Follow-up of 3 Million Persons Undergoing Colonoscopy in Germany: Utilization of Repeat Colonoscopies and Polypectomies Within 10 Years

Abstract

INTRODUCTION: Given the sparsity of longitudinal studies on colonoscopy use, we quantified utilization of repeat colonoscopy within 10 years and the proportion of persons with polypectomies at first repeat colonoscopy using a large German claims database. METHODS: Based on the German Pharmacoepidemiological Research Database, we identified persons who underwent colonoscopy between 2006 and 2015 (index colonoscopy) and assessed colonoscopies and polypectomies during follow-up. We defined 3 subcohorts based on available procedure/diagnosis codes at index colonoscopy: persons with snare polypectomy, which is reimbursable for lesions ≥5 mm in size (cohort 1), with a forceps polypectomy (cohort 2), and without such procedures/diagnoses (cohort 3). We stratified all analyses by diagnostic vs screening index colonoscopy. RESULTS: Overall, we included 3,076,657 persons (cohort 1–3: 15%, 13%, 72%). Among persons with screening index colonoscopy (30%), the proportions with a repeat colonoscopy within 10 years in cohorts 1, 2, and 3 were 78%, 66%, and 43%, respectively, and a snare polypectomy at first repeat colonoscopy was performed in 27%, 17%, and 12%, respectively. In cohort 1, 32% of persons with a (first) repeat colonoscopy after 9 years had a snare polypectomy (after 3 years: 25%). Among persons with diagnostic index colonoscopies, 80%, 78%, and 65% had a repeat colonoscopy, and 27%, 17%, and 10% had a snare polypectomy at first repeat colonoscopy, respectively. DISCUSSION: Our study suggests substantial underuse of repeat colonoscopy among persons with previous snare polypectomy and overuse among lower risk groups. One-quarter of persons with a snare polypectomy at baseline had another snare polypectomy at first repeat colonoscopy.

Colorectal Cancer After Screening Colonoscopy: 10-Year Incidence by Site and Detection Rate at First Repeat Colonoscopy

“…GePaRD does not contain information on number, size, and histology of polyps removed during a colonoscopy, but based on procedure and diagnosis codes, we have developed an algorithm to distinguish between persons with snare polypectomy (reimbursable for removing lesions >5 mm in size), persons with forceps polypectomy, and persons without polypectomy. Comparison of this classification with the distribution of snare polypectomy and forceps polypectomy observed in the German colonoscopy registry showed very good agreement ( 15 ). CRC diagnoses in GePaRD are coded according to the German modification of the International Classification of Diseases, 10th revision ( ICD-10-GM ).…”

“…CRCs occurring in this group might have been avoided if the recommendations had been followed. In a previous analysis, we were able to show that approximately 35% of persons with a snare polypectomy at screening colonoscopy in Germany did not undergo a repeat colonoscopy within 6 years ( 15 ). Implementing a reminder system for these persons to undergo surveillance colonoscopy as recommended by guidelines might be a promising strategy.…”

“…German claims data may partly fill these gaps. Although these data are limited regarding information on findings at colonoscopy—apart from CRC diagnoses, there is only information on whether polypectomy was performed ( 15 )—they offer a large sample size and a long follow-up. In addition, they include information on utilization of repeat colonoscopy with an exact date of the respective examination.…”

Estimating the environmental impact of disposable endoscopic equipment and endoscopes

“…For instance, studies suggest considerable overutilisation of upper and lower endoscopies. Approximately 40% of upper endoscopies may be repeated unnecessarily, and a similar proportion of patients have a repeat colonoscopy too early 38–41. Furthermore, re-examining screening approaches with less invasive tests as the primary choice (eg, faecal immunochemical testing instead of colonoscopy for colorectal cancer screening) may be viewed as more environmentally sustainable.…”

Screening colonoscopy similarly prevented distal and proximal colorectal cancer: a prospective study among 55–69-year-olds

“…Third, the effect of screening also depends on adherence to recommended surveillance intervals, which may be lower in a real-world setting compared to trials. In Germany, at least 40% of persons with polypectomy have been estimated to not adhere to recommended surveillance intervals [19]. Furthermore, the effect of screening depends on the background prevalence of diagnostic colonoscopy.…”