Clinical and Medical Economic Value of Screening Colonoscopy before Laparoscopic Cholecystectomy.

Abstract

Objective: Clinical value of screening colonoscopy (SC) has been widely accepted; however, its clinical utility remains controversial in patients who undergo laparoscopic cholecystectomy (LC). The aim of this study is to evaluate the clinical value of medical care costs for SC before LC.

Subject and methods: Of the 509 patients who underwent LC, 335 underwent preoperative SC before LC. The electronic medical records were retrospectively reviewed, and the technical fees of SC and endoscopic and/or surgical resection for colorectal neoplasia (CRN) were analyzed.

Results: In the 335 patients with SC before LC, the rate of CRN requiring resection, including advanced adenoma and adenocarcinoma, were 13.1%. The detected rate of CRN requiring resection in the age groups of <45, 44-55, 55-65, 65-75, ≥75 years were 5.3%, 3.8%, 9.8%, 17.4%, and 22.9%, respectively. Of the 174 patients without SC before LC, four patients were diagnosed with resectable colorectal carcinomas after LC. The total technical fees of SC and/or treatment of CRNs among the 335 patients with SC before LC and surgical procedures among the four patients with resectable colorectal carcinoma were 84,700 United States dollar (USD) and 32,000 USD, respectively. Regarding the technical fee per person, the former group (250 USD) had much economic advantage compared to the latter group (8,000 USD).

Conclusions: Scheduling LC is recognized as an important chance to undergo SC. For the patients aged ≥55 years, colonoscopy is no longer a screening option but a clinical necessity due to the high detected rates of CRN requiring resection.