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Original research
Rates of repeated colonoscopies to clean the colon from low-risk and high-risk adenomas: results from the EPoS trials
  1. Frederik Emil Juul1,2,
  2. Kjetil Garborg1,2,
  3. Eugen Nesbakken1,2,
  4. Magnus Løberg1,2,
  5. Paulina Wieszczy1,2,3,
  6. Joaquín Cubiella4,
  7. Mette Kalager1,2,
  8. Michael F Kaminski1,2,3,5,
  9. Rune Erichsen6,7,
  10. Hans-Olov Adami1,2,8,
  11. Monika Ferlitsch9,
  12. Siv K B Furholm10,
  13. Ann G Zauber11,
  14. Enrique Quintero12,
  15. Marek Bugajski5,
  16. Øyvind Holme1,2,13,
  17. Evelien Dekker14,15,
  18. Rodrigo Jover16,17,
  19. Michael Bretthauer1,2
  1. 1Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
  2. 2Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
  3. 3Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
  4. 4Gastroenterology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
  5. 5Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
  6. 6Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  7. 7Department of Surgery, Randers Regional Hospital, Randers, Denmark
  8. 8Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  9. 9Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
  10. 10Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
  11. 11Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  12. 12Facultad de Medicina, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
  13. 13Department of Gastroenterology, Sørlandet Sykehus HF, Kristiansand, Norway
  14. 14Dept of Gastroenterology and Hepatology C2-115, Amsterdam University Medical Centres, Duivendrecht, Netherlands
  15. 15Bergman Clinics IZA, Amsterdam, The Netherlands
  16. 16Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
  17. 17Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Universidad Miguel Hernández, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
  1. Correspondence to Dr Michael Bretthauer, University of Oslo, Oslo 1089, Norway; michael.bretthauer{at}medisin.uio.no

Abstract

Objective High-quality colonoscopy (adequate bowel preparation, whole-colon visualisation and removal of all neoplastic polyps) is a prerequisite to start polyp surveillance, and is ideally achieved in one colonoscopy. In a large multinational polyp surveillance trial, we aimed to investigate clinical practice variation in number of colonoscopies needed to enrol patients with low-risk and high-risk adenomas in polyp surveillance.

Design We retrieved data of all patients with low-risk adenomas (one or two tubular adenomas <10 mm with low-grade dysplasia) and high-risk adenomas (3–10 adenomas, ≥1 adenoma ≥10 mm, high-grade dysplasia or villous components) in the European Polyp Surveillance trials fulfilling certain logistic and methodologic criteria. We analysed variations in number of colonoscopies needed to achieve high-quality colonoscopy and enter polyp surveillance by endoscopy centre, and by endoscopists who enrolled ≥30 patients.

Results The study comprised 15 581 patients from 38 endoscopy centres in five European countries; 6794 patients had low-risk and 8787 had high-risk adenomas. 961 patients (6.2%, 95% CI 5.8% to 6.6%) underwent two or more colonoscopies before surveillance began; 101 (1.5%, 95% CI 1.2% to 1.8%) in the low-risk group and 860 (9.8%, 95% CI 9.2% to 10.4%) in the high-risk group. Main reasons were poor bowel preparation (21.3%) or incomplete colonoscopy/polypectomy (14.4%) or planned second procedure (27.8%). Need of repeat colonoscopy varied between study centres ranging from 0% to 11.8% in low-risk adenoma patients and from 0% to 63.9% in high-risk adenoma patients. On the second colonoscopy, the two most common reasons for a repeat (third) colonoscopy were piecemeal resection (26.5%) and unspecified reason (23.9%).

Conclusion There is considerable practice variation in the number of colonoscopies performed to achieve complete polyp removal, indicating need for targeted quality improvement to reduce patient burden.

Trial registration number NCT02319928.

  • POLYP
  • COLONOSCOPY
  • SURVEILLANCE
  • ENDOSCOPIC POLYPECTOMY

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Footnotes

  • Collaborators Members of the EPoS study group: Rodrigo Jover, Michael Bretthauer, Marek Bugajski, Joaquin Cubiella, Evelien Dekker, Mette Kalager, Louise Emilsson, Rune Erichsen, Mogens Harrits Jepsen, Uffe Schou Løve, Asser Mathiassen Oppfeldt, Jesper Beck Jørgensen, Monika Ferlitsch, Yuichi Mori, Magnus Løberg, Kjetil Garborg, Maria Pellisé, Hans-Olov Adami, Frederik Emil Juul, Eugen Nesbakken, Anita Aalby, Madeleine Skotnes, Siv Isaksen, Lise M. Helsingen, Henrik Toft Sørensen, Mette Lund Boysen, Jaroslaw Regula, Paulina Wieszczy, Ann Zauber, Enrique Quintero, Iris Lansdorp-Vogelaar, Miguel Hernan, Christer Tønnesen, Siv Furholm, Lars Aabakken, Lene Larsen, Ole Darre-Næss, Jens Aksel Nilsen, Øyvind Holme, Gunnar Qvigstad, Hans Jakob Jaatun, Volker Moritz, Øystein Kjellevold, Magne Henriksen, Kristine Melbye Kolbjørnsen, Kristian Espeland, Silje Hugin, Jan Magnus Kvamme, Birgitte Seip, Stefan Willmarsson, Erik Florwald, Ervin Toth, Alejandro Martínez-Roca, Carolina Mangas-Sanjuan, Oscar Murcia, Sandra Baile-Maxía, Noelia Sala-Miquel, Anabel García-Heredia, Enrique Santana, Eva Serrano, Francisco A. Ruíz-Gómez, Laura Carot Bastard, Xavier Bessa Caserras, Anna Serradesanferm, Angels Pozo, Isabel Torà, Jaume Grau, Mireia Diaz, Rebeca Moreira, Antoni Castells, Aberto Lué, Pilar Roncalés, Ángel Ferrández, Ángel Lanas, Luisa De Castro, Romina Fernández-Poceiro, Vicent Hernández, Marta García-Cougil, Agueda Iglesias-Gómez, Laura Codesido-Prado, Astrid Díez-Martín, Cristina Requeiro-Exposito, Raquel Almazán-Ortega, Elena Rodríguez-Camacho, Adolfo Suárez González, Verónica Álvarez García, Olegario Castaño Fernández, Lorena Blanco García, Eva Barreiro Alonso, Oscar Luis González Bernardo, Yaiza Cedrés Expósito, Goretti Hernández Mesa, Jose Luis Baute, Angeles Pizarro, Angeles Garzón, Idoia Ganchegui-Aguirre, Maite Escalante-Martín, Marta Salvador-Pérez. Fidencio Bao Pérez. Francisco Polo-Ortiz. César Ibarra-Ponce de León. María Fernández-Calderón. Anaiansi Hernández-Martín. Daniel Henández-Amunarriz. Leire Zubiaurre-Lizarralde. Nora Otegui-Irastorza. Leiri Mendibil-Esquisabel. Julio Alfredo Bernuy-Guevara. Luis Bujanda-Fernández de Pierola. Isabel Idigoras-Rubio. Isabel Bilbao-Iturribarria. Pilar Diez Redondo, Henar Núñez Rodríguez, Vicente Lorenzo-Zúñiga García, Lucia Gorriz Torres, Luis Hernández Villalba, Akiko Ono, Carlos Tourne-García, Juan Egea Valenzuela, Fernando Alberca de las Parras, Barbara Bastiaansen, Manon van der Vlugt, David van Toledo, Aukje Munnik, Christine Cohen, Manon Spaander, Monique van Leerdam, Anne-Marie van Berkel, Frank ter Borg, Jeroen Kolkman, Daniel Keszthelyi, Iris Nagtegaal, Anne-Katrien Depla.

  • Contributors All authors had access to the study data and reviewed and approved the final manuscript and accept full responsibility for the overall content and publication of the manuscript.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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