Original Title: Técnicas endoscópicas y radiológicas en el diagnóstico de cáncer colo-rectal. evaluación de la variabilidad de uso y aceptabilidad

Authors' objectives: Make a systematic review of scientific literature in order to determine the sensitivity and specificity of the techniques used in the diagnosis of the malign neoplastic lesion and benign neoplasia of the colon. Determine the use of the endoscopic and radiological techniques in the diagnosis and screening of this pathology, by analysing their acceptability to patients and any variability in their use among the specialists who deal with this pathology.

Authors' results and conclusions: The predominant symptom that led to the endoscopic examination was bleeding of the lower digestive tract and in more than half the cases, a diagnosis of malignant neoplasia or polypoidea lesion was obtained. For most of the colonoscopies or OEs performed, intestines were cleaned by the ingestion of 4 litres of water with polyethylenglycol, but only 55.3% of patients were able to take the total amount of water. Almost 50% considered that intestinal cleaning was harsh or very harsh. Only 63.1% of patients were able to attain an adequate level of intestinal cleaning. On the other hand, tolerance to the endoscopic method was acceptable only to 30% of patients, and the OE was acceptable to 87.2%. The discomfort deriving from the endoscopic technique was labelled by most patients as moderate to severe, abdominal pain being the most frequent form of distress. Hypotension and bradycardia was reported in 32 patients, obliging doctors to suspend their examination. Sedo-analgesia was performed under the supervision of the Intensive Care Unit in 5.4% of cases; in all cases, examination was conclusive and there was no discomfort deriving from the test. The endoscopist considered that the percentage of pancoloscopies could have increased 20% using sedo-analgesia. A total of 59 cases of malignant neoplasic lesions or polyps, probably degenerated, were diagnosed and 111 cases of polyps with a benign appearance from the endoscopic viewpoint. The mean value recorded for carcinoma was 69.9 and for the generated polyp, 65. In more than 50% (25) of cases, the postsurgical stage of tumours was III or IV according to the TNM classification. In 77 cases, a polypectomy was performed and in 15, the removal of the polyp was performed with biopsy forceps. OE was requested in 39 cases prior to the colonoscopy. For the carcinoma diagnosis, a sensitivity of 88.8% and a specificity of 86.6% were calculated, taking the colonoscopy as the reference technique. For the detection of polyps a sensitivity of 83.3% and a specificity of 62.9% was calculated. In our survey, 7 examinations were requested due to case histories of CRC in members of the patient’s immediate family and 105 due to personal case histories. In none of these cases was the examination made of asyntomatic individuals who did not belong to these two groups.

Authors' recommendations: In spite of the fact that it has the lowest tolerance levels, the technique chosen for the diagnosis and screening of CRC is the endoscopy as this offers higher levels of sensitivity and specificity than radiology and allows biopsies to be taken and polypectomies which may be curative to be performed. Sedoanalgesia may contribute to increasing the tolerance to and quality of examinations.Adequate intestinal cleaning in all examinations continues to be an important objective to aim for as the available methods are not, in general, well tolerated by patients.The fact that the average CRC diagnosis age is 69.9 and the development stage at the time of diagnosis is advanced (III, IV) in 53% of cases, it is necessary to consider the possibility of performing screening surveys of younger individuals. In this country, there is still no consistent scientific evidence to recommend screening tests in asyntomatic individuals of more than 50, but it is essential to carry out an active search of subjects with CRC risk factors. According to this survey, in our environment an adequate screening was not made of asymtomatic patients with previous cases of CRC in their families, although in view of the low number of patients studied, it is not possible to reach any conclusion on this point.

Authors' methods: 1-. Survey of 425 patients who required a diagnostic and/or therapeutic colonoscope, performed over a period of three months in the area covered by Galdakao Hospital (Vizcaya). The OE was taken into account if this was made before the endoscopic examination. Tolerance to examinations and previous preparation was analysed by means of a survey carried out among patients. 2-. Interview of the endoscopist involved in each examination in order to determine the final diagnosis, the path explored, the tolerance to the test from the medical point of view and the performance or not of therapies. 3-. Interview of different specialists who handle this pathology (interns, surgeons and specialists in the digestive tract) belonging to two hospitals in this Autonomous Community (Santiago Hospital in Vitoria and Galdakao Hospital in Vizcaya), in order to show the variability with which the radiological and endoscopic techniques are used, as well as the performance, or not, of screening in different CRC risk groups. 4-. Review of the results of pathologic anatomy in cases of endoscopies carried out on suspect malignant neoplastic lesion and/or polypoidea and the prognostic stage of the CRCs diagnosed. 5-. Review of the level of adherence to the standards stipulated by the American Gastroenterological Association (AGA). 6-. Bibliographical review of the background to CRC and the current status.

Project Status: Completed

Year Published: 2002

URL for published report: https://www.euskadi.eus/contenidos/informacion/2002_osteba_publicacion/es_def/adjuntos/2002/d_02-02_cancer_colo_r.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>