COMMENTARY

Top 10 Practice Changers in Gastroenterology: 2014

David A. Johnson, MD

Disclosures

December 09, 2014

In This Article

Author's Note: The year 2014 produced some very notable publications in gastroenterology, including both research findings and evidence-based guidelines that will change clinical practice. In this highlight review, I have selected 10 articles that I believe will influence clinical management or serve as a "go-to" reference for guidelines or recommendations for the practice of gastroenterology.

Prevention, Early Detection, and Overdiagnosis of Colorectal Cancer Within 10 Years of Screening Colonoscopy in Germany

Brenner H, Altenhofen L, Stock C, Hoffmeister M
Clin Gastroenterol Hepatol. 2014 Sep 15. [Epub ahead of print]

Is Screening Colonoscopy Worth It?

Between 2003 and 2012, more than 4.4 million screening colonoscopies were performed on individuals aged 55-79 years. Using data from the German national registry, investigators assessed data from millions of screening colonoscopies and assessed related effects on prevention, early detection, and overdiagnosis of colorectal cancer (CRC).

Using a Markov model, Brenner and colleagues estimated that colonoscopy prevented 180,000 CRCs (1 per 28 screening colonoscopies) and early detection of 40,000 colorectal cancers (1 per 121 colonoscopies). These benefits occurred almost entirely in persons aged < 75 years. "Overdiagnosis" was defined as cancer detected at screening colonoscopy that would not otherwise have clinically manifested during the patient's lifetime. This occurred in approximately 4500 cases (1 per 1089 colonoscopies), and 28% arose from screening colonoscopies in individuals aged > 75 years.

This study is important in further supporting the value of screening colonoscopy, but clinicians need to pay attention to the "overdiagnosis" concept and be cognizant of the need to assess when screening should stop.

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