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Endoscopy 2020; 52(01): 61-67
DOI: 10.1055/a-1031-5672
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Serrated polyp detection rate and advanced adenoma detection rate from a US multicenter cohort

Jagpal S. Klair
1   Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, Iowa, United States
,
Munish Ashat
1   Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, Iowa, United States
,
Dane Johnson
2   Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama, United States
,
Sumant Arora
1   Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, Iowa, United States
,
Nirmal Onteddu
3   Division of Gastroenterology and Hepatology, Medical Center Hospital, Odessa, Texas, United States
,
Jose G. Machain Palacio
4   Division of Gastroenterology and Hepatology, CHI Creighton University School of Medicine, Omaha, Nebraska, United States
,
Ronald Samuel
5   Division of Gastroenterology and Hepatology, University of Texas Medical Branch Galveston, Texas, United States
,
Mohammad Bilal
5   Division of Gastroenterology and Hepatology, University of Texas Medical Branch Galveston, Texas, United States
,
Avanija Buddam
4   Division of Gastroenterology and Hepatology, CHI Creighton University School of Medicine, Omaha, Nebraska, United States
,
Ashutosh Gupta
3   Division of Gastroenterology and Hepatology, Medical Center Hospital, Odessa, Texas, United States
,
Alan Gunderson
1   Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, Iowa, United States
,
Praveen Guturu
5   Division of Gastroenterology and Hepatology, University of Texas Medical Branch Galveston, Texas, United States
,
Kaartik Soota
2   Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama, United States
,
Subhash Chandra
4   Division of Gastroenterology and Hepatology, CHI Creighton University School of Medicine, Omaha, Nebraska, United States
,
Arvind R. Murali
1   Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, Iowa, United States
› Author Affiliations
Further Information

Publication History

submitted 14 June 2019

accepted after revision 07 October 2019

Publication Date:
18 November 2019 (online)

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Author commentary on Jagpal S. Klair et al.Endoscopy 2020; 52(01): v5-v5
DOI: 10.1055/a-1071-4954

Abstract

Background Interval colorectal cancers may be associated with a low serrated polyp detection rate (SDR) and advanced adenoma detection rate (AADR). We aimed to determine the SDR and AADR for endoscopists in a United States multicenter cohort.

Methods We included average-risk screening colonoscopies from five medical centers in the United States. Endoscopists with data on at least 100 average-risk screening colonoscopies were included. We calculated median SDR and AADR for endoscopists with adequate adenoma detection rates (ADRs) > 25 %. We analyzed the relationship between ADR and SDR, and between ADR and AADR using nonparametric Spearman correlation coefficients, scatter plots, and linear regression.

Results We included 3513 screening colonoscopies performed by 26 gastroenterologists. The mean age of patients was 56.8 years (SD 7.4) and 1585 (45 %) were male. All but one endoscopist had an ADR above 25 %. There was a significant positive but modest correlation between ADR and SDR (rho = 0.67, P < 0.01), and between ADR and AADR (rho = 0.56, P < 0.01). For endoscopists with an adequate ADR, median (interquartile range) ADR was 43 % (32.0 % – 48.6 %), median SDR was 8.4 % (7.3 % – 11.4 %), and median AADR was 9.3 % (6.4 % – 12.6 %).

Conclusion A significant percentage of endoscopists have either a low SDR or low AADR despite an adequate ADR, justifying the need for separate SDR and AADR benchmarks. Based on our multicenter cohort, endoscopists with adequate ADRs had a median SDR and median AADR of about 8 % and 9 %, respectively.

Refers to:

Detection rates during colonoscopy: What matters most?Endoscopy 2020; 52(01): 15-16
DOI: 10.1055/a-1058-8854

 

  • References

  • 1 Siegel RL, Miller KD, Fedewa SA. et al. Colorectal cancer statistics, 2017. CA Cancer J Clin 2017; 67: 177-193
    CrossrefPubMedSearch in Google Scholar
  • 2 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
    CrossrefPubMedSearch in Google Scholar
  • 3 Baxter NN, Sutradhar R, Forbes SS. et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 140: 65-72
    CrossrefPubMedSearch in Google Scholar
  • 4 Cooper GS, Xu F, Barnholtz Sloan JS. et al. Prevalence and predictors of interval colorectal cancers in medicare beneficiaries. Cancer 2012; 118: 3044-3052
    CrossrefPubMedSearch in Google Scholar
  • 5 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
    CrossrefPubMedSearch in Google Scholar
  • 6 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
    CrossrefPubMedSearch in Google Scholar
  • 7 Erichsen R, Baron JA, Stoffel EM. et al. Characteristics and survival of interval and sporadic colorectal cancer patients: a nationwide population-based cohort study. Am J Gastroenterol 2013; 108: 1332-1340
    CrossrefPubMedSearch in Google Scholar
  • 8 Samadder NJ, Curtin K, Tuohy TM. et al. Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology 2014; 146: 950-960
    CrossrefPubMedSearch in Google Scholar
  • 9 Bressler B, Paszat LF, Chen Z. et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96-102
    CrossrefPubMedSearch in Google Scholar
  • 10 Brenner H, Chang-Claude J, Seiler CM. et al. Interval cancers after negative colonoscopy: population-based case-control study. Gut 2012; 61: 1576-1582
    CrossrefPubMedSearch in Google Scholar
  • 11 Crockett SD, Gourevitch RA, Morris M. et al. Endoscopist factors that influence serrated polyp detection: a multicenter study. Endoscopy 2018; 50: 984-992
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Schramm C, Janhsen K, Hofer JH. et al. Detection of clinically relevant serrated polyps during screening colonoscopy: results from seven cooperating centers within the German colorectal screening program. Endoscopy 2018; 50: 993-1000
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Anderson JC, Butterly LF. Colonoscopy: quality indicators. Clin Transl Gastroenterol 2015; 6: e77
    CrossrefPubMedSearch in Google Scholar
  • 14 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
    CrossrefPubMedSearch in Google Scholar
  • 15 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    CrossrefPubMedSearch in Google Scholar
  • 16 Anderson JC, Rangasamy P, Rustagi T. et al. Risk factors for sessile serrated adenomas. J Clin Gastroenterol 2011; 45: 694-699
    CrossrefPubMedSearch in Google Scholar
  • 17 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1329
    CrossrefPubMedSearch in Google Scholar
  • 18 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
    CrossrefPubMedSearch in Google Scholar
  • 19 Sawhney MS, Farrar WD, Gudiseva S. et al. Microsatellite instability in interval colon cancers. Gastroenterology 2006; 131: 1700-1705
    CrossrefPubMedSearch in Google Scholar
  • 20 Kushnir VM, Oh YS, Hollander T. et al. Impact of retroflexion vs. second forward view examination of the right colon on adenoma detection: a comparison study. Am J Gastroenterol 2015; 110: 415-422
    CrossrefPubMedSearch in Google Scholar
  • 21 Anderson JC, Butterly LF, Goodrich M. et al. Differences in detection rates of adenomas and serrated polyps in screening versus surveillance colonoscopies, based on the new hampshire colonoscopy registry. Clin Gastroenterol Hepatol 2013; 11: 1308-1312
    CrossrefPubMedSearch in Google Scholar
  • 22 Anderson JC, Butterly LF, Robinson CM. et al. Impact of fair bowel preparation quality on adenoma and serrated polyp detection: data from the New Hampshire colonoscopy registry by using a standardized preparation-quality rating. Gastrointest Endosc 2014; 80: 463-470
    CrossrefPubMedSearch in Google Scholar
  • 23 Anderson JC, Weiss JE, Robinson CM. et al. Adenoma detection rates for screening colonoscopies in smokers and obese adults: data from the New Hampshire Colonoscopy Registry. J Clin Gastroenterol 2017; 51: e95-e100
    CrossrefPubMedSearch in Google Scholar
  • 24 IJspeert JE, van Doorn SC, van der Brug YM. et al. The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps. Gastrointest Endosc 2015; 82: 870-877
    CrossrefPubMedSearch in Google Scholar
  • 25 Liang J, Kalady MF, Appau K. et al. Serrated polyp detection rate during screening colonoscopy. Colorectal Dis 2012; 14: 1323-1327
    CrossrefPubMedSearch in Google Scholar
  • 26 Anderson JC, Butterly LF, Weiss JE. et al. Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2017; 85: 1188-1194
    CrossrefPubMedSearch in Google Scholar
  • 27 Brenner H, Hoffmeister M, Stegmaier C. et al. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies. Gut 2007; 56: 1585-1589
    CrossrefPubMedSearch in Google Scholar
  • 28 Greenspan M, Rajan KB, Baig A. et al. Advanced adenoma detection rate is independent of nonadvanced adenoma detection rate. Am J Gastroenterol 2013; 108: 1286-1292
    CrossrefPubMedSearch in Google Scholar
  • 29 Click B, Pinsky PF, Hickey T. et al. Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA 2018; 319: 2021-2031
    CrossrefPubMedSearch in Google Scholar
  • 30 Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg 2018; 126: 1763-1768
    CrossrefPubMedSearch in Google Scholar
  • 31 Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med 2018; 18: 91-93
    CrossrefPubMedSearch in Google Scholar
  • 32 Sanduleanu S, le Clercq CM, Dekker E. et al. Definition and taxonomy of interval colorectal cancers: a proposal for standardising nomenclature. Gut 2015; 64: 1257-1267
    CrossrefPubMedSearch in Google Scholar
  • 33 Butterly L, Robinson CM, Anderson JC. et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2014; 109: 417-426
    CrossrefPubMedSearch in Google Scholar
  • 34 IJspeert JE, de Wit K, van der Vlugt M. et al. Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists. Endoscopy 2016; 48: 740-746
    Thieme ConnectPubMedSearch in Google Scholar
  • 35 Baek MD, Jackson CS, Lunn J. et al. Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans. J Gastrointest Oncol 2017; 8: 636-642
    CrossrefPubMedSearch in Google Scholar
  • 36 Rex DK, Repici A, Gross SA. et al. High-definition colonoscopy versus Endocuff versus EndoRings versus full-spectrum endoscopy for adenoma detection at colonoscopy: a multicenter randomized trial. Gastrointest Endosc 2018; 88: 335-344 e2
    CrossrefPubMedSearch in Google Scholar
  • 37 van Doorn SC, van der Vlugt M, Depla A. et al. Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial. Gut 2017; 66: 438-445
    CrossrefPubMedSearch in Google Scholar
  • 38 Zong L, Abe M, Ji J. et al. Tracking the correlation between CpG island methylator phenotype and other molecular features and clinicopathological features in human colorectal cancers: a systematic review and meta-analysis. Clin Transl Gastroenterol 2016; 7: e151
    CrossrefPubMedSearch in Google Scholar
  • 39 Li D, Woolfrey J, Jiang SF. et al. Diagnosis and predictors of sessile serrated adenoma after educational training in a large, community-based, integrated healthcare setting. Gastrointest Endosc 2018; 87: 755-765 e1
    CrossrefPubMedSearch in Google Scholar
  • 40 Ohki D, Tsuji Y, Shinozaki T. et al. Sessile serrated adenoma detection rate is correlated with adenoma detection rate. World J Gastrointest Oncol 2018; 10: 82-90
    CrossrefPubMedSearch in Google Scholar
  • 41 Payne SR, Church TR, Wandell M. et al. Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. Clin Gastroenterol Hepatol 2014; 12: 1119-1126
    CrossrefPubMedSearch in Google Scholar
  • 42 Khalid O, Radaideh S, Cummings OW. et al. Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J Gastroenterol 2009; 15: 3767-3770
    CrossrefPubMedSearch in Google Scholar
  • 43 Anderson JC, Lisovsky M, Greene MA. et al. Factors associated with classification of hyperplastic polyps as sessile serrated adenomas/polyps on morphologic review. J Clin Gastroenterol 2018; 52: 524-529
    CrossrefPubMedSearch in Google Scholar
  • 44 O’Connell BM, Crockett SD. The clinical impact of serrated colorectal polyps. Clin Epidemiol 2017; 9: 113-125
    CrossrefPubMedSearch in Google Scholar
  • 45 Obuch JC, Pigott CM, Ahnen DJ. Sessile serrated polyps: detection, eradication, and prevention of the evil twin. Curr Treat Options Gastroenterol 2015; 13: 156-170
    CrossrefPubMedSearch in Google Scholar
  • 46 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy – results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80 e1
    CrossrefPubMedSearch in Google Scholar
  • 47 Kankanala V, Austin GL. Tu1337 A diagnostic colonoscopy is associated with a lower adenoma detection rate despite longer withdrawal times compared to a screening or surveillance colonoscopy. Gastrointest Endosc 2013; 77: AB505
    PubMedSearch in Google Scholar