Utilization and determinants of follow‐up colonoscopies within 6 years after screening colonoscopy: Prospective cohort study

Hoffmeister, Michael; Holleczek, Bernd; Stock, Christian; Zwink, Nadine; Stolz, Thomas; Stegmaier, Christa; Brenner, Hermann

doi:10.1002/ijc.31862

Cited by 15 publications

(17 citation statements)

References 46 publications

(98 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent study from Germany including 6,407 persons showed substantial overuse of repeat colonoscopies in persons with negative findings and underuse in persons with low- and high-risk adenomas at baseline. However, that study was restricted to screening participants and to a follow-up of 6 years ( 6 ). Studies from Australia, Canada, and the United States showed similar patterns but were also restricted to participants of screening colonoscopy ( 5 , 8 , 10 , 13 ) or considered any colonoscopy, i.e., screening and diagnostic colonoscopies combined ( 3 , 4 , 7 , 9 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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

Schwarz

Schäfer

Horenkamp-Sonntag

et al. 2020

Clin Transl Gastroenterol

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Schwarz

Schäfer

Horenkamp-Sonntag

et al. 2020

Clin Transl Gastroenterol

View full text Add to dashboard Cite

show abstract

“…For opportunistic screening programs, further increases in screening adherence are to be expected when an organized screening program with personal invitations is introduced . An organized screening program including invitation of the target population could also help to reduce both underuse and overuse of screening and surveillance colonoscopies, which are major issues in the current opportunistic screening program in Germany …”

Section: Discussionmentioning

confidence: 99%

“…27,28 An organized screening program including invitation of the target population could also help to reduce both underuse and overuse of screening and surveillance colonoscopies, which are major issues in the current opportunistic screening program in Germany. 29 Our study has a number of specific strengths and limitations. A major strength is the unique possibility to address screening use in both cross-sectional and longitudinal manner based on a large, statewide cohort study of older adults recruited shortly before introduction of screening colonoscopy as an alternative CRC screening offer.…”

Section: Discussionmentioning

confidence: 99%

Changes in colorectal cancer screening use after introduction of alternative screening offer in Germany: Prospective cohort study

Guo

Chen

Schöttker

et al. 2019

Intl Journal of Cancer

Self Cite

View full text Add to dashboard Cite

In October 2002, screening colonoscopy was added to the German colorectal cancer (CRC) screening program as an alternative to fecal occult blood test (FOBT). We aimed to evaluate the change in CRC screening use after introduction of the dual screening offer and to assess determinants of screening use. Data were drawn from a population‐based cohort study initiated during 2000–2002 in Germany (n = 5,845, age range at recruitment: 50–75 years). We conducted both cross‐sectional and longitudinal analyses to obtain uptake rates of CRC screening based on four waves of data. Age‐group specific proportions of participants having had FOBT within 2 years remained essentially unchanged at 61–67% between 2000 and 2002 (1st wave) and 2005–2007 (3rd wave). The proportions of participants having undergone screening colonoscopy within 10 years increased from 23–29% to 46–57%, leading to a substantial overall increase in being up‐to‐date with CRC screening from 66–68% to 77–80%. In 2008–2010 (4th wave), FOBT use declined and colonoscopy use continued to increase. Obesity was significantly associated with lower prevalence of being up‐to‐date with FOBT (odds ratio [OR] at 8‐year follow‐up 0.68; 95% confidence interval [CI], 0.58–0.80) and screening colonoscopy (OR, 0.73; 95% CI, 0.62–0.86). Also, smokers were less likely to have ever used FOBT (OR, 0.54; 95% CI, 0.40–0.75) or colonoscopy (OR, 0.75; 95% CI, 0.63–0.90) compared to nonsmokers. After the introduction of dual screening offer, the overall adherence to CRC screening steeply increased, mainly due to an increase in screening colonoscopy uptake. Screening tests kept being underused by obese people and smokers who are at elevated CRC risk.

show abstract

“…The German Guideline Program in Oncology cites one small repeat colonoscopy study from 1996 with a mean interval between examinations of 5.5 years,3 as well as further indirect evidence from case-control studies, in which cases were composed of only participants with colorectal cancer 45 Moreover, despite these guideline recommendations, several studies have suggested considerable overuse of repeat screening colonoscopy before the end of the recommended interval 67 8 9 10…”

Section: Introductionmentioning

confidence: 99%

Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis

Heisser

Peng

Weigl

et al. 2019

BMJ

Self Cite

View full text Add to dashboard Cite

ObjectiveTo review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex.DesignSystematic review and meta-analysis of all available studies.Data sourcesPubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings.Eligibility criteriaStudies assessing the outcome of a follow-up colonoscopy among participants at average risk for colorectal cancer with a negative previous colonoscopy (no adenomas).Results28 studies were identified, including 22 cohort studies, five cross sectional studies, and one case-control study. Findings for an interval between colonoscopies of one to five, five to 10, and more than 10 years were reported by 17, 16, and three studies, respectively. Summary estimates of prevalences of any neoplasm were 20.7% (95% confidence interval 15.8% to 25.5%), 23.0% (18.0% to 28.0%), and 21.9% (14.9% to 29.0%) for one to five, five to 10, and more than 10 years between colonoscopies. Corresponding summary estimates of prevalences of any advanced neoplasm were 2.8% (2.0% to 3.7%), 3.2% (2.2% to 4.1%), and 7.0% (5.3% to 8.7%). Seven studies also reported findings stratified by sex. Summary estimates stratified by interval and sex were consistently higher for men than for women.ConclusionsAlthough detection of any neoplasms was observed in more than 20% of participants within five years of a negative screening colonoscopy, detection of advanced neoplasms within 10 years was rare. Our findings suggest that 10 year intervals for colonoscopy screening after a negative colonoscopy, as currently recommended, may be adequate, but more studies are needed to strengthen the empirical basis for pertinent recommendations and to investigate even longer intervals.Study registrationProspero CRD42019127842.

show abstract

Utilization and determinants of follow‐up colonoscopies within 6 years after screening colonoscopy: Prospective cohort study

Cited by 15 publications

References 46 publications

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

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

Changes in colorectal cancer screening use after introduction of alternative screening offer in Germany: Prospective cohort study

Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis

Contact Info

Product

Resources

About