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Circumstances in which colonoscopy misses cancer.

ABSTRACT: Colonoscopy is associated with a varying risk of missing colorectal cancer (CRC). The objective of this paper was to review the existing evidence that indicates when colonoscopy may miss cancer in usual clinical practice and to provide information that would be helpful to endoscopists in their daily practice. CRC is diagnosed within 3 years in about 5% of persons with CRC who undergo colonoscopy in whom the cancer is not detected. Future research should be directed at disentangling the relative contributions of tumour biology and colonoscopy quality in explaining this result. When consent is obtained for colonoscopy, patients must be informed of the small risk that a cancer may not be detected. Steps that can be taken to address colonoscopy quality include formal training in colonoscopy and polypectomy technique, coupled with maintenance of skills by performing at least 300 colonoscopies per year. The use of split dose bowel preparation is advised. Colonoscopy should be completed to the caecum with documentation of landmarks (ileocaecal valve; appendiceal orifice). Careful colonoscopy technique includes examining the proximal sides of flexures and folds, washing and suctioning debris and ensuring adequate colonic distension. Caecal intubation and adenoma detection rates should be reported and reviewed. Lesions should be completely removed at polypectomy and attention given to appropriate surveillance.

SUBMITTER: Rabeneck L

PROVIDER: S-EPMC5517157 | biostudies-other | 2010 Apr

REPOSITORIES: biostudies-other

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Project description:BackgroundNo head-to-head randomized controlled trials have demonstrated the superiority of one colorectal screening modality over another in reducing colorectal cancer mortality. We conducted a pilot randomized controlled trial of fecal occult blood testing (FOBT), optical colonoscopy (OC), and virtual colonoscopy (VC), to inform the planning of a larger evaluative trial.MethodsEligible patients (aged 50 to 70) were recruited from five primary care practices in Hamilton, ON, Canada, between March 23, 2010 and August 11, 2010, and randomized 1:1:1 in a parallel design using an automated, centralized telephone service to either FOBT, OC, or VC. To reflect conventional practice, patients received no additional reminders to complete their allocated screening test beyond those received in usual practice. The primary outcome was completion of the assigned screening procedure. Results of the index test and any follow-up investigations were ascertained at 6 months. Participants, caregivers, and outcome assessors were not blinded to group assignment. The trial was stopped early due to lack of ongoing funding.ResultsA total of 198 participants were enrolled, of whom 67 were allocated to FOBT, 66 to OC, and 65 to VC. The allocated screening procedure was completed by 43 (64%) subjects allocated to FOBT (95% confidence interval [CI], 52-75%), 53 (80%) subjects allocated to OC (95% CI, 69-88%), and 50 (77%) subjects allocated to VC (95% CI, 65-85%); because the trial stopped early, we had insufficient statistical power to detect clinically relevant differences in completion rates. During 6 months follow-up, colorectal adenomas were detected in 0 (0%) subjects allocated to FOBT, 12 (18%) subjects allocated to OC, and 2 (3%) subjects allocated to VC. One subject in the OC arm had histological evidence of high-grade dysplasia. No subjects were diagnosed with colorectal cancer.ConclusionsIn this pilot randomized controlled trial of colorectal cancer screening in a primary care setting, 64-80% of subjects completed their allocated screening test. These findings may be of value to investigators planning clinical trials to evaluate the effectiveness of colorectal cancer screening.Trial registrationClinicalTrials.gov NCT00865527. https://clinicaltrials.gov/ct2/show/NCT00865527.

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Circumstances in which colonoscopy misses cancer.

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