The BSG/ACPGBI guidelines for colonoscopic screening: what are we missing?

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Colorectal cancer screening protocols for family history patients were inconsistent before 2002.
• Local guidelines were often more liberal than current British Society of Gastroenterology and Association of Coloproctology of Great Britain and Ireland guidelines.
• This study evaluates missed diagnoses under newer guidelines.

Purpose of the Study:

• To analyze significant colorectal cancer pathology missed by applying 2002 guidelines retrospectively.
• To compare screening outcomes between patients indicated for screening under new guidelines versus those not indicated.

Main Methods:

• 399 patients with a family history of colorectal cancer underwent screening endoscopy.
• Patients were divided into two groups: those screened under new guidelines and those not.
• Pathology findings were graded as significant or insignificant and compared between groups.

Main Results:

• 557 endoscopies were performed; 50% were indicated under new guidelines (Group 1), 50% were not (Group 2).
• Significant pathology or carcinoma was detected in 15.8% of Group 1 endoscopies and 10.0% of Group 2 endoscopies.
• The difference in significant pathology detection between groups was statistically significant.

Conclusions:

• Retrospective application of 2002 guidelines would have reduced procedures by 50%.
• However, this would have resulted in missing 10% of significant pathology in moderate-risk patients.
• This 10% represents 39% of all significant colorectal cancer pathology found in the studied cohort.