Elsevier

Gastrointestinal Endoscopy

Volume 64, Issue 6, December 2006, Pages 948-954
Gastrointestinal Endoscopy

Original Article
Clinical Endoscopy
Impact of a colonoscopic screening examination for colorectal cancer on later utilization of distal GI endoscopies

https://doi.org/10.1016/j.gie.2006.08.006Get rights and content

Background

Colonoscopic screening for colorectal cancer is being implemented in an increasing number of countries. This might lead to a demand for colonoscopies that could outstrip supply.

Objective

We wanted to investigate whether undergoing a colonoscopic examination for colorectal cancer would affect the utilization of later distal GI endoscopies for other indications than follow-up of the findings at the screening examination (usual-care endoscopies).

Design

Prospective case control study.

Patients

In 1996, a screening group of 634 individuals, aged 63 to 72 years, randomly drawn from the official population registry, was invited to a “once only” colonoscopic screening examination for colorectal cancer. A total of 451 individuals (71%) attended. An age- and sex-matched control group of 634 individuals was enrolled from the same registry. Both groups belonged to the encatchment area of a single hospital.

Main Outcome Measurements

Distal endoscopies performed in the 2 groups from January 1996 to November 2004 were registered by investigating medical records.

Results

A total of 1268 individuals (52.4% women) were followed for 9 years. Sixty-three individuals (9.9%) in the screening group and 110 (17.4%) individuals in the control group (odds ratio 0.53, 95% confidence interval 0.38-0.73) had had a total of 85 and 169 usual-care distal endoscopies, respectively (P < .001).

Conclusions

Undergoing a colonoscopic examination for colorectal cancer seems to reduce the utilization of later usual-care endoscopic examinations. This finding could have an impact on the estimation of endoscopic resources needed for colorectal cancer screening.

Section snippets

Patients and methods

In 1983, 400 individuals, aged 50 to 59 years, were randomly drawn from the official Norwegian population registry of Telemark County and offered a screening examination for CRC by flexible sigmoidoscopy.9 An age- and sex-matched group of controls (n = 399), not being offered screening examination, was also drawn from the same registry. Three hundred twenty-three individuals (81%) attended the screening examination; 76 (19%) refused to attend after 1 postal reminder. A total of 112 (35%) in the

Results

A total of 1268 individuals, 634 in each group, were studied for 9 years. In each group, 332 were women (52.4%). The mean age in the 2 groups at the start of the observation period in 1996 was 67.5 years (range, 63-72 years).

In the screening group, 63 individuals (9.9%), and, in the control group, 110 individuals (17.4%) attended 1 or more usual-care distal endoscopies during the observation period (odds ratio 0.53, 95% confidence interval 0.38-0.73, P < .001). The total number of usual-care

Discussion

Implementing a population-based colonoscopic screening program will inevitably increase the utilization of procedures. One will, however, expect that those who receive colonoscopy screening will have fewer lower-GI investigations over the next few years. This assumption was confirmed in the present study where the screening group had 50% fewer usual-care distal endoscopic examinations than the control group during 9 years after a screening colonoscopy. Such an effect of screening on the

Acknowledgments

We thank Deidi Ann Bergestuen for linguistic revision of the manuscript.

References (26)

  • S. Vijan et al.

    Projections of demand and capacity for colonoscopy related to increasing rates of colorectal cancer screening in the United States

    Aliment Pharmacol Ther

    (2004)
  • C.J.A. Bowles et al.

    A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?

    Gut

    (2004)
  • G. Hoff et al.

    Epidemiology of polyps in the rectum and sigmoid colon. Design of a population screening study

    Scand J Gastroenterol

    (1985)
  • Oral presentation at Digestive Disease Week, Los Angeles, California, May 21-24, 2006.

    View full text