Endoscopy 2019; 51(04): S138-S139
DOI: 10.1055/s-0039-1681577
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 13:00 – 13:30: CRC screening 1 ePoster Podium 3
Georg Thieme Verlag KG Stuttgart · New York

PROXIMAL NEOPLASIA YIELD AMONG SUBJECTS REFERRED FOR COLONOSCOPY FOLLOWING A POSITIVE SCREENING SIGMOIDOSCOPY, ACCORDING TO REFERRAL INDICATION

C Senore
1   SSD Epidemiologia e screening – CPO, AOU Città della Salute e della Scienza, CPO Piemonte, Turin, Italy
,
A Arrigoni
2   SC Gastroenterologia U, AOU Città della Salute e della Scienza, Turin, Italy
,
R Fasoli
3   SC Gastroenterologia, AO S. Croce e Carle, Cuneo, Italy
,
P Cassoni
4   Dipartimento di Scienze Mediche, Università di Torino, Turin, Italy
,
C Hassan
5   Endoscopy, Nuovo Regina Margherita, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

The Piedmont (Italy) CRC screening program adopted once-only sigmoidoscopy (FS), at age 58, as primary screening test. Screenees are referred for colonoscopy (TC), based on the following criteria: >= 1 high-risk (HR – size > 9 mm.; size < 10 mm and villous component> 20% or high-grade dysplasia; > 2 adenomas < 10 mm) distal polyp; inadequate bowel preparation in subjects with polyps (any size); increased CRC risk due to family history (FH), or symptoms (endoscopist's judgement), among subjects with negative FS. Limited evidence is available about the proximal neoplasia yield of the different indications.

Methods:

We estimated positive predictive value (PPV) for CRC, advanced adenoma (AA) and advanced neoplasia (AN – CRC+AA) of TC referral and the number needed to scope (NNScope) to detect 1 AN, by referral indication, among subjects referred for TC between January 1st 2012 and December 12th.

Results:

Out of the 6832 screenees undergoing TCs during the study period, positive FH accounted for 15% of referrals and symptoms for 6%, while 55% and 24% of patients had been detected with a HR polyp, or with polyps during a FS with inadequate preparation, respectively. The AN PPV was 5.1% among screenees with positive FH (only 1 CRC detected), 6.6% among symptomatic patients; 12.7% among those with HR polyps and 8.6% among those with inadequate bowel preparation and polyps; the corresponding figures for the NNScope to detect 1 AN were: 19.4, 7.8, 11.6, 15.1. The NNScope was higher among women (25.6) than among men (11.7) when considering symptomatic subjects.

Conclusions:

The proximal AN yield is high when polyps are detected in the distal colon, while it is low for other indications. A wide variability among endoscopists was observed in the proportion of TC referrals for FH, or symptoms, suggesting the need to implement efforts aimed to promote a more efficient TC utilization.