Colorectal polyp prevalence and aspirational detection targets determined using high definition colonoscopy and a high level detector in 2017

Rex, Douglas K.; Sullivan, Andrew W.; Perkins, Anthony J.; Vemulapalli, Krishna C.

doi:10.1016/j.dld.2019.08.019

Cited by 19 publications

(21 citation statements)

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“…For us, adopting the highest detectors’ performance level as the aspirational benchmark is not desirable because that level is achieved by detecting and removing all diminutive lesions, both adenomas and NNPs. 32,33 ADR is the ideal tool to improve adenoma detection but should not lead to an endless race. There is no proof that the risk of post-colonoscopy CRC of very high detectors is significantly lower than that of high detectors.…”

Section: Discussionmentioning

confidence: 99%

“…The overall rates of NNPs and diminutive polyps were much lower in our population-based study than in a single high level detector series (22.9% vs 35.7%, and 54.7% vs 75.0%, respectively, p<0.00001). 33 “High-level detectors can produce a substantial economic burden of polyp resection and pathology charges for lesions with minimal clinical significance”. 33 A maximum standard for the target ADR is thus desirable.…”

Section: Discussionmentioning

confidence: 99%

“…33 “High-level detectors can produce a substantial economic burden of polyp resection and pathology charges for lesions with minimal clinical significance”. 33 A maximum standard for the target ADR is thus desirable. To determine this maximum, we propose to adopt the true prevalence of “clinically relevant adenomas”, and not of “all adenomas”.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, using another method, Rex et al proposed an aspirational target of 65-70% for FIT-positive colonoscopies, similar to our 55-70% proposition. 33…”

Section: Discussionmentioning

confidence: 99%

“…8 Authors rarely mention whether SSLs are included 5,35 or excluded. 4,6,7,32,33,36 The US recommendations exclude SSLs because most are not adenomas (no dysplasia). 8 However, most are premalignant lesions (actually 9.4% of all premalignant lesions).…”

Section: Discussionmentioning

confidence: 99%

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Adenoma detection rate in fecal immunochemical test positive colonoscopies: a population-based observational study

Denis¹,

Gendre

Tuzin

et al. 2020

Preprint

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Background and aims: Neoplasia-related indicators, such as adenoma detection rate (ADR), are a priority in the quality improvement process for colonoscopy. Our aim was to assess and compare different detection and characterization indicators in fecal occult blood test (FOBT)-positive colonoscopies, to analyze the factors influencing their variance, and to propose benchmarks. Methods: Retrospective analysis of prospectively collected data from all colonoscopies performed between 2007 and 2019 after a positive guaiac-based FOBT or a fecal immunochemical test (FIT) in the population-based colorectal cancer (CRC) screening program conducted in Alsace, part of the French national program. Detection indicators included ADR, NewADR (including proximal serrated lesions), mean number of adenomas per colonoscopy, and proximal serrated lesion detection rate. Characterization indicators included non-neoplastic polyp detection rate. Results: Overall, 13.455 FIT-positive colonoscopies were performed by 116 endoscopists. The overall ADR was 57.6% (95%CI 56.8-58.5). For each 10 microg/g increase in fecal hemoglobin concentration, a 2% increase in ADR was observed. Endoscopists whose ADR was ≥55% were high detectors for all neoplasia, including proximal serrated lesions and number of adenomas. The non-neoplastic polyp detection rate was 39.5% in highest detectors (ADR >70%), significantly higher than in lower detectors (21.4%) (p<0.001). There was a strong correlation between detection and characterization indicators, e.g. between proximal serrated lesion and non-neoplastic polyp detection rates (Pearson = 0.73; p<0.01). Conclusions: A single indicator, NewADR, including proximal serrated lesions, is enough to assess the neoplasia yield of colonoscopy provided the target standard is raised between 55% and 70% in FIT-positive colonoscopies (65-80% in men, 45-60% in women).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Interestingly, using another method, Rex et al proposed an aspirational target of 65-70% for FIT-positive colonoscopies, similar to our 55-70% proposition. 33…”

Section: Discussionmentioning

confidence: 99%