Clinical and Medical Economic Value of Screening Colonoscopy before Laparoscopic Cholecystectomy.

OBJECTIVE

Clinical value of screening colonoscopy (SC) has been widely accepted; however, its clinical utility remains controversial in patients who undergo laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the clinical value of medical care costs for SC before LC.

SUBJECT AND METHODS

Of the 509 patients who underwent LC, 335 underwent preoperative SC before LC. The electronic medical records were retrospectively reviewed, and the technical fees of SC and endoscopic and/or surgical resection for colorectal neoplasia (CRN) were analyzed.

RESULTS

In the 335 patients with SC before LC, the rate of CRN requiring resection, including advanced adenoma and adenocarcinoma, was 13.1%. The detected rate of CRN requiring resection in the age-groups of <45, 44-55, 55-65, 65-75, ≥75 years was 5.3%, 3.8%, 9.8%, 17.4%, and 22.9%, respectively. Of the 174 patients without SC before LC, 4 patients were diagnosed with resectable colorectal carcinomas after LC. The total technical fees of SC and/or treatment of CRNs among the 335 patients with SC before LC and surgical procedures among the 4 patients with resectable colorectal carcinoma were United States dollar (USD) 84,700 and USD 32,000 USD, respectively. Regarding the technical fee per person, the former group (USD 250) had much economic advantage compared to the latter group (USD 8,000).

CONCLUSION

Scheduling LC is recognized as an important chance to undergo SC. For the patients aged ≥55 years, colonoscopy is no longer a screening option but a clinical necessity due to the high detected rates of CRN requiring resection.