Tag: colonoscopy

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Experience, Time and Dye Linked to Better Polyp Detection in IBD Surveillance

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The first UK-wide analysis of bowel screening for patients with inflammatory bowel disease (IBD) has identified opportunities to improve the early detection of cancer.

The study – the largest of its kind globally – found that checks performed by professionals with regular experience, allowing more time for the procedure, and the use of a special dye to improve visibility were each associated with finding small growths called polyps, which may become cancer.

Experts say the findings provide a starting point for measuring and improving care for those with IBD, and support further investigation into whether more consistent pathways and protected time could lead to better patient outcomes.

People with IBD such as Crohn’s disease or ulcerative colitis that affects the large bowel have a higher risk of bowel cancer. Regular endoscopies can find early changes. These are usually scheduled alongside other hospital procedures, which can make consistent care harder to plan.

Researchers, led by the University of Edinburgh, carried out the first national-scale analysis of UK data on the quality of IBD endoscopies to see how the checks are being delivered and what factors are associated with finding polyps, some of which may be precancerous.

The research team analysed data from the National Endoscopy Database, covering approximately 65 per cent of UK endoscopy units. This included almost 16 000 procedures in 2024 by 4669 endoscopists, who perform the tests.

They found that fewer than one in five endoscopists performed the checks at least monthly, yet were responsible for carrying out 57 per cent of procedures.

The study provides the first national evidence linking polyp detection with the experience of the person doing the test, the time allowed and use of dye.

Better evidence could ultimately help people with IBD receive more consistent care and improve the chances of finding important changes early, experts say.

The study team highlights that the database did not include laboratory results for removed polyps, so cannot determine whether the differences led to fewer cancers. Further research is needed to find out which changes improve cancer prevention.

The study is published in the Journal of Crohn’s and Colitis: https://academic.oup.com/ecco-jcc/article-lookup/doi/10.1093/ecco-jcc/jjag126. The UK-wide collaboration involved clinicians and researchers from NHS organisations and universities across all four nations.

The study’s principal investigator, Dr Shahida Din, from the University of Edinburgh’s Institute of Genetics and Cancer, said: “IBD cancer checks are important, but unlike organised bowel cancer screening, they do not have the same protected capacity. A small proportion of endoscopists perform most of these checks, and regular experience, more time and use of dye were associated with finding more polyps. Further research should establish whether more consistent pathways and dedicated time improve detection of precancerous changes and, ultimately, patient outcomes.”

Source: University of Edinburgh

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Longer Intervals Between Colonoscopies May Be Safe

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Photo by Tima Miroshnichenko

Patients who have had high-risk polyps removed from their bowel can probably wait five years, rather than three, until their next colonoscopy without increasing their risk of colon and rectal cancer. This is shown by two new studies published in the New England Journal of Medicine, in which researchers from the Karolinska Institutet have participated. The findings, from ”Colonoscopy Intervals and Colorectal Cancer Incidence after Adenoma Removal” and “Colorectal Cancer Risk among Patients with Serrated Polyps” could reduce the number of examinations and thus the burden on both patients and the healthcare system.

Every year, around 1.9 million people worldwide are diagnosed with bowel cancer. To prevent the disease, many countries have introduced screening programmes that enable more polyps to be detected and removed before cancer develops.

However, some patients are assessed as being at increased risk of developing new polyps or cancer and are therefore recommended to undergo regular follow-up colonoscopies. These examinations are resource-intensive for the healthcare system and can be perceived as burdensome for patients.

The first results from the European Polyp Surveillance (EPoS) study, a large randomised research project on follow-up after polyp removal, are now being presented. In the EPoS II study, 10 799 patients across eight European countries who had previously had high-risk adenomas – a type of polyp – removed were followed up. Participants were randomised to undergo their first follow-up colonoscopy after either three or five years.

Low risk in both groups

After five years of follow-up, the risk of colorectal cancer was very low in both groups. Among those who waited five years for their first check-up, 0.77 per cent developed cancer, compared with 0.82 per cent among those examined after three years. Nor did the researchers observe any clear differences in how far the cancer had progressed when it was detected.

At the same time, the longer follow-up interval meant that the number of colonoscopies fell sharply. During the follow-up period, nearly 4200 fewer examinations were carried out in the group that waited five years for their first follow-up.

”More than 99 per cent of patients did not develop colorectal cancer within five years of the polyps being removed. “The results suggest that we need to reassess when these patients should be called in for their next colonoscopy,” says Hans-Olov Adami, Professor Emeritus at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, who coordinated the Swedish part of the research project.

At the same time, the researchers are presenting results from the parallel EPoS III study, which involved 1,861 patients with so-called serrated polyps, another type of polyp that can also be a precursor to cancer. In that group, too, the risk of cancer was low. After five years, around one per cent of the participants had developed colorectal cancer and none had died from the disease.

“The low risk of cancer was observed in both patients with high-risk adenomas and those with serrated polyps. This also underlines the importance of the first colonoscopy, as the studies are based on the polyps having been detected and completely removed,” says Hans-Olov Adami.

Source: Karolinska Institutet

Categories : CancerTags :

Disappointing Colorectal Cancer Screening Results with Colonoscopy

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Colon cancer cells
Colon cancer cells. Source: National Cancer Institute on Unsplash

A randomised study of northern European data shows that colonoscopy screening reduces the risk of colorectal cancer by 18%, much smaller than experts previously assumed. The results of the study appear in the New England Journal of Medicine.

Colonoscopy may not even perform better than screening with faecal tests, said Louise Emilsson, docent at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and national Swedish principal investigator of the study.

Prior to the publication of this study, experts assumed that screening with colonoscopy had significantly better effect than screening with faecal tests. Faecal tests are used in colorectal cancer screening programs in many countries, and other countries have introduced screening with colonoscopy based on the fact that researchers via observational and modelling studies estimated that up to nine out of ten cases of colorectal cancer could be prevented with a colonoscopy screening. With faecal tests, similar models has estimated the effect to be two to three out of ten.

In the NordICC study, the researchers investigated the extent to which colonoscopy screening actually prevents colorectal cancer. Overall, 1.2% of those randomised to no screening were diagnosed with colon cancer during ten years, compared to 0.98% in those offered screening.

This translates to an 18% reduced risk of colorectal cancer among the participants who were offered colonoscopy screening. Furthermore, 455 colonoscopies were required to prevent one single case of colorectal cancer. Colonoscopy is fairly invasive and costly procedure, involving preparation, bowel prep with laxatives, and a 30-45 minute examination of the bowel with a camera inserted via the rectum. The figure of 455 procedures to prevent one case of cancer is certainly disappointing, Louise Emilsson concluded.

Colorectal cancer mortality was also found to be lower than expected in the NordICC study. Only three in a thousand died of the disease within ten years, regardless of whether they were offered screening or not, and thus, there was no significant difference between the groups in terms of mortality. The low mortality rate is however encouraging and likely caused by significantly improved treatment options over the past ten years.

Source: Karolinska Institutet