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Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome

2020; Elsevier BV; Volume: 20; Issue: 3 Linguagem: Inglês

10.1016/j.cgh.2020.11.002

1542-7714

Ariadna Sánchez, Victorine H. Roos, Matilde Navarro, Marta Pineda, Berta Caballol, Lorena Moreno, Sabela Carballal, Lorena Rodríguez‐Alonso, Teresa Ramón y Cajal, Gemma Llort, Virgı́nia Piñol, Adrià López‐Fernández, Inmaculada Salces, María Dolores Picó, Laura Rivas, Luís Bujanda, Marta Garzón‐Benavides, Ángeles Pizarro, Eva Martínez de Castro, Maria Jesus López-Arias, Carmen Povés, Catalina Garau, Daniel Rodríguez-Alcalde, Maite Herráiz, Cristina Alvarez-Urrutia, Andrés Dacal, Marta Carrillo‐Palau, Lucía Cid, Marta Ponce, Eva Barreiro Alonso, Esteban Saperas, Elena Aguirre, Cristina Romero, Barbara A.J. Bastiaansen, Maribel González‐Acosta, Blai Morales‐Romero, Teresa Ocaña, Liseth Rivero, Gerhard Jung, Xavier Bessa, Joaquín Cubiella, Rodrigo Jover, Francisco Rodríguez‐Moranta, Judith Balmañà, Joan Brunet, Antoni Castells, Evelien Dekker, Gabriel Capellá, Miquel Serra‐Burriel, Leticia Moreira, María Pellisé, Francesc Balaguer,

Cancer Genomics and Diagnostics

Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS.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.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).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.