ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-8_5 Petersen-ASGE at ACG Oct21_2022

8_5 Petersen-ASGE at ACG Oct21_2022 - Comments on Nordic Trial

Pdf Summary

The NordICC Trial is a population-based randomized trial that compared the outcomes of screening colonoscopy versus no screening for colorectal cancer (CRC) neoplasia. The trial enrolled 95,000 patients from Norway, Poland, Sweden, and the Netherlands from 2009 to 2014. The intention-to-screen analysis showed that invitation to screening colonoscopy resulted in an 18% reduction in the risk of CRC at 10 years compared to no screening. However, there was no significant reduction in CRC mortality. <br /><br />Challenges with the study include the low uptake of colonoscopy among invited patients (only 42%), the use of an intention-to-screen analysis which may introduce bias and contamination of enrolled groups, and the premature analysis at 10 years instead of the intended 15-year follow-up. The authors noted that the progression from polyp to cancer is a slow process, and studies on pooled sigmoidoscopy data have shown sustained effects on CRC incidence and mortality for up to 15 years. <br /><br />Other challenges in the NordICC Trial include disparate performance in adenoma detection rates (ADR) among endoscopists and varied rates of cecal intubation. The US response to the trial includes organizations cautioning against changing the understanding of CRC risk and the benefits of screening colonoscopy. The American Society for Gastrointestinal Endoscopy (ASGE) has provided guidance to the media and members, conducted webinars with the authors, and emphasized ongoing education of patients and families to maintain progress in CRC screening. <br /><br />Overall, the data from the NordICC Trial should not change the current paradigm of offering colonoscopy as the first screening test for CRC. It remains the most accurate method for detecting and treating CR neoplasia and preventing CRC. The best screening test is the one that the patient is willing and able to undergo.

Keywords

NordICC Trial

screening colonoscopy

colorectal cancer

CRC neoplasia

intention-to-screen analysis

reduction in risk

CRC mortality

low uptake of colonoscopy

15-year follow-up

adenoma detection rates