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. 2020 Dec 22;12(1):e00279.
doi: 10.14309/ctg.0000000000000279.

Follow-up of 3 Million Persons Undergoing Colonoscopy in Germany: Utilization of Repeat Colonoscopies and Polypectomies Within 10 Years

Sarina Schwarz  1 , Wiebke Schäfer  1 , Dirk Horenkamp-Sonntag  2 , Judith Liebentraut  2 , Ulrike Haug  1   3
Affiliations

Follow-up of 3 Million Persons Undergoing Colonoscopy in Germany: Utilization of Repeat Colonoscopies and Polypectomies Within 10 Years

Sarina Schwarz et al. Clin Transl Gastroenterol. .

Erratum in

Abstract

Introduction: Given the sparsity of longitudinal studies on colonoscopy use, we quantified utilization of repeat colonoscopy within 10 years and the proportion of persons with polypectomies at first repeat colonoscopy using a large German claims database.

Methods: Based on the German Pharmacoepidemiological Research Database, we identified persons who underwent colonoscopy between 2006 and 2015 (index colonoscopy) and assessed colonoscopies and polypectomies during follow-up. We defined 3 subcohorts based on available procedure/diagnosis codes at index colonoscopy: persons with snare polypectomy, which is reimbursable for lesions ≥5 mm in size (cohort 1), with a forceps polypectomy (cohort 2), and without such procedures/diagnoses (cohort 3). We stratified all analyses by diagnostic vs screening index colonoscopy.

Results: Overall, we included 3,076,657 persons (cohort 1-3: 15%, 13%, 72%). Among persons with screening index colonoscopy (30%), the proportions with a repeat colonoscopy within 10 years in cohorts 1, 2, and 3 were 78%, 66%, and 43%, respectively, and a snare polypectomy at first repeat colonoscopy was performed in 27%, 17%, and 12%, respectively. In cohort 1, 32% of persons with a (first) repeat colonoscopy after 9 years had a snare polypectomy (after 3 years: 25%). Among persons with diagnostic index colonoscopies, 80%, 78%, and 65% had a repeat colonoscopy, and 27%, 17%, and 10% had a snare polypectomy at first repeat colonoscopy, respectively.

Discussion: Our study suggests substantial underuse of repeat colonoscopy among persons with previous snare polypectomy and overuse among lower risk groups. One-quarter of persons with a snare polypectomy at baseline had another snare polypectomy at first repeat colonoscopy.

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Conflict of interest statement

Guarantor of the article: Ulrike Haug, PhD.

Specific author contributions: S.S. and U.H. conceptualized the study and developed the data analysis plan. S.S. and W.S. contributed to data analysis. S.S. drafted the first version of the article. All authors contributed to interpretation of the results and critically revised the manuscript draft. All authors approved the final version of the article. U.H. and D.H.-S. acquired funding for this project, and U.H. supervised the project.

Financial support: This study was supported by a grant (01VSF16037) from the Federal Joint Committee (G-BA).

Potential competing interests: None to report.

Figures

Figure 1.
Figure 1.
Cumulative proportion of persons with a repeat colonoscopy according to years since index colonoscopy and stratified by cohorts 1–31. (a) Persons with a screening index colonoscopy. (b) Persons with a diagnostic index colonoscopy. 1Cohort 1: persons with a code for snare polypectomy, cohort 2: persons assigned to the group “forceps polypectomy,” and cohort 3: persons without codes indicating polyps/polypectomy.
Figure 2.
Figure 2.
Proportion of persons with a snare polypectomy at first repeat colonoscopy1 according to years since index colonoscopy and stratified by cohorts 1–32. (a) Persons with a screening index colonoscopy. (b) Persons with a diagnostic index colonoscopy. 1Excluding those with repeat colonoscopies within the first 6 months as this is already represented in the cohort definition. 2Cohort 1: persons with a code for snare polypectomy, cohort 2: persons assigned to the group “forceps polypectomy,” and cohort 3: persons without such codes indicating polyps/polypectomy.
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