublin, Ireland.
BMJ Open Gastroenterol. 2023 Sep;10(1). doi: 10.1136/bmjgast-2023-001160.
To evaluate the impact of British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE) 2019 polypectomy surveillance guidelines within a national faecal immunochemical test-based bowel cancer screening (BS) cohort on surveillance activity and detection of pathology by retrospective virtual application.
A retrospective review of BS colonoscopies performed in 2015-2016 with 5 years prospective follow-up in single institution. Index colonoscopies were selected. Incomplete colonoscopies were excluded. Histology of all resected polyps was reviewed. Surveillance intervals were calculated according to BSG/ACPGBI/PHE 2019 guidelines and compared with pre-existing 'European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis' (EUQA 2013). Total number of colonoscopies deferred by virtual implementation of BSG/ACPGBI/PHE 2019 guidelines were calculated. Pathology identified on procedures that would have been deferred was reviewed.
Total number of index BS colonoscopies performed in 2015-2016 inclusive was 890. 115 were excluded (22 no caecal intubation, 51 inadequate bowel preparation, 56 incomplete polyp clearance). N=509 colonoscopies were scheduled within a 5-year interval following index colonoscopy surveillance rounds based on EUQA guidelines. Overall, volume of surveillance was significantly reduced with retrospective application of BSG/ACPGBI/PHE 2019 guidelines (n=221, p<0.0001). No cancers were detected within the 'potentially deferred' procedures who attended for follow-up (n=330) with high-risk findings found in<10% (n=30) of colonoscopies within the BSG/ACPGBI/PHE cohort.
BSG/ACPGBI/PHE 2019 guidelines safely reduce the burden of colonoscopy demand with acceptable pathology findings on deferred colonoscopies.
评估英国胃肠病学会/英国结直肠外科学会/英国公共卫生署（BSG/ACPGBI/PHE）2019 年息肉切除术监测指南在全国基于粪便免疫化学试验的结直肠癌筛查（BS）队列中的应用对监测活动和通过回顾性虚拟应用检测病理学的影响。
这是一项在单家机构进行的 2015-2016 年 BS 结肠镜检查的回顾性研究，前瞻性随访 5 年。选择了索引结肠镜检查。排除了不完全结肠镜检查。审查了所有切除息肉的组织学。根据 BSG/ACPGBI/PHE 2019 指南计算监测间隔，并与现有的“欧洲结直肠癌筛查和诊断质量保证指南”（EUQA 2013）进行比较。计算了通过虚拟实施 BSG/ACPGBI/PHE 2019 指南而延迟的结肠镜检查总数。审查了原本会被推迟的手术中发现的病理学。
2015-2016 年进行的索引 BS 结肠镜检查总数为 890 例。排除 115 例（22 例未到达盲肠，51 例肠道准备不充分，56 例息肉清除不完全）。根据 EUQA 指南，在索引结肠镜检查监测轮次后的 5 年内，计划对 509 例结肠镜检查进行监测。总体而言，通过回顾性应用 BSG/ACPGBI/PHE 2019 指南，监测量显著减少（n=221，p<0.0001）。在接受随访的“可能被推迟”手术中未发现癌症（n=330），在 BSG/ACPGBI/PHE 队列中，仅有<10%（n=30）的结肠镜检查发现高危发现。
BSG/ACPGBI/PHE 2019 指南通过安全地减少结肠镜检查需求的负担，同时在推迟的结肠镜检查中获得可接受的病理学发现。
