Colonoscopy practices in France in 2011: results of an electronic survey entitled "a week of endoscopy in France"

There is little data available on colonoscopy practices and its diagnostic performance in Europe. We have carried out a national prospective study, evaluating colonoscopy practices and the diagnostic performance of this examination. An online questionnaire was sent to 2,600 French gastroenterologists. Information from healthcare professionals who responded was collected and compared with national data from the Ordre des M,decins (French equivalent of the General Medical Council in the UK). Over a one week period, data on all gastrointestinal endoscopies carried out, including histological results, were recorded online. The results were extrapolated for a whole year of endoscopy in France, and factors linked to adenoma detection rates (ADR), polyps or colorectal cancer (CRC) were determined. 342 gastroenterologists representing the speciality provided data on 3,266 colonoscopies. In 90% of cases, this was a full colonoscopy. 48% percent of patients were male, aged over 50 years in 77% of cases. Colonoscopy was indicated to investigate colorectal cancer in 40% of cases, gastrointestinal symptoms in 39% of cases and following a positive HemoccultA (R) test in 5% of cases. Polyp resection was performed in 31.3% of cases, with lesions being > 10 mm in 21% of cases, n > 3 in 14% of cases and occurring in the right colon in 47% of cases. Adenoma and adenocarcinoma detection rates were 17.7% and 2.9% of cases respectively. Factors associated with an increased ADR were: being male (p < 0.0001), being > 50 years old (p < 0.0001), family risk factors of colorectal cancer (p = 0.0002), a previous personal history of polyps or colorectal cancer (p < 0.001) and a positive HemoccultA (R) test (p = 0.0008). CCR rates were three times higher for patients who had never had a colonoscopy before (4.2% vs 1.4%, p < 0.0001). This prospective national data on colonoscopy practices, including for the first time in France histological results, underlines the importance of improvements to colon preparation, resulting in an overall ADR of 17.7% and confirming the preventive role of colonoscopic monitoring in the appearance of CRC.