Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome

Ariadna Sánchez, Victorine H. Roos, Matilde Navarro, Marta Pineda, Berta Caballol, Lorena Moreno, Sabela Carballal, Lorena Rodríguez-Alonso, Teresa Ramon y Cajal, Gemma Llort, Virginia Piñol, Adrià López-Fernández, Inmaculada Salces, Maria Dolores Picó, Laura Rivas, Luis Bujanda, Marta Garzon, Angeles Pizarro, Eva Martinez de Castro, Maria Jesus López-AriasCarmen Poves, Catalina Garau, Daniel Rodriguez-Alcalde, Maite Herraiz, Cristina Alvarez-Urrutia, Andres Dacal, Marta Carrillo-Palau, Lucia Cid, Marta Ponce, Eva Barreiro-Alonso, Esteban Saperas, Elena Aguirre, Cristina Romero, Barbara Bastiaansen, Maribel Gonzalez-Acosta, Blai Morales-Romero, Teresa Ocaña, Liseth Rivero-Sánchez, Gerhard Jung, Xavier Bessa, Joaquin Cubiella, Rodrigo Jover, Francisco Rodríguez-Moranta, Judith Balmaña, Joan Brunet, Antoni Castells, Evelien Dekker, Gabriel Capella, Miquel Serra-Burriel, Leticia Moreira, Maria Pellise, Francesc Balaguer

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12 Citations (Scopus)


Background & Aims: Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS. Methods: We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model. Results: The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%–65.2%) and 7.9% (95% CI, 5.2%–10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06–4.3), complete colonoscopies (20% vs 0%; P =.01), and pan-chromoendoscopy use (OR, 2.14; 95% CI, 1.15–3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14–0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03–1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17–3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02–2.33). Conclusions: Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
Original languageEnglish
JournalClinical Gastroenterology and Hepatology
Early online date2021
Publication statusE-pub ahead of print - 2021


  • Colonoscopy
  • Colonoscopy Quality
  • Colorectal Neoplasms
  • Hereditary Colorectal Cancer
  • Hereditary Nonpolyposis Colorectal Cancer
  • Lynch Syndrome

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