Original ArticlesProcedural success and complications of large-scale screening colonoscopy☆,☆☆,*
Section snippets
Patients and methods
The study protocol was approved by a central Human Rights Committee (CSPCC Perry Point, MD Department of Veterans Affairs Medical Center), and by the institutional review board of each participating center. Asymptomatic subjects age 50 to 75 years who had not undergone examination of the colon within 10 years were recruited between February 1994 and January 1997 from 13 Department of Veterans Affairs Medical Centers (VAMC) across the country. They were recruited in 1 of 3 ways: random selection
Results
Selected demographics of the subjects who underwent screening colonoscopy are presented in Table 1. CVA/TIA, Cerebrovascular accident/transient ischemic attack; COPD, chronic obstructive pulmonary Empty Cell N = 3196 Mean age (SD) 63.0 (7.1) Gender (% male) 96.8 Race (% white) 83.5 Major comorbid conditions Coronary heart disease (%) 21.1 CVA/TIA (%) 8.2 Diabetes (%) 20.8 COPD (%) 8.5 Medications (% patients receiving) Meperidine 70.7 Fentanyl 19.1 Midazolam 71.4 Diazepam 8.5 Atropine 13.3 Glucagon 0.7
Discussion
Indirect evidence and modeling analyses suggest that colonoscopy may be the most cost-effective way to screen the average-risk population for colorectal neoplasia.13, 14, 15 Support for colonoscopy as a primary screening modality comes from 3 lines of indirect evidence. First, the majority of colorectal cancers arise from slowly growing precancerous adenomas that occur throughout the colon. Colonoscopy is highly accurate at detecting adenomas, and their removal by colonoscopic polypectomy has
Acknowledgements
We are indebted to the members of the Data Monitoring Board of the VA Cooperative Study Group No. 380: C. Richard Boland, MD, Martin Brown, PhD, Randall Burt, MD, Ralph B. D'Agostino, PhD, Bernard Levin, MD, and Douglas K. Rex, MD for their careful oversight of the progress of the trial; the Executive Committee: David A. Lieberman, MD (Portland, OR), Dennis J. Ahnen, MD (Denver, CO), John Bond, MD (Minneapolis, MN), Greg Chejfec, MD (Hines, IL), Harinder Garewal, MD, PhD (Tucson, AZ), Sheila
References (38)
- et al.
Randomised, controlled trial of faecal-occult-blood screening for colorectal cancer
Lancet
(1996) - et al.
Randomised study of screening for colorectal cancer with faecal-occult-blood test
Lancet
(1996) - et al.
Colorectal cancer screening: clinical guidelines and rationale
Gastroenterology
(1997) - et al.
Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology
Am J Gastroenterol
(2000) Cost-effectiveness model for colon cancer screening
Gastroenterology
(1995)- et al.
Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages
Am J Gastroenterol
(2000) - et al.
Total colonoscopy: is it always possible?
Gastrointest Endosc
(1991) - et al.
The frequency of total colonoscopy and terminal ileal intubation in the 1990s
Gastrointest Endosc
(1993) - et al.
Factors affecting insertion time and patient discomfort during colonoscopy
Gastrointest Endosc
(2000) - et al.
Prevalence of proximal colonic polyps in average-risk asymptomatic patients with negative fecal occult blood tests and flexible sigmoidoscopy
Gastrointest Endosc
(1996)
Rates of colonoscopic perforation in current practice
Gastroenterology
Complications and adverse effects of colonoscopy with selective sedation
Gastrointest Endosc
Prospective analysis of complications 30 days after outpatient colonoscopy
Gastrointest Endosc
Endoscopic perforation of the colon: lessons from a 10-year study
Am J Gastroenterol
Factors that predict incomplete colonoscopy: thinner is not always better
Am J Gastroenterol
Cancer statistics, 2001
CA Cancer J Clin
Reducing mortality from colorectal cancer by screening for fecal occult blood
N Engl J Med
A case-control study of screening sigmoidoscopy and mortality from colorectal cancer
N Engl J Med
Screening sigmoidoscopy and colorectal cancer mortality
J Natl Cancer Inst
Cited by (0)
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Supported by the Cooperative Studies Program, Department of Veterans Affairs.
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Reprint requests: Douglas B. Nelson, MD, Associate Professor of Medicine, VA Medical Center (111-D), One Veterans Drive, Minneapolis, MN 44417.
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Participants from the VA Cooperative Study Group #380: William V. Harford, MD; Dennis J. Ahnen MD; Dawn Provenzale, MD, MS; Stephen J. Sontag, MD, Thomas G. Schnell, MD; Donald R. Campbell, MD; Theodore E. Durbin, MD; John G. Lee, MD; George Triadafilopoulos, MD; Francisco C. Ramirez, MD; Judith F. Collins, MD, M. Brian Fennerty, MD; Harinder Garewal, MD, PhD, Richard E. Sampliner, MD, Thomas G. Morales, MD, Ronnie Fass, MD; Robert E. Smith, MD, Yogesh Maheshwari, MD