Evaluating Screening Age for Colonoscopy

Overholt, Bergein F.; Brooks-Belli, Linda; Grace, Michael; Rankin, Kristin; Harrell, Royce; Turyk, Mary E.; Rosenberg, Fred; Barish, Robert W.; Gilinsky, Norman H.

doi:10.1097/mcg.0b013e3181cadce5

Cited by 7 publications

(1 citation statement)

References 12 publications

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“…6 Referral indications fall under three categories: screening for CRC, surveillance to detect recurrent pre-cancers or disease, and symptom assessment for patients with suspected disease. 6,7 The impact of restricted access to colonoscopy during the COVID-19 pandemic across procedure indications and patient demographic groups has not been reported. In this study, we analyzed patient demographic and clinical characteristics associated with delayed colonoscopy and characterized the evolution of colonoscopy delays by procedure indication throughout the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 Pandemic on Colonoscopy Wait Times by Procedure Indication

Thibault,

Barkun,

Martel

et al. 2024

Preprint

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Background: Patients are referred for colonoscopy for symptom assessment, screening, and surveillance. Public health measures to mitigate the spread of the COVID−19 pandemic disrupted services and increased patient delays for colonoscopy services in Quebec. The differential impact of these interruptions by colonoscopy indication is largely unknown. Methods: Using 2018−2022 retrospective clinical data from two high-volume Montreal endoscopy centres and provincial administrative data, we characterized changes in colonoscopy wait times and the proportion of waitlisted patients who were delayed (wait time exceeded provincial guidelines) by procedure indication and demographics. We used regression to examine patient characteristics associated with delayed procedures during pre- and intra−COVID−19 periods. We used time series analysis to characterize trends in the proportion of waitlisted patients delayed. Results: The COVID-19−related public health measures resulted in record-high delays (median increase in wait times of 34−159% across indications). While older patients experienced longer wait times pre-pandemic, intra−COVID−19 wait times increased disproportionately for patients younger than 50. The proportion of waitlisted patients delayed peaked mid−2020 (56.9% for screening; 56.0% for symptom assessment patients). By early 2022, the proportion delayed had fallen to 37.3% for screening patients but remained at 53.8% for symptom assessment patients. Conclusions: In Quebec, intra-COVID-19 colonoscopy delays disproportionately impacted symptom assessment procedures and younger patients. Additional capacity or improved triaging may be needed to address persistent delays. Understanding the effects of the pandemic on colonoscopy services can help inform strategies to mitigate harms from on-going delays in Quebec.

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Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 Pandemic on Colonoscopy Wait Times by Procedure Indication

Thibault,

Barkun,

Martel

et al. 2024

Preprint

View full text Add to dashboard Cite

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Systematic Review of Prevalence, Risk Factors, and Risk for Metachronous Advanced Neoplasia in Patients With Young-Onset Colorectal Adenoma

Enwerem

Cho

Demb

et al. 2021

Clinical Gastroenterology and Hepatology

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BACKGROUND AND AIMS: Incidence and mortality from early onset colorectal cancer (CRC) is rising. Adenoma detection, removal and subsequent endoscopic surveillance may modify risk of CRC diagnosed prior to age 50 (early onset CRC). We conducted a systematic review of young onset adenoma (YOA) prevalence, associated risk factors, and rate of metachronous advanced neoplasia after YOA diagnosis. METHODS:Through a systematic search of multiple electronic databases through 2/12/2019, we identified studies with individuals age 18 to 49 years which reported on prevalence of adenoma, risk factors for adenoma, and/or risk for metachronous advanced neoplasia. Summary estimates were derived using random effects meta-analysis, when feasible. RESULTS:Pooled overall prevalence of YOA was 9.0% (95% CI: 7.1%-11.4%) based on 24 studies including 23,142 individuals. On subgroup analysis, pooled prevalence of YOA for autopsy studies was 3.9% (95% CI: 1.9%-7.6%), while prevalence for colonoscopy studies was 10.7% (95% CI: 8.5%-13.5). Only advancing age was identified as a consistent risk factor for YOA based on 4 studies including 78,880 individuals. Pooled rate of metachronous advanced neoplasia after baseline YOA diagnosis was 6.0% (95% CI: 4.1%-8.6%), based on 3 studies including 1,493 individuals undergoing follow-up colonoscopy, with only 1 CRC case reported.Overall there were very few studies reporting metachronous advanced neoplasia, and no studies evaluating whether routine surveillance colonoscopy decreases risk of CRC. CONCLUSIONS:Prevalence of YOA is estimated to be 9% and increases with age. Risk for metachronous advanced neoplasia after YOA diagnosis is estimated to be 6%. More research is needed to understand the prevalence, risk factors, and risk of CRC associated with YOA.

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