Monitoring the performance of sigmoidoscopy screening: the need for a comprehensive approach
Menée en Angleterre dans le cadre d'un programme national de dépistage du cancer colorectal comportant une sigmoïdoscopie flexible et destiné aux personnes âgées de 55 ans, cette étude identifie, à partir de données portant sur 8 256 examens endoscopiques, les facteurs associés au taux de détection d'adénomes
Available evidence suggests that flexible sigmoidoscopy screening is associated with substantial and long-lasting reductions in incidence of colorectal cancer and mortality from the disease, as well as with a reduction in all-cause mortality at 11–12 years of follow-up. The limited diffusion of primary screening with flexible sigmoidoscopy, adopted in only two population-based programmes in Europe, probably explains the absence of established and standardised performance measures developed specifically for monitoring quality of endoscopy in this setting. However, the inter-endoscopist variability in adenoma detection rate (ADR) described in flexible sigmoidoscopy screening trials, and the association between low levels of adenoma detection by flexible sigmoidoscopy and increased risk of distal interval colorectal cancer (which shows the same trend as that reported for colonoscopy), indicate the need to implement quality assurance efforts. Therefore, a study by Roisin Bevan and colleagues reported in The Lancet Gastroenterology & Hepatology, which aimed to assess how performance data from six pilot sites involved in the English Bowel Scope Screening (BoSS) programme can be used to form quality standards, provides valuable information. In their retrospective analysis of flexible sigmoidoscopy screening procedures performed in individuals aged 55 years, overall ADR was 9·1% (95% CI 8·5–9·8; 755 of 8256 procedures), varying from 7·4% (6·2–8·9) to 11·0% (9·1–13·4) by screening centre; ADR was 11·5% (10·6–12·5) in men and 6·6% (5·9–7·4) in women.
The Lancet Gastroenterology & Hepatology , commentaire en libre accès, 2018