Significant colonic neoplasia prevalence and ASGE recommendations: is it time for a change?
OBJECTIVE
To Evaluate the indications versus diagnostic yield of significant colonic neoplasia (SCN) in the open-access era and screening colonoscopy.


METHODS
During 6-year period, all procedural data were obtained from all consecutive patients who underwent colonoscopies. Indications were compared with American Society for Gastrointestinal Endoscopy guidelines.


RESULTS
In all 22,341 procedures were included in the study. Indications were divided into 3 groups: Screening (21.89% of the procedures), surveillance (17.60%) and symptoms/signs (60.51%). A total of 2867 patients (12.83%) had SCNs. Of these, 278 (7.00%) SCNs were found in the group less than 50 years of age and 2589 in the group over the age of 50 years (14.10%). SCN as per indication frequency was 12.69% in the symptom/sign group (subdivided to 7.24% and 14.01% in the under 50 and over 50, age groups, respectively); screening 13.37% (5.48% and 15.09%, respectively); surveillance 12.64% (8.48% and 13.19%, respectively). The indications leading to the highest SCN rate (over 25%) were: abnormal imaging, elevated carcinoembryonic antigen, and rectal pain.


CONCLUSIONS
Colonoscopy is a unique screening tool that can detect neoplastic lesions. SCN prevalence in our study was between 13% and 15% for all indications in patients above 50 years of age. This emphasizes performing a screening colonoscopy for the entire population over the age of 50 years, regardless of the indication. We feel that American Society for Gastrointestinal Endoscopy guidelines should be reassessed. The revised criteria should state that the primary indication, are all people over the age of 50 years, who should have a colonoscopy performed, unless otherwise contraindicated.
Keren
Dean
D
Gastroenterology Unit, Bnai-Zion Medical Center, Haifa, Israel. dean.keren@b-zion.org.il
Rainis
Tova
T
Goldstein
Omer
O
Stermer
Edy
E
Lavy
Alexandra
A
D000367:Age Factors; D002272:Carcinoembryonic Antigen / Q000097:blood; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D015995:Prevalence; D012007:Rectum; D012955:Societies, Medical; D014481:United States
D002272:Carcinoembryonic Antigen