Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test

Manuel Zorzi, Carlo Senore, Anna Turrin, Paola Mantellini, Carmen Beatriz Visioli, Carlo Naldoni, Priscilla Sassoli de' Bianchi, Chiara Fedato, Emanuela Anghinoni, Marco Zappa, Cesare Hassan, Manuela Di Giacomo, Angelo Sigillito, Liliana Rizzo, Giovanna Luciano, Nora Coppola, Alessandra Barca, Gabriella Paoli, Luigina Bonelli, Liliana CoppolaLucia Di Furia, Giuseppe Cecere, Nereo Segnan, Antonio Fanolla, Silvano Piffer, Cinzia Annatea Germinario, Pierina Tanchis, Gabriella Dardanoni, Mariadonata Giaimo, Gabriella Furfaro

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives To assess the appropriateness of recommendations for endoscopic surveillance in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT). Design 74 Italian CRC screening programmes provided aggregated data on the recommendations given after FIT-positive colonoscopies in 2011 and 2013. Index colonoscopies were divided into negative/no adenoma and low- risk, intermediate-risk and high-risk adenomas. Postcolonoscopy recommendations included a return to screening (FIT after 2 years or 5 years), an endoscopic surveillance after 6 months or after 1 year, 3 years or 5 years, surgery or other. We assessed the deviation from the postcolonoscopy recommendations of the European Guidelines in 2011 and 2013 and the correlation between overuse of endoscopic surveillance in 2011 and the process indicators associated with the endoscopic workload in 2013. Results 49 704 postcolonoscopy recommendations were analysed. High-risk, intermediate-risk and low-risk adenomas, and no adenomas were reported in 5.9%, 19.3%, 15.3% and 51.5% of the cases, respectively. Endoscopic surveillance was inappropriately recommended in 67.4% and 7%, respectively, of cases with low-risk and no adenoma. Overall, 37% of all endoscopic surveillance recommendations were inappropriate (6696/17 860). Overuse of endoscopic surveillance was positively correlated with the extension of invitations (correlation coefficient (cc) 0.29; p value 0.03) and with compliance with post-FIT+ colonoscopy (cc 0.25; p value 0.05), while it was negatively correlated with total colonoscopy waiting times longer than 60 days (cc -0.26; p value 0.05). Conclusions In organised screening programmes, a high rate of inappropriate recommendations for patients with low risk or no adenomas occurs, affecting the demand for endoscopic surveillance by a third.

Original languageEnglish
JournalGut
DOIs
Publication statusAccepted/In press - Aug 21 2015

ASJC Scopus subject areas

  • Gastroenterology

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