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      Expert opinions and scientific evidence for colonoscopy key performance indicators

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          Abstract

          Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.

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          Most cited references 311

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          Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.

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            Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial.

            Colorectal cancer is the third most common cancer worldwide and has a high mortality rate. We tested the hypothesis that only one flexible sigmoidoscopy screening between 55 and 64 years of age can substantially reduce colorectal cancer incidence and mortality. This randomised controlled trial was undertaken in 14 UK centres. 170 432 eligible men and women, who had indicated on a previous questionnaire that they would accept an invitation for screening, were randomly allocated to the intervention group (offered flexible sigmoidoscopy screening) or the control group (not contacted). Randomisation by sequential number generation was done centrally in blocks of 12, with stratification by trial centre, general practice, and household type. The primary outcomes were the incidence of colorectal cancer, including prevalent cases detected at screening, and mortality from colorectal cancer. Analyses were intention to treat and per protocol. The trial is registered, number ISRCTN28352761. 113 195 people were assigned to the control group and 57 237 to the intervention group, of whom 112 939 and 57 099, respectively, were included in the final analyses. 40 674 (71%) people underwent flexible sigmoidoscopy. During screening and median follow-up of 11.2 years (IQR 10.7-11.9), 2524 participants were diagnosed with colorectal cancer (1818 in control group vs 706 in intervention group) and 20 543 died (13 768 vs 6775; 727 certified from colorectal cancer [538 vs 189]). In intention-to-treat analyses, colorectal cancer incidence in the intervention group was reduced by 23% (hazard ratio 0.77, 95% CI 0.70-0.84) and mortality by 31% (0.69, 0.59-0.82). In per-protocol analyses, adjusting for self-selection bias in the intervention group, incidence of colorectal cancer in people attending screening was reduced by 33% (0.67, 0.60-0.76) and mortality by 43% (0.57, 0.45-0.72). Incidence of distal colorectal cancer (rectum and sigmoid colon) was reduced by 50% (0.50, 0.42-0.59; secondary outcome). The numbers needed to be screened to prevent one colorectal cancer diagnosis or death, by the end of the study period, were 191 (95% CI 145-277) and 489 (343-852), respectively. Flexible sigmoidoscopy is a safe and practical test and, when offered only once between ages 55 and 64 years, confers a substantial and longlasting benefit. Medical Research Council, National Health Service R&D, Cancer Research UK, KeyMed. Copyright 2010 Elsevier Ltd. All rights reserved.
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              American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected].

              This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5-10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).
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                Author and article information

                Journal
                Gut
                Gut
                gutjnl
                gut
                Gut
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0017-5749
                1468-3288
                December 2016
                8 October 2016
                : 65
                : 12
                : 2045-2060
                Affiliations
                [1 ]Department of Gastroenterology, South Tyneside District Hospital , South Shields, UK
                [2 ]Department of Gastroenterology, North Tees University Hospital , Stockton-on-Tees, UK
                [3 ]Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf , Hamburg, Germany
                [4 ]Department of Gastroenterology, Indiana University , Indianapolis, USA
                [5 ]Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
                [6 ]Department of Gastroenterology and Hepatology, Edouard Herriot Hospital, Lyon University , Lyon, France
                [7 ]Department of Health Management and Health Economics and KG Jebsen Center for Colorectal Cancer Research, University of Oslo , Oslo, Norway
                [8 ]Department of Gastroenterology, Medical Center for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw, Poland
                [9 ]Department of Gastroenterology, St Mark's Hospital and Academic Institute , Harrow, UK
                [10 ]Digestive Endoscopy Unit, Catholic University , Rome, Italy
                [11 ]Department of Gastroenterology, Westmead Hospital , Sydney, Australia
                Author notes
                [Correspondence to ] Professor Colin J Rees, Department of Gastroenterology, South Tyneside District Hospital, South Shields NE34 0PL, UK; colin.rees@ 123456stft.nhs.uk
                gutjnl-2016-312043
                10.1136/gutjnl-2016-312043
                5136701
                27802153
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/

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                Recent Advances in Clinical Practice
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                Gastroenterology & Hepatology

                endoscopy, colonic polyps, endoscopic polypectomy, colonoscopy

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