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Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis.

ABSTRACT: OBJECTIVE:To review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex. DESIGN:Systematic review and meta-analysis of all available studies. DATA SOURCES:PubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings. ELIGIBILITY CRITERIA:Studies assessing the outcome of a follow-up colonoscopy among participants at average risk for colorectal cancer with a negative previous colonoscopy (no adenomas). RESULTS:28 studies were identified, including 22 cohort studies, five cross sectional studies, and one case-control study. Findings for an interval between colonoscopies of one to five, five to 10, and more than 10 years were reported by 17, 16, and three studies, respectively. Summary estimates of prevalences of any neoplasm were 20.7% (95% confidence interval 15.8% to 25.5%), 23.0% (18.0% to 28.0%), and 21.9% (14.9% to 29.0%) for one to five, five to 10, and more than 10 years between colonoscopies. Corresponding summary estimates of prevalences of any advanced neoplasm were 2.8% (2.0% to 3.7%), 3.2% (2.2% to 4.1%), and 7.0% (5.3% to 8.7%). Seven studies also reported findings stratified by sex. Summary estimates stratified by interval and sex were consistently higher for men than for women. CONCLUSIONS:Although detection of any neoplasms was observed in more than 20% of participants within five years of a negative screening colonoscopy, detection of advanced neoplasms within 10 years was rare. Our findings suggest that 10 year intervals for colonoscopy screening after a negative colonoscopy, as currently recommended, may be adequate, but more studies are needed to strengthen the empirical basis for pertinent recommendations and to investigate even longer intervals. STUDY REGISTRATION:Prospero CRD42019127842.

SUBMITTER: Heisser T

PROVIDER: S-EPMC6853024 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis.

Heisser Thomas T Peng Le L Weigl Korbinian K Hoffmeister Michael M Brenner Hermann H

BMJ (Clinical research ed.) 20191113

<h4>Objective</h4>To review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex.<h4>Design</h4>Systematic review and meta-analysis of all available studies.<h4>Data sources</h4>PubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality rating ...[more]

PMID: 31722884

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Project description:BackgroundNeonatal mortality is one of the major public health problems throughout the world and most notably in developing countries. There exist inconclusive findings on the effect of antenatal care visits on neonatal death worldwide. Thus, the aim of this systematic review and meta-analysis was to reveal the pooled effect of antenatal care visits on neonatal death.MethodsThe present systematic review and meta-analysis was performed using published literature, which was accessed from national and international databases such as, Medline/PubMed, EMBASE, CINAHL, Cochrane Central library, Google Scholar, and HINARI. STATA/SE for windows version 13 software was used to calculate the pooled effect size with 95% confidence intervals (95% CI) of maternal antenatal care visits on neonatal death using the DerSimonian and Laird random effects meta-analysis (random effects model), and results were displayed using forest plot. Statistical heterogeneity was checked using the Cochran Q test (chi-squared statistic) and I2 test statistic and by visual examination of the forest plot.ResultsA total of 18 studies, which fulfilled the inclusion criteria, were included in the present systematic review and meta-analysis. The finding of the present systematic review and meta-analysis revealed that antenatal care visits decrease the risk of neonatal mortality [pooled effect size 0.66 (95% CI, 0.54, 0.80)]. Cochrane Q test (P?<?0.001) revealed no significant heterogeneity among included studies, but I2 statistic revealed sizeable heterogeneity up to 80.5% (I2?=?80.5%). In the present meta-analysis traditional funnel plot, Egger’s weighted regression (P?=?0.48) as well as Begg’s rank correlation statistic (P?=?0.47) revealed no evidence of publication bias.ConclusionsThe present systematic review and meta-analysis revealed that antenatal care visits were significantly associated with lower rates of neonatal death. The risk of neonatal death was significantly reduced by 34% among newborns delivered from mothers who had antenatal care visits. Thus, visiting antenatal care clinics during pregnancy is strongly recommended especially in resource-limited settings like countries of sub-Saharan Africa.Electronic supplementary materialThe online version of this article (10.1186/s40985-018-0110-y) contains supplementary material, which is available to authorized users.

Project description:BACKGROUND: People with cancer receive regular structured follow up after initial treatment, usually by a specialist in a cancer centre. Increasing numbers of cancer survivors prompts interest in alternative structured follow-up models. There is worldwide evidence of increasing interest in delivering cancer follow-up using technology. This review sough evidence supporting the use of technology in cancer follow-up from good quality randomised controlled trials. METHOD: A search strategy was developed to identify randomised controlled trials and reviews of randomised trials of interventions delivering some aspect of structured cancer follow-up using new technologies. Databases searched were: All EBM Reviews; Embase; Medline (No Revisions); Medline (Non-Indexed Citations), and CAB Abstracts. Included articles were published in English between 2000 and 2014. Key words were generated by the research question. Papers were read independently and appraised using a standardised checklist by two researchers, with differences being resolved by consensus [J Epidemiol Community Health, 52:377-384, 1998]. Information was collected on the purpose, process, results and limitations of each study. All outcomes were considered, but particular attention paid to areas under consideration in the review question. RESULTS: The search strategy generated 22879 titles. Following removal of duplicates and abstract review 17 full papers pertaining to 13 randomised controlled studies were reviewed. Studies varied in technologies used and the elements of follow-up delivered, length of follow-up, tumour type and numbers participating. Most studies employed only standard telephone follow-up. Most studies involved women with breast cancer and included telephone follow-up. Together the results suggest that interventions comprising technology had not compromised patient satisfaction or safety, as measured by symptoms, health related quality of life or psychological distress. There was insufficient evidence to comment on the cost effectiveness of technological cancer follow-up interventions. CONCLUSIONS: Modern technology could deliver cancer follow-up that is acceptable and safe. More research is required to develop cancer follow-up systems which exploit modern technology, which should be assessed using randomised trials, with consistent outcomes, so that evidence on the acceptability, safety, cost effectiveness and impact in quality of life of technological follow-up can accumulate and be made available to patients, professionals and policy makers.

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Dataset Information

Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis.

Publications

Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis.

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