Successful implementation of pan-European colorectal cancer (CRC) screening programmes may be pushing endoscopy services to the limit, according to experts from United European Gastroenterology (UEG). Greater public awareness of the benefits of CRC screening and roll-out of the faecal immunochemical screening test (FIT) are predicted to boost screening uptake across Europe, leading to a significantly increased need for trained endoscopists to cope with the expanding workload. According to Professor Thierry Ponchon from the Herriot University Hospital in Lyon, France, and a member of UEG’s CRC Task Group, pre-empting the increased manpower requirement will be essential to delivering safe and effective endoscopic services. “We know that CRC screening saves lives,” he said. “But better uptake of screening opportunities will lead to more referrals for endoscopic procedures, and plans must be in place now to cope with the increased workload.”
Colorectal cancer screening programmes are now firmly established in many European countries, with faecal occult blood testing (FOBT) and sigmoidoscopy the primary screening modalities in most regions. Randomized, controlled trials have shown that annual or biennial guaiac-based FOBT (gFOBT) is associated with a 15–33% reduction in CRC mortality, however, multiple expert groups have called for the FIT to replace the gFOBT because of its improved performance and ease of use. A recent pilot study in the UK involving more than 1 million people compared uptake rates between the FIT and the gFOBT and reported almost double the uptake with FIT than with gFOBT amongst previous screening non-responders and encouraging increases in participation from first-time invitees.
“The FIT is easier for people to use and usually requires only one stool sample and it is now recommended in European guidelines for CRC screening,” explained Prof. Ponchon. “However, we know from studies conducted in the Netherlands that introduction of FIT-based screening programmes is likely to require at least a 15% increase in endoscopy capacity, and we are concerned that this may not be achievable without better planning.”
Endoscopy services in Europe: where are we now?
The UEG Survey of Digestive Health Across Europe identifies significant variation in the current provision of endoscopy services and capacity across the continent, with many countries still relying solely on physicians to deliver screening services and few countries making endoscopy a national policy priority. Trained nurse endoscopists can provide vital support to meet the growing demand for endoscopic procedures as part of CRC screening, with a recent US study demonstrating that, in a supervised setting, nurse endoscopists can perform colonoscopies according to quality and safety standards that are comparable to those of physician endoscopists – and at a greatly reduced cost.
Prof. Ponchon urges health service providers “to look closely at their anticipated endoscopy resource, start training more physicians and nurses now to meet the increasing endoscopy demands, and make sure we save as many lives as possible in the coming years.”