Screening colonoscopy: high yield, low risk

Screening colonoscopy in asymptomatic patients older than 55 detects colonic neoplasia in about 20% and has few complications, data from 269,000 procedures in Germany has shown. Tubular adenomas were identified in 15.6% of cases, villous/tubulovillous  adenomas in 3.7%, and invasive cancers in 0.8%.  'Advanced' adenomas larger than 1 cm and/or with high-grade dysplasia were found in 7.1% of cases. Immediate polypectomy was performed for 95% of polyps that were between 5 mm and 30 mm. Perforations occurred in only 0.02%, and all cases were treated successfully by surgery with no fatalities observed. The perforation rate was ten-fold lower than previous estimates.  Bleeding occurred in 0.8% after polypectomy but was managed conservatively in the vast majority of cases: only 4.3% of all bleeding episodes needed surgery. Cardiopulmonary complications were noted in 0.1% of patients. "Screening colonoscopy seems to be effective because of high detection rates of colorectal neoplasms, a profound shift towards early stages of colorectal cancer, and low complication rates," the report concluded.  Although the German health system funded screening colonoscopy for all older patients, the participation rate was only about 3%. More effort was needed to increase awareness of the benefits and safety of the procedure – among both patients and doctors. European Journal of Gastroenterology and Hepatology 2009; published online...