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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Supply and quality of colonoscopy according to the characteristics of gastroenterologists in the French population-based colorectal-cancer screening program
Akoï Koïvogui, Catherine Vincelet, Gaëlle Abihsera, Hamou Ait-Hadad, Hélène Delattre, Tu Le Trung, Agnès Bernoux, Rachel Carroll, Jérôme Nicolet
Akoï Koïvogui, Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Bondy 93146, France
Catherine Vincelet, Site des Yvelines, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Le Chesnay Cedex 78153, France
Gaëlle Abihsera, Rachel Carroll, Site du Val-de-Marne, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Joinville-le-Pont 94340, France
Hamou Ait-Hadad, Site de Seine-et-Marne, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Lieusaint 77763, France
Hélène Delattre, Site des Hauts-de-Seine, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Nanterre 92000, France
Tu Le Trung, site du Val-d’Oise, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Cergy Saint-Christophe 95800, France
Agnès Bernoux, Site de l’Essonne, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Fontenay-Les-Briis 91640, France
Jérôme Nicolet, Siège Paris, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Paris 75015, France
Author contributions: Koïvogui A, Vincelet C, Abihsera G, Ait-Hadad H, Delattre H, Le Trung T, and Bernoux A are the doctors in charge of coordinating the screening program in each department; Nicolet J is the medical director of the CRCDC-IDF; Koïvogui A conceptualized and designed the project; all doctors in charge of coordinating the screening program collected the field data; Koïvogui A, Vincelet C, and Abihsera G analyzed the data, interpreted the results, and drafted the manuscript; all the authors revised the manuscript, read, and approved the final version of this manuscript.
Institutional review board statement: This study is co-signed by the heads of the structures involved, as such, no further Institutional Review Board was required.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that was obtained after each patient agreed to participate in screening campaigns.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Data and materials are available when requested by e-mail. However, each request will be processed following French legislation on the availability of research data.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Akoï Koïvogui, MD, MHSc, MSc, Doctor, Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), 41 Avenue de Verdun, Bondy 93146, France. aakoivogui@live.fr
Received: November 17, 2022
Peer-review started: November 17, 2022
First decision: January 23, 2023
Revised: February 7, 2023
Accepted: February 27, 2023
Article in press: February 27, 2023
Published online: March 7, 2023
BACKGROUND
Since its complete roll-out in 2009, the French colorectal cancer screening program (CRCSP) experienced 3 major constraints [use of a less efficient Guaiac-test (gFOBT), stopping the supply of Fecal-Immunochemical-Test kits (FIT), and suspension of the program due to the coronavirus disease 2019 (COVID-19)] affecting its effectiveness.
AIM
To describe the impact of the constraints in terms of changes in the quality of screening-colonoscopy (Quali-Colo).
METHODS
This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France (France). The changes in Quali-colo (Proportion of colonoscopies performed beyond 7 mo (Colo_7 mo), Frequency of serious adverse events (SAE) and Colonoscopy detection rate) were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints [gFOBT: Normal progress of the CRCSP using gFOBT (2010-2014); FIT: Normal progress of the CRCSP using FIT (2015-2018); STOP-FIT: Year (2019) during which the CRCSP experienced the cessation of the supply of test kits; COVID: Program suspension due to the COVID-19 health crisis (2020)]. The link between each dependent variable (Colo_7 mo; SAE occurrence, neoplasm detection rate) and the predictive factors was analyzed in a two-level multivariate hierarchical model.
RESULTS
The 533 gastroenterologists (cohort) achieved 21509 screening colonoscopies over gFOBT period, 38352 over FIT, 7342 over STOP-FIT and 7995 over COVID period. The frequency of SAE did not change between periods (gFOBT: 0.3%; FIT: 0.3%; STOP-FIT: 0.3%; and COVID: 0.2%; P = 0.10). The risk of Colo_7 mo doubled between FIT [adjusted odds ratio (aOR): 1.2 (1.1; 1.2)] and STOP-FIT [aOR: 2.4 (2.1; 2.6)]; then, decreased by 40% between STOP-FIT and COVID [aOR: 2.0 (1.8; 2.2)]. Regardless of the period, this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital [aOR: 2.1 (1.3; 3.6)] compared to screening-colonoscopy performed in a private clinic. The neoplasm detection, which increased by 60% between gFOBT and FIT [aOR: 1.6 (1.5; 1.7)], decreased by 40% between FIT and COVID [aOR: 1.1 (1.0; 1.3)].
CONCLUSION
The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE’s occurrence, highlighting the need for a respectable reference time-to-colonoscopy in CRCSP.
Core Tip: The study showed that the detection rate of colonoscopy dropped significantly in France during the years 2019 and 2020, probably due to the coronavirus disease health crisis. The risk of a long delay (> 7 mo) in performing the colonoscopy was twice as high in a public hospital compared to colonoscopies performed in a private endoscopy practice. The constraints likely affected the time to colonoscopy as well as the colonoscopy detection rate without impacting the occurrence of serious adverse events.
