Importance Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the United States. Objective To systematically review the effectiveness, diagnostic accuracy, and harms of screening for CRC. Data Sources Searches of MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2008, through December 31, 2014, with surveillance through February 23, 2016. Study Selection English-language studies conducted in asymptomatic populations at general risk of CRC. Data Extraction and Synthesis Two reviewers independently appraised the articles and extracted relevant study data from fair- or good-quality studies. Random-effects meta-analyses were conducted. Main Outcomes and Measures Colorectal cancer incidence and mortality, test accuracy in detecting CRC or adenomas, and serious adverse events. Results Four pragmatic randomized clinical trials (RCTs) evaluating 1-time or 2-time flexible sigmoidoscopy (n = 458 002) were associated with decreased CRC-specific mortality compared with no screening (incidence rate ratio, 0.73; 95% CI, 0.66-0.82). Five RCTs with multiple rounds of biennial screening with guaiac-based fecal occult blood testing (n = 419 966) showed reduced CRC-specific mortality (relative risk [RR], 0.91; 95% CI, 0.84-0.98, at 19.5 years to RR, 0.78; 95% CI, 0.65-0.93, at 30 years). Seven studies of computed tomographic colonography (CTC) with bowel preparation demonstrated per-person sensitivity and specificity to detect adenomas 6 mm and larger comparable with colonoscopy (sensitivity from 73% [95% CI, 58%-84%] to 98% [95% CI, 91%-100%]; specificity from 89% [95% CI, 84%-93%] to 91% [95% CI, 88%-93%]); variability and imprecision may be due to differences in study designs or CTC protocols. Sensitivity of colonoscopy to detect adenomas 6 mm or larger ranged from 75% (95% CI, 63%-84%) to 93% (95% CI, 88%-96%). On the basis of a single stool specimen, the most commonly evaluated families of fecal immunochemical tests (FITs) demonstrated good sensitivity (range, 73%-88%) and specificity (range, 90%-96%). One study (n = 9989) found that FIT plus stool DNA test had better sensitivity in detecting CRC than FIT alone (92%) but lower specificity (84%). Serious adverse events from colonoscopy in asymptomatic persons included perforations (4/10 000 procedures, 95% CI, 2-5 in 10 000) and major bleeds (8/10 000 procedures, 95% CI, 5-14 in 10 000). Computed tomographic colonography may have harms resulting from low-dose ionizing radiation exposure or identification of extracolonic findings. Conclusions and Relevance Colonoscopy, flexible sigmoidoscopy, CTC, and stool tests have differing levels of evidence to support their use, ability to detect cancer and precursor lesions, and risk of serious adverse events in average-risk adults. Although CRC screening has a large body of supporting evidence, additional research is still needed.

/pdf/screening-for-colorectal-cancer-updated-evidence-report-and-j05wmu0j1q.pdf

Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline

/pdf/guidelines-of-diagnostics-and-treatment-of-acute-left-sided-1po8mr4e3z.pdf

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Post-Colonoscopy Complications: A Systematic Review, Time Trends, and Meta-Analysis of Population-Based Studies.

Objective To perform a comprehensive audit of all colonoscopy undertaken in the UK over a 2-week period. Design Multi-centre survey. All adult (≥16 years of age) colonoscopies that took place in participating National Health Service hospitals between 28 February 2011 and 11 March 2011 were included. Results Data on 20 085 colonoscopies and 2681 colonoscopists were collected from 302 units. A validation exercise indicated that data were collected on over 94% of all procedures performed nationally. The unadjusted caecal intubation rate (CIR) was 92.3%. When adjusted for impassable strictures and poor bowel preparation the CIR was 95.8%. The polyp detection rate was 32.1%. The polyp detection rate for larger polyps (≥10mm diameter) was 11.7%. 92.3% of resected polyps were retrieved. 90.2% of procedures achieved acceptable levels of patient comfort. A total of eight perforations and 52 significant haemorrhages were reported. Eight patients underwent surgery as a consequence of a complication. Conclusions This is the first national audit of colonoscopy that has successfully captured the majority of adult colonoscopies performed across an entire nation during a defined time period. The data confirm that there has been a significant improvement in the performance of colonoscopy in the UK since the last study reported seven years ago (CIR 76.9%) and that performance is above the required national standards.

https://gut.bmj.com/content/gutjnl/61/Suppl_2/A3.2.full.pdf

The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK

Das kolorektale Karzinom ist mit etwa 68 000 Neuerkrankungen bei beiden Geschlechtern die zweithäufigste Krebserkrankung. Jährlich sterben etwa 27 000 Patienten an den Folgen der Erkrankung. Wichtige Teile der S3-Leitlinie Kolorektales Karzinom sind im letzten Jahr aktualisiert worden. Im Folgenden sollen einzelne wichtige Neuerungen der Leitline vorgestellt werden.

/pdf/s3-leitlinie-kolorektales-karzinom-334qelxdrc.pdf

S3-Leitlinie – Kolorektales Karzinom.

Background and study aims Data on process quality and complications of colonoscopies are sparse, especially for the screening setting. We describe process quality in routine care, estimate the incidence of acute complications, and identify risk indicators for substandard care and complications. Patients and methods We analyzed data from 236 087 compulsory health insurance (CHI) members who underwent colonoscopies in 2006. Data were documented prospectively in the Electronic Colonoscopy Documentation of the Bavarian Association of CHI Physicians, a registry of outpatient colonoscopies performed in practices throughout Bavaria, Germany. It covers demographic characteristics, indications, quality indicators, macroscopic and histological findings, diagnoses, and acute complications. Results Colon preparation resulted in clear bowels in 76.31 % of patients, liquid residues in 22.22 %, and dirty bowels in 1.47 %. In total, 92.85 % of the examinations were performed with patients under sedation/analgesia and 97.43 % of colonoscopies were complete. Photo documentation was present for 98.87 %. Male sex, middle age, screening, satisfactory bowel preparation, and sedation/analgesia were associated with completeness. A total of 735 patients (0.31 %) suffered complications, among them 520 bleedings (0.22 %), 69 perforations (0.03 %), and 152 cardiorespiratory complications (0.06 %). Male sex, higher age, nonscreening indication, biopsies, polypectomies, and absence of sedation/analgesia were indicative of a higher bleeding risk. Perforations were also related to biopsies and polypectomies. Higher age was the only discernible risk indicator for cardiorespiratory events. Conclusions Outpatient colonoscopy is a safe procedure with a low risk of acute complications. Improving bowel preparation enhances completeness. Sedation/analgesia is conducive to both completeness and the lowering of the risk of acute complications.

Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies.

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Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies.