Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines

Abstract

Background/Aims: There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. Methods: The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. Results: Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). Conclusions: More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

The comparison of risk factors for colorectal neoplasms at different anatomical sites

“…By comparison, we found that only when CRN occurred in the proximal colon did the proportion of women exceed that of men, which is consistent with previous findings that women are at higher risk for CRC in the proximal colon [14], especially in the ascending colon [9]. In many studies, advanced age is a risk factor for colorectal adenoma and colorectal cancer [9,12,15,16]. This may be related to the adenoma-carcinoma sequence of colorectal tumors [5,17]; when normal cells accumulate multiple genetic mutations over many years, they become cancerous [18,19].…”

“…Age over 70 years was most associated with the risk of CRN in the proximal colon among women and rectal CRN among men. Men are more likely to develop CRN than women, possibly because men lack the protective effect of estrogen [12]. Moreover, it has been suggested that androgens may be involved in the formation of colorectal tumors by regulating the proliferation of intestinal epithelial cells [13].…”

Quality indicators in colonoscopy: the chasm between ideal and reality

“…In a recent study from primary health-care institutions in Korea, the proportion of incomplete examinations attributed to poor bowel preparation or difficulty in cecal intubation was only 4.9%. 49 In addition, most hospital-based studies on screening colonoscopy in Korea reported a high CIR of nearly 100%. 50 As the primary health-care institutions are sufficiently achieving the target CIR (≥95%), the CIR may have little room for improvement in Korea.…”

Virtual colonoscopy and fibrocolonoscopy in colorectal polyp patients

“…Анализирана е документацията на 14029 болни -6949 мъже на средна възраст от 55,9±13,4 г. и 7080 жени на средна възраст от 57,2±12,7 г., подложени на колоноскопия в 40 първични медицински институции в Южна Корея с цел диагностика на полипите на дебелото черво (13). Честотата на полипите на дебелото черво, аденомите, аденомите в напреднал стадий и аденомите с висок риск е съответно 59,9%, 38,9%, 5,9% и 11,4% от колоректални полипи (31,97%; между 30,97% и 33,28% при доверителен интервал от 95%) в сравнение с контролната група (25,9%; между 25,1% и 26,72% при доверителен интервал от 95%) при фактическо съотношение между стойностите на тази заболяемост от 1,235 (между 1,174 и 1,300 при доверителен интервал от 95%) (3).…”