Search

BACKGROUND: Obesity is a known risk factor of colorectal cancer (CRC). However, precise interconnections between excessive body fat and CRC are still vague. Therefore, the aim of this study was to assess whether stage of CRC detected in overweight and obese individuals differs from individuals with normal body mass index (BMI). A secondary aim of this study was to elucidate whether overweight and obesity influence the overall survival in CRC. METHODS: This study was a cross-sectional analysis of 163,129 individuals who underwent screening colonoscopy performed on data from a prospectively maintained database of the Polish Colonoscopy Screening Program. RESULTS: Overweight and obese individuals present with a less advanced CRC in screening setting (p = 0.014). This trend is the most pronounced in males (p = 0.001). Univariable and multivariable analyses revealed that obesity was a negative predictor of detection of advanced CRC with odds ratio 0.72 (95% confidence interval 0.52–1.00; p = 0.047). Furthermore, overweight and obesity were not statistically significant predictors of risk of death (p = 0.614 and p = 0.446, respectively). CONCLUSIONS: Obese screenees present with a less advanced disease in comparison to non-obese. Moreover, survival stratified by clinical stage seems to not be influenced by BMI category. Therefore, a higher proportion of early diagnosed cancers can potentially create a survival benefit in this group.

The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i.e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures both for small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, for which performance measures had already been identified, this is the first time small-bowel endoscopy quality measures have been proposed. ispartof: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL vol:7 issue:5 pages:614-641 ispartof: location:England status: published

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have identified quality of endoscopy as a major priority and we described our rationale for this in a first manuscript that also addressed the methodology of the quality initiative process.1 The identification of upper gastrointestinal (UGI) performance measures presents a considerable challenge, in contrast to the situation with colonoscopy for instance, where several performance measures (inspection time, adenoma detection rate, and interval cancers, among others) have been identified over the last decade.2,3 Following the Quality in UGI Endoscopy meeting held in Lisbon in 2013, it was clear that there was a need to identify performance measures for the UGI tract, and that quality standards could be identified although there is a paucity of evidence. This lack of evidence helps however to identify research priorities for the development of clinical trials that will further validate and substantiate the implementation of performance measures. The aim therefore of the UGI working group was twofold: (a) to identify performance measures for UGI endoscopy; (b) to identify the evidence or absence of evidence that would develop the research priorities in this field. We used an innovative methodology to facilitate the quality initiative process, which combined a thorough search and standardized evaluation of the available evidence for each clinical question, followed by a Delphi process (http://is.njit.edu/pubs/delphibook/delphibook.pdf) using an online platform.4,5 This online platform permitted iterative rounds of modification and comment by all members of the UGI working group until agreement was reached on the performance measure. We now report these newly identified performance measures.

The adenoma detection rate of the endoscopist has been related to the post-colonoscopy interval risk of colorectal cancer.The objective of this article is to estimate the impact of adenoma detection rate on the long-term colorectal cancer prevention rate.A Markov model was constructed to simulate the efficacy and cost of colonoscopy screening according to the adenoma detection rate of the endoscopist in 100,000 individuals. Post-colonoscopy interval colorectal cancer risk and the relative risk of interval cancer among endoscopists with different adenoma detection rates were extracted from the literature. A 1.5 relative risk was assumed between endoscopists with low and average adenoma detection rates, and a relative risk of 11 between those with average and high adenoma detection rates. Both efficacy and costs were projected over a steady-state American population.Screening colonoscopy performed by endoscopists with low adenoma detection rates resulted in a 7% absolute reduction in the long-term colorectal cancer incidence prevention rate as compared to the same procedure performed by those with an average adenoma detection rate (70% vs. 77%). This difference increased to 21% when comparing endoscopists with an average with those with a high adenoma detection rate. When projected on the US population, this reduced efficacy resulted in an additional 1728 and 16,123 colorectal cancer cases and the loss of $117 million and $906 million per year in the two scenarios, respectively. These estimates were sensitive to the risk of post-colonoscopy interval colorectal cancer.A substantial reduction in long-term colorectal cancer prevention rate may be expected when screening colonoscopy is performed by endoscopists with a suboptimal adenoma detection rate. A substantial saving may be expected when implementing policies to improve endoscopist adenoma detection rate.