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

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The NordICC Trial, a population-based randomized trial conducted in Norway, Poland, Sweden, and the Netherlands, compared the outcomes of screening colonoscopy versus no screening for colorectal neoplasia. The study enrolled 95,000 patients between 2009 and 2014 and assessed the incidence and mortality of colorectal cancer (CRC) over 10 and 15 years. The intention-to-screen analysis showed that screening colonoscopy reduced the risk of CRC incidence by 18% at 10 years, but there was no significant reduction in CRC mortality. However, the study had low uptake, with only 42% of invited patients undergoing colonoscopy. There were challenges with the study's use of intention-to-screen analysis and its premature analysis at 10 years. Additionally, there were questions about the detection rates among endoscopists and the cecal intubation rates. <br /><br />The American Society for Gastrointestinal Endoscopy (ASGE) responded to the study by cautioning against changes in understandings regarding CRC risk and the benefits of screening colonoscopy. Numerous media interviews and educational opportunities were conducted to address the new data and compare it with existing data and standards of practice. Ongoing education of patients and families will be necessary to maintain progress in CRC screening. <br /><br />In summary, the NordICC Trial showed a reduction in CRC incidence but not mortality with screening colonoscopy. However, there were challenges with the study's methodology and questions about detection rates and intubation rates. The ASGE emphasized that colonoscopy remains the most accurate means of detecting and treating colorectal neoplasia and preventing colorectal cancer. The study's findings should not change the current screening paradigm of offering colonoscopy as the first option and noninvasive tests to those who refuse colonoscopy. The best screening test is the one the patient is willing and able to undergo.

Keywords

NordICC Trial

screening colonoscopy

colorectal neoplasia

CRC incidence

CRC mortality

intention-to-screen analysis

detection rates

cecal intubation rates

ASGE

CRC screening