Colonoscopy utilization and outcomes 2000 to 2011

Abstract

Background: Understanding colonoscopy utilization and outcomes can help determine when the procedure is most effective.

Objective: To study trends in utilization and outcomes of colonoscopy in the United States from 2000 to 2011.

Design: Prospective collection of colonoscopy data.

Setting: A total of 84 adult diverse GI practices.

Patients: All adult patients receiving colonoscopy for any reason.

Intervention: Colonoscopy.

Main outcome measurements: Polyps >9 mm or suspected malignant tumor.

Results: We analyzed 1,372,838 reports. The most common reason for colonoscopy in patients aged <50 years is evaluation of symptoms such as irritable bowel syndrome (IBS) (28.7%) and bleeding or anemia (35.3%). In patients aged 50 to 74 years, colorectal cancer screening accounts for 42.9% of examinations. In patients aged >74 years, surveillance for cancer or polyps is the most common indication. The use of colonoscopy for average-risk screening increased nearly 3-fold during the study period. The prevalence of large polyps increases with age and is higher in men for every procedure indication. The prevalence of large polyps in patients with symptoms of IBS was lower than in those undergoing average-risk screening (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.83-0.87). With increasing age, there was a shift from distal to proximal large polyps. The rate of proximal large polyps is higher in the black population compared with the white population (OR 1.19; 95% CI, 1.13-1.25).

Limitations: In the absence of pathology data, use of surrogate as the main outcome.

Conclusion: Colonoscopy utilization changed from 2000 to 2011, with an increase in primary screening. The proximal location of large polyps in the black population and with advancing age has implications for screening and surveillance.