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Colorectal cancer. The quality of colonoscopy is good, but many shortcomings and inconsistencies between screening centers. sig investigation

Under the lens of the Italian Society of Gastroenterology and Gastrointestinal Endoscopy 64 hospitals in 17 regions. Compliance analysis of international guidelines. In the North, the number of colonoscopy examinations is higher (6500) than in the South-Central centers (4 thousand and 3 thousand, respectively). The number of endoscopy specialists also varies: they are on average 6.5 in the middle in the north and 5 and 3.5 in the center and in the south

June 28

If the results are generally positive, there are many shortcomings and inconsistencies between the different centers in which endoscopic colorectal cancer screening is performed.

This is the “diagnosis” that emerged from a study he conducted Italian Society of Gastroenterology and Gastrointestinal Endoscopy (SIGE) – Conducted on a sample of 64 hospitals in 17 regions and just published online in the scientific journal Gastrointestinal and liver diseases– Who for the first time evaluated the quality of colonoscopy in Italy.

SIGE is therefore calling for institutions to pay greater attention to support and control of second-level screening activities, such as colonoscopy and all factors that determine their quality.

Colorectal cancer is a major health problem worldwide. Suffice it to say that it represents the third cancer in terms of incidence and second in mortality, and in fact there are approximately 50 thousand new cases in one year in Italy, about 500 thousand in Europe and about 2 million in the world. What makes the difference in patients’ clinical history is screening, which allows for early diagnosis and reduced mortality.

“In Italy, the test used is the fecal occult blood test, which is performed every two years for people aged 50 to 69 years, with the exception of the Piedmont region where a rectal sigmoidoscopy is performed,” he explains. Marcelo MaedaMD, medical director of the Unit for Complex Gastroenterology Operations at Sant Elia-Raimondi Hospitals in Caltanissetta and member of the National Council of the Italian Society of Gastroenterology and Gastrointestinal Endoscopy (SIGE) – If the first level test is positive, the screening program includes a colonoscopy as the second level exam. The quality of this examination is therefore crucial to ensuring the effectiveness of the entire prevention programme.”

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The goal is actually to remove any precancerous lesions, such as polyps, at an early stage and asymptomatic. In this way, we intervene in a less aggressive manner and increase the chances of effective treatment, less impact on the patient and with a greater likelihood of recovery.

That is why SIGE conducted a survey aimed at assessing the quality of the colonoscopy performed for this purpose.

In this way, data for 64 hospitals in 17 Italian regions were analyzed: about 50 percent from the north, about 20 (18.75 percent) from the center and just over 30 percent (31.25 percent) from southern Italy.

In each center there are an average of 5 endoscopy specialists participating in the examination and of these about 3 out of 4 (71.4%) are gastroenterologists. If most centers (93.8%) plan to perform a colonoscopy quickly and in any case within 3 months, then what is striking is the conflicting data in the different Italian regions. In fact, significantly more colonoscopy examinations (6500) were recorded in the North than in the South-Central centers (4 thousand and 3 thousand, respectively) on average in one year. The same dyslexia was found in the number of endoscopy specialists, who averaged 6.5 in the middle in the north and 5 and 3.5 in the middle and in the south.

“As SIGE, we have decided to conduct a dedicated study to assess the quality of colonoscopy examination in Italy, the techniques by which they are performed and what is the adherence to international guidelines in clinical practice. On the one hand, if we can be satisfied with the quality offered to patients in Italy – Maida continues – on the one hand Other, we cannot fail to record a large variation among all participating centres, with a significant difference in behavior in implementing endoscopic screening for colon cancer – respectively. These aspects should be adapted and standardized at the national level through continuous monitoring of the activity of the screening centres.”

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The study – unique in that it analyzed for the first time the activity of screening centers in Italy on a large sample and based on data analysis for each hospital – is also the first to verify the individual centers’ adherence to international guidelines.

“Colon cancer screening has a significant impact on the natural history of this cancer and helps reduce mortality – and Maeda concludes – therefore, institutions should pay more attention to implementing these activities. First of all, with national guidance in order to ensure greater standardization of behavior among All centers but also through increased investment to ensure sufficient staff and appropriate and constantly updated technological equipment. From this point of view, national scientific societies will be able to play an important role in supporting the process of consolidation and the growth of individual centers throughout the national territory.”

June 28, 2022
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