SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gastroenterology
  2015/08  
 
  2015 Aug;149(2):356-366.e1  
  doi: 10.1053/j.gastro.2015.04.012  
 
  Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program  
 
  Brenner H, Altenhofen L, Kretschmann J, Rösch T, Pox C, Stock C, Hoffmeister M  
  http://www.ncbi.nlm.nih.gov/pubmed/25911510  
 
 

BACKGROUND & AIMS:

The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program.

METHODS:

We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry.

RESULTS:

We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3% to 22.3% among men and from 8.4% to 14.9% among women. This increase was mostly due to an increase in detection rates of adenomas <0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4% to 9.0% among men, and from 4.4% to 5.2% among women) and colorectal cancer. In 2012, overall ADR reached 31.3% and 20.1% in men and women, respectively.

CONCLUSIONS:

We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas <0.5 cm). Further research should address potential implications for defining screening and surveillance intervals.

 
Question posée
 
Quelle a été l’évolution annuelle du taux de détection d’adénomes (TDA) au cours de la dernière décennie ?
 
Question posée
 
A partir du registre national allemand consacré aux coloscopies de dépistage du cancer colorectal, les auteurs ont montré une augmentation globale et stable du TDA dans les différentes catégories d’âge et dans les 2 sexes, pour atteindre 31,3% chez les hommes et 20,1% chez les femmes en 2012. Cette augmentation concernait principalement les adénomes de moins de 5 mm, et paraissait (au moins en partie) liée à l’apport des nouveaux endoscopistes.
 
Commentaires

Si les raisons de cette augmentation restent largement à explorer, cette étude a le mérite de donner des chiffres récents concernant le TDA à une échelle nationale dans un pays européen, qui seront probablement utiles dans le futur pour aider à définir les standards en terme de détection des adénomes et réfléchir aux intervalles de surveillance des coloscopies.

 
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