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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
ARTICLE HIGHLIGHTS
Research background
The impact of the Screening program on controlling the colorectal cancer (CRC) morbidity and mortality has been proved. But since its complete roll-out in 2009, the French population-based colorectal cancer screening program (CRCSP) experienced 3 major constraints [use of a less efficient Guaiac-test (gFOBT), Stopping the supply of Faecal-Immunochemical-Test kits (FIT), Suspension of the program due to the coronavirus disease 2019 (COVID-19)] affecting its effectiveness.
Research motivation
At this time when all the spotlights are focused on the impact of the health crisis linked to COVID-19, our motivation was to warn of the continued deterioration in the quality of screening colonoscopies in France.
Research objectives
To describe the impact of the constraints in terms of changes to the quality of screening colonoscopies.
Research methods
This retrospective cohort study included screening colonoscopies performed by the gastroenterologists between January 2010 and December 2020 in people aged 50-74 Living in Ile-de-France (France). The changes to the quality of screening colonoscopy (proportion of colonoscopies performed beyond 7 mo, Frequency of serious adverse events and the 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.
Research results
The retrospective cohort was made up of 533 gastroenterologists. These 533 gastroenterologists achieved 21509 screening colonoscopies over the gFOBT period, 38,352 over FIT, 7342 over STOP-FIT and 7995 over the COVID period. The frequency of serious adverse events 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 colonoscopies performed beyond 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)].
Research conclusions
The study showed that the constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the occurrence of the serious adverse events, highlighting the need for a respectable reference time-to-colonoscopy in CRCSP.
Research perspectives
At the end of this study, we initially aim to develop, evaluate, and validate a standard form for collecting data from screening colonoscopies in France. In a second step, we will evaluate the impact of the patient’s motivation by the attending physician on the time taken to perform the colonoscopy.
