Endoscopy 2019; 51(04): S100
DOI: 10.1055/s-0039-1681465
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: Colonic polyps: detection Club D
Georg Thieme Verlag KG Stuttgart · New York

ADENOMA DETECTION RATE AND COLONOSCOPY INDICATION: BEYOND SCREENING PROCEDURES

, , QUALISCOPIA Study Group
C Mangas-Sanjuan
1   Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
E Santana
1   Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
,
J Cubiella
3   Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
A Seoane
4   Department of Gastroenterology, Parc de Salut Mar, Barcelona, Spain
,
A Suárez
5   Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
,
E Quintero
6   Department of Gastroenterology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
,
Á Ferrández
7   Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
,
V Hernández
8   Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
,
M Ponce
9   Endoscopy Unit, La Fe Polytechnic University Hospital, Valencia, Spain
,
I Portillo
10   BioCruces Health Research Institute, Barakaldo, Spain
,
M Pellisé
11   Endoscopy Unit, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
,
P Díez-Redondo
12   Endoscopy Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
,
M Herráiz
13   Endoscopy Unit, Clínica Universitaria de Navarra, Pamplona, Spain
,
A Ono
14   Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
,
Á Pizarro
15   Department of Gastroenterology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
,
P Zapater
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
16   Unit of Clinical Pharmacology, Hospital General Universitario de Alicante, Alicante, Spain
,
R Jover
1   Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
2   Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Adenoma detection rate (ADR) is the most important quality measure in screening colonoscopies because it's inversely related to the development of interval cancer and mortality. Minimum standard ADR recommended according to ESGE Guidelines is ≥25%; however, this recommendation's made for primary screening colonoscopies and it remains unknown whether this cut-off must be the same for other colonoscopy indications. Hence, the aim of this study was to describe the ADR based on procedure indication and to predict the ADR recommended for other indications.

Methods:

An observational, multicenter and cross-sectional study was conducted between February 2016 and December 2017 across 14 Spanish centers. Four colonoscopy indications have been considered: primary screening colonoscopies, positive fecal inmmunochemical test (+FIT) (OC-SensorTM; cut-off level 20 µg/g), post-polypectomy surveillance and gastrointestinal symptoms. The ADR was calculated by age group and sex. The ESGE Guideline published in 2017 by Kaminski MF et al has been considered as a reference for ADR recommendations. Logistic regression analysis was used and population proportions and its confidence intervals (95% CI) were calculated using the exact Clopper-Pearson method.

Results:

A total of 14867 patients were included and the ADR was 38%. According to procedure indications and adjusted by sex and age, statistically significant differences between ADRs were found (p-value< 0.001). The ADR in gastrointestinal symptoms was 28.1% (OR 0.76, 95% CI 0.66 – 0.87), 46.4% (OR 1.50, 95% CI 1.31 – 1.72) in FIT-based procedures, 48.2% (OR 1.51, 95% CI 1.30 – 1.76) in endoscopic surveillance compared to 30.8% in primary screening colonoscopies. 95% CI calculated for ADR population proportions were 26.9 – 29.3% in symptoms, 45.1 – 47.8% in +FIT endoscopies, 46.1 – 50.3% in post-polypectomy surveillance and 28.2 – 33.5% in colonoscopy screening group.

Conclusions:

ADR significantly differs between colonoscopy indications. According to population proportions, we suggest new minimum standard ADR recommendations when procedure indication differs from primary screening colonoscopy: ≥27% in gastrointestinal symptoms, ≥45% in FIT-based screening and ≥46% in endoscopic surveillance.