The COVID-19 pandemic has impacted all aspects of medical care, including cancer screening and preventative measures. Colorectal cancer screening declined significantly at the onset of the pandemic as the result of an intentional effort to conserve resources, prioritize emergencies and reduce risk of transmission. There has already been an increase in diagnosis at more advanced stages and symptomatic emergencies due to suspended screenings. As endoscopy units find their way back to pre-pandemic practices, a backlog of cases remains. The missed CRC diagnoses amongst the missed screenings carry a risk of increased morbidity and mortality which will only increase as time-to-diagnosis grows. This review discusses the impact of COVID-19 on colonoscopy screening rates, trends in stages/symptoms/circumstances at diagnosis, and economic and social impact of delayed diagnosis. Triaging and use of FITs are proposed solutions to the challenge of catching up with the large number of pandemic-driven missed CRC screenings.
BACKGROUND Texture-and-Color-Enhancing-Imaging(TXI, Olympus, Japan) was recently proposed as a substitute to standard high-definition white-light(WLI) to increase lesion detection during colonoscopy. We performed an international, multicenter randomized trial to assess the efficacy of TXI in detection of colorectal neoplasia. METHODS We enrolled consecutive patients ≥40 years old undergoing screening, surveillance or diagnostic colonoscopies at 5 centers (Italy, Germany, Japan) from September 2021 through May 2022. Patients were randomly assigned (1:1) to TXI or WLI (controls). Primary outcome was Adenoma Detection Rate(ADR). Secondary outcomes were adenomas per colonoscopy(APC) and withdrawal time. Adjusted Relative Risks (RR) for age, sex and colonoscopy indication were calculated. RESULTS We enrolled 747 patients, men: 50.2%, mean age 62.3 ±9.5 years. ADR was significantly higher in the TXI group (221/375, 58.9%) versus WLI group (159/372, 42.7%; adjustedRR:1.38[95%CI:1.20-1.59]). This was significant both for ≤5mm (RR:1.42[1.16-1.73]) and 6-9mm (RR:1.36[1.01-1.83]) adenomas. A higher proportion of both polypoid (151/375, 40.3% vs. 104/372, 28%; RR:1.43[1.17-1.75]) and non-polypoid adenomas (136/375, 36.3% vs. 102/372, 27.4%; RR:1.30[1.05-1.61]) and both proximal (143/375 [38.1%] vs 111/372 [29.8%], RR, 1.28[1.05–1.57]) and distal (144/375 [38.4%] vs 98/372 [25.6%], RR, 1.46 [1.18–1.80]) lesions were found in the TXI group. APC was higher in the TXI group (1.36 ±1.79 vs 0.89 ±1.35; incident rate ratio, 1.53[1.25-1.88]). CONCLUSIONS In a randomised trial, TXI increased ADR and APC among unselected patients undergoing colonoscopy for various indications. TXI increased detection of polyps <10mm in size, both in the proximal and in the distal colon, and may help to increase colonoscopy quality indicators.
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