Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 22:13:1276520.
doi: 10.3389/fonc.2023.1276520. eCollection 2023.

Development, quality, and influencing factors of colonoscopy in China: results from the national census in 2013 and 2020

Yun-Fei Jiao  1   2 , Zhi-Yuan Cheng  3 , Ye Gao  1   2 , Chu-Ting Yu  1   2 , Hui-Shan Jiang  1   2 , Ting-Lu Wang  1   2 , Ying Deng  1   2 , Han Lin  1   2 , Tian-Jiao Wang  1   2 , Wei Wang  1   2 , Rong Wan  3 , Zhao-Shen Li  1   2 , Lei Xin  1   2 , Luo-Wei Wang  1   2
Affiliations

Development, quality, and influencing factors of colonoscopy in China: results from the national census in 2013 and 2020

Yun-Fei Jiao et al. Front Oncol. .

Abstract

Background and aim: With the increasing burden of colorectal cancer (CRC), the practice of colonoscopy is gaining attention worldwide. However, it exhibits distinct trends between developing and developed countries. This study aims to explore its development and identify influencing factors in China.

Methods: The Chinese Digestive Endoscopy Censuses were conducted twice in mainland China under the supervision of health authorities. Information regarding the practice of colonoscopy was collected through a structured online questionnaire. The authenticity of the data was evaluated through logical tests, and a random selection of endoscopic reports underwent manual validation by Quality Control Centers. Potential factors associated with colonoscopy were analyzed using real-world information.

Results: From 2012 to 2019, the number of hospitals that performed colonoscopy increased from 3,210 to 6,325 (1.97-fold), and the volume increased from 5.83 to 12.92 million (2.21-fold). The utilization rate rose from 436.0 to 914.8 per 100,000 inhabitants (2.10-fold). However, there was an exacerbation of regional inequality in the adequacy of colonoscopy. Regions with higher incidence of CRC, higher gross domestic product per capita, more average numbers of endoscopists and tertiary hospitals tended to provide more accessible colonoscopy (P<0.001). Nationwide, the cecal intubation rate improved from 83.9% to 94.4% and the unadjusted adenoma detection rate (ADR) improved from 16.3% to 18.1%. Overall, hospital grading, educational background of endoscopists, economic income, and colonoscopy volume were observed as the significantly positive factors affecting ADR (P<0.05), but not the incidence of CRC or the number of endoscopists.

Conclusions: Tremendous progress in colonoscopy has been made in China, but some issues needed timely reflection. Our findings provide timely evidence for better colonoscopy strategies and measures, such as quality control and medical education of endoscopists.

Keywords: adenoma detection rate; cecal intubation rate; colonoscopy; colorectal cancer; quality improvement.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Regional distribution of the utilization rates of colonoscopy in mainland China in 2012 and 2019. Nationwide, the adequacy of the colonoscopy utilization had been improved apparently, but the regional rates varied widely both for the period 2012 and 2019.
Figure 2
Figure 2
The slope index of inequality in regional colonoscopy service in China. The utilization rate was used to represent the availability of the colonoscopy and the regions were ranked by SDI. The indexes imply that the highly developed regions not only have a better basis but also the faster improvement of colonoscopy, which led to the aggravation of the inequality.
Figure 3
Figure 3
Regional distribution of the ADR of colonoscopy in mainland China in 2012 and 2019. The overall level of ADR had been risen, but the regional disparity was still substantial.
See this image and copyright information in PMC

References

    1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin (2005) 55(2):74–108. doi: 10.3322/canjclin.55.2.74 - DOI - PubMed
    1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin (2015) 65(2):87–108. doi: 10.3322/caac.21262 - DOI - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin (2021) 71(3):209–49. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut (2017) 66(4):683–91. doi: 10.1136/gutjnl-2015-310912 - DOI - PubMed
    1. Global Cancer Observatory (2023). Available at: https://gco.iarc.fr/today/home.