Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome.
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Sánchez Ariadna, Roos Victorine H, Navarro Matilde, Pineda Marta, Caballol Berta, Moreno Lorena, Carballal Sabela, Rodríguez-Alonso Lorena, Ramon Y Cajal Teresa, Llort Gemma, Piñol Virginia, López-Fernández Adrià, Salces Inmaculada, Picó Maria Dolores, Rivas Laura, Bujanda Luis, Garzon Marta, Pizarro Angeles, Martinez de Castro Eva, López-Arias Maria Jesus, Poves Carmen, Garau Catalina, Rodriguez-Alcalde Daniel, Herraiz Maite, Alvarez-Urrutia Cristina, Dacal Andres, Carrillo-Palau Marta, Cid Lucia, Ponce Marta, Barreiro-Alonso Eva, Saperas Esteban, Aguirre Elena, Romero Cristina, Bastiaansen Barbara, Gonzalez-Acosta Maribel, Morales-Romero Blai, Ocaña Teresa, Rivero-Sánchez Liseth, Jung Gerhard, Bessa Xavier, Cubiella Joaquin, Jover Rodrigo, Rodríguez-Moranta Francisco, Balmaña Judith, Brunet Joan, Castells Antoni, Dekker Evelien, Capella Gabriel, Serra-Burriel Miquel, Moreira Leticia, Pellise Maria, Balaguer Francesc
Аннотация
METHODS: 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.
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 (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).
CONCLUSIONS: 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.