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La coloscopie en France en 2008: résultats de l’enquête de deux jours d’endoscopie en France

Colonoscopy in France in 2008: results of the two-day survey of endoscopy in France

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Acta Endoscopica

Résumé

Objectifs

Obtenir une évaluation du nombre et des motifs des endoscopies digestives basses en 2008, en France.

Patients et méthodes

Il s’agit d’une enquête prospective réalisée par l’envoi d’un questionnaire auprès de l’ensemble des gastroentérologues (n = 3 125) français, leur demandant de renseigner leur activité endoscopique sur une période donnée; 1 039 cahiers de réponses complètes et analysables ont été recueillis chez 1 039 gastroentérologues, soit 7 247 endoscopies réalisées chez 6 250 patients.

Résultats

Un million cent quarante-sept mille neuf cent cinquante et une coloscopies ont été réalisées en 2008, soit 2,5 % ou 30 000 coloscopies en moins par rapport à 2006. L’ensemble des endoscopies digestives basses a diminué de 5,2 %, en passant de 1 323 200 en 2006 à 1 253 002 en 2008. Le principal geste endoscopique thérapeutique est la polypectomie qui demeure stable, avec 311 757 coloscopies avec polypectomie, soit 27 % des 1 148 000 coloscopies. Six cent huit mille des 1 253 002 (54 %) endoscopies digestives basses, soit 57 % des coloscopies, sont réalisées dans le cadre d’un dépistage primaire ou secondaire pour surveillance et contrôle après polypectomie ou suivi des cancers colorectaux (CCR) traités. Les coloscopies, réalisées dans les 24 mois qui suivent une coloscopie antérieure, représentent 8 % des 1 147 951 coloscopies totales, soit 91 023 examens, alors qu’au total 46 % des patients ont déjà eu une coloscopie totale préalable, dont 68 % depuis plus de trois ans. Au cours de 1 254 000 endoscopies basses enlevant 951 535 polypes sur la base du plus gros polype, 77 % endoscopies basses enlevaient au moins un polype qui faisait moins de 10 mm ou, respectivement, 29 et 48 %, mesurant entre 5 et 10 mm et moins de 5 mm.

Conclusions

Dix ans après la première enquête réalisée, en 1998, par la SFED, le taux de participation des gastroentérologues est, en 2008, le plus élevé. Le nombre de coloscopies réalisées en 2008 est inférieur à celui réalisé en 2006, ce qui témoigne de la rationalisation de la pratique de la coloscopie et du respect par les gastroentérologues des indications ainsi que des différentes mesures mises en place pour la diffusion des recommandations. L’Acbus sur la coloscopie, fixé à 0,5 %, ne semble pas réaliste, car en pratique 8%des coloscopies étaient réalisées dans les deux ans suivant une coloscopie antérieure mais en particulier pour des motifs indiscutables (préparation insuffisante de l’examen ou risque hémorragique dû à l’absence d’arrêt des anticoagulants justifiant la reprise du patient pour résection du polype), pour 3,5 % des cas.

Abstract

Objectives

Obtaining an evaluation of the number of endoscopies of the lower digestive tract in France in 2008, and the reasons for carrying them out.

Patients and methods

It was a forward-looking survey carried out by sending questionnaires to all the French gastroenterologists (N = 3,125), asking them to forward information about their endoscopy activities over a given period; 1,039 sets of complete, analysable replies were received from 1,039 gastroenterologists, covering 7,247 endoscopies carried out on 6,250 patients.

Results

Sixty-one million four hundred sixty-six thousand nine hundred fifty-one colonoscopies were carried out in 2008, i.e. 2.5% or 30,000 fewer colonoscopies than in 2006. The overall number of endoscopies of the lower digestive tract fell by 5.2%, from 1,323,200 in 2006 to 1,253,002 in 2008. The main therapeutic endoscopic act was polypectomy, which remained stable at 311,757 colonoscopies with polypectomy, i.e. 27% of the 1,148,000 colonoscopies. Six hundred eight thousand (54%) of the 1,253,002 endoscopies of the lower digestive tract, i.e. 57% of the colonoscopies, were carried out within the framework of primary or secondary screening for monitoring and checks after polypectomy or monitoring after treatment of colorectal cancers. The colonoscopies carried out within 24 months after a previous colonoscopy made up 8% of the total of 1,147,951 colonoscopies, i.e. 91,023 examinations, whereas in all 46% of the patients had already had a full prior colonoscopy, 68% of which had been carried out more than three years beforehand. During 1,254,000 lower endoscopies to remove 951,535 polyps on the basis of the largest polyps, 77% lower endoscopies involved removal of at least one polyp measuring less than 10 mm or 29 and 48% measuring between 5 and 10 mm and less than 5 mm respectively.

Conclusions

Ten years after the first survey carried out by the SFED in 1998, the highest level of participation by gastroenterologists was in 2008. The number of colonoscopies carried out in 2008 was lower than in 2006, which shows rationalization of the practice of colonoscopy and the gastroenterologists’ compliance with the indications, together with the various measures implemented to distribute the recommendations. The Acbus (Agreement Covering Rational Use of Care) target of 0.5% for colonoscopy does not seem realistic, as in practice 8% of the colonoscopies were carried out less than two years after a previous colonoscopy on indisputable grounds (insufficient preparation of the examination or risk of haemorrhage due to failure to stop taking anticoagulants, justifying a second procedure for patients to remove polyps) in 3.5% of the cases.

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Authors and Affiliations

  1. Société française d’endoscopie digestive (SFED), boulevard Pereire-Malesherbes, F-75017, Paris, France

    J. M. Canard, D. Heresbach, J.-C. Letard & R. Laugier

  2. 50, boulevard de Port-Royal, F-75005, Paris, France

    J. M. Canard, D. Heresbach, J.-C. Letard & R. Laugier

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Canard, J.M., Heresbach, D., Letard, JC. et al. La coloscopie en France en 2008: résultats de l’enquête de deux jours d’endoscopie en France. Acta Endosc 40, 58–65 (2010). https://doi.org/10.1007/s10190-010-0028-9

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