Distribution, size and shape of colorectal adenomas as determined by a colonoscopist with a high lesion detection rate: Influence of age, sex and colonoscopy indication

Klein, Johannes L; Okcu, Murat; Preisegger, K H; Hammer, Heinz F.

doi:10.1177/2050640615610266

Cited by 19 publications

(19 citation statements)

References 34 publications

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“…Thus, there may be uncertainties about which polyps are included in the PR concept. For practical purposes, polyps < 5 mm are most likely ignored or biopsied (and up to 80 % of them may not be adenomas 12 ) while polyps ≥ 5 mm are usually suited for true polypectomy by snare and most of these are adenomas. Therefore, if choosing to use PDR-5 mm as a quality indicator until ADR can be made more easily accessible, PR or PDR restricted to polyps ≥ 5 mm may be more valid as a proxy for ADR than a global PDR including diminutive polyps with dominantly non-adenomatous histology.…”

Section: Discussionmentioning

confidence: 99%

Polyp detection rates as quality indicator in clinical versus screening colonoscopy

et al. 2019

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Background Adenoma and Polyp Detection Rates (ADR and PDR) are advocated as general performance measures for screening and clinical colonoscopy, but their evidence is largely derived from screening data. This study compares PDRs in colonoscopy for screening versus clinical indications. Methods Consecutive patients at two Norwegian centers were examined by eight endoscopists either for colonoscopy screening in a randomized colonoscopy screening trial (Nordic-European Initiative on Colorectal Cancer, NordICC) or for clinical indications during the same time period (January 2013 to December 2014). PDR-5 mm, defined as the proportion of colonoscopies with detection of at least one polyp with diameter ≥ 5 mm, was measured prospectively. We fitted multivariable logistic regression models and calculated the adjusted odds ratios (OR) to evaluate factors for differences in PDR-5 mm between screening and clinical colonoscopies. Results The study included 2939 clinical and 771 screening colonoscopies. The PDR-5 mm was 26 % and 31 %, respectively ( P = 0.005). Among sex, age, cecum intubation, bowel cleansing, and endoscopist, only the latter explained the higher PDR-5 mm in screening compared to routine colonoscopy. In the fully adjusted logistic regression model, the detection of polyps ≥ 5 mm was not associated with indication for colonoscopy. The OR for polyp detection in screening vs. routine colonoscopy was 1.04; 95 % confidence interval 0.85 – 1.27. Conclusion In this study, the differences in PDR-5 mm between clinical and screening colonoscopies could be explained by the endoscopist. Accordingly, PDR-5 mm benchmarks may be similar for clinical and screening colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Polyp detection rates as quality indicator in clinical versus screening colonoscopy

et al. 2019

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“…Third, the incidence of R-sided cancer is increasing and is even more prevalent than L-sided cancer especially in the older age group [ 29 - 31 ]. A recent study also showed that the majority of adenomas were found in the proximal colon for patients beyond age 59 years [ 32 , 33 ]. While the mean age of our patients was 66.1 years, the “proximal shift” of colonic neoplasia may account for the higher risk of metachronous lesions found on surveillance colonoscopy in patients with L-sided tumor.…”

Section: Discussionmentioning

confidence: 99%

Rates of metachronous adenoma after curative resection for left-sided or right-sided colon cancer

et al. 2018

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Background/AimsWe determined the rates of metachronous colorectal neoplasm in colorectal cancer (CRC) patients after resection for right (R)-sided or left (L)-sided cancer.MethodsConsecutive CRC patients who had undergone surgical resection for curative intent in our hospital between 2001 and 2004 were identified. R-sided colonic cancers refer to cancer proximal to splenic flexure whereas L-sided cancers include rectal cancers. Patients were included only if they had a clearing colonoscopy performed either before or within 6 months after the operation. Findings of surveillance colonoscopy performed up to 5 years after colonic resection were included in the analysis.ResultsEight hundred and sixty-three CRC patients underwent curative surgical resection during the study period. Three hundred and twenty-seven patients (107 R-sided and 220 L-sided) fulfilled the inclusion criteria and had at least 1 postoperative surveillance colonoscopy performed. The proportion of patients who had polyp and adenoma on surveillance colonoscopy was significantly higher among patients with L-sided than R-sided cancers (polyps: 30.9% vs. 19.6%, P=0.03; adenomas: 25.5% vs. 13.1%, P=0.01). The mean number of adenoma per patient on surveillance colonoscopy was also higher for patients with L-sided than R-sided tumors (0.52; 95% confidence interval [CI], 0.37–0.68 vs. 0.22; 95% CI, 0.08–0.35; P<0.01). Multivariate analysis showed that L-sided cancers, age, male gender and longer follow-up were independent predictors of adenoma detection on surveillance colonoscopy.ConclusionsPatients with Lsided cancer had a higher rate of metachronous polyps and adenoma than those with R-sided cancer on surveillance colonoscopy.

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“…The same study showed that female patients had a lower prevalence of polyps larger than 9 mm 15 . Other studies have shown an increase in ADR with increasing patient age 15 16 17 and in male as compared to female patients 16 17 18 19 . In a population-based study from the New Hampshire Colonoscopy Registry, the ADR was significantly higher in surveillance colonoscopies (37 %) than screening colonoscopies (25 %; P < 0.001) which is similar to the results of this study 13 .…”

Section: Discussionmentioning

confidence: 82%

Variability in, and factors associated with, sizing of polyps by endoscopists at a large community practice

et al. 2017

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Background and aims Accurate sizing of polyps at time of colonoscopy is critical for determining surveillance intervals. Endoscopists routinely over- or underestimate the size of polyps at colonoscopy. We evaluated the variability in sizing of polyps among multiple endoscopists, and the effect of patient and physician related factors on polyp size estimation in a large community-based practice. Methods Adult patients who underwent a colonoscopy with polypectomy at five endoscopy centers in Minneapolis/St. Paul by one of 52 endoscopists in 2013 were included in this study. Association of patient, physician, and procedure related factors on polyp sizing was assessed. Results In the study time frame, 38 624 colonoscopies were performed at five ambulatory endoscopy centers. Of these, 16 336 had one or more polyp removed with size information available, and were included in this analysis. There was significant inter-physician variation for estimating polyp sizes larger than 5 mm (intraclass correlation coefficient [ICC] 0.13). Older patient age (OR 1.08, 95 %CI 1.06 – 1.11), and male physician gender (OR 1.92, 95 %CI 1.26 – 2.94) were associated with increased odds of physicians sizing polyps as larger in size. Surveillance procedures had a higher odds of larger polyp sizing compared to screening (OR 0.91, 95 %CI 0.86 – 0.97) and diagnostic procedures (OR 0.86, 95 %CI 0.78 – 0.94). Conclusion In a large community setting, variation of polyp sizing estimates exists between physicians. Male physicians were more likely to size polyps as larger in size. Older patients and patients undergoing surveillance procedures were more likely to have polyps that were sized as larger in size.

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Distribution, size and shape of colorectal adenomas as determined by a colonoscopist with a high lesion detection rate: Influence of age, sex and colonoscopy indication

Cited by 19 publications

References 34 publications

Polyp detection rates as quality indicator in clinical versus screening colonoscopy

Polyp detection rates as quality indicator in clinical versus screening colonoscopy

Rates of metachronous adenoma after curative resection for left-sided or right-sided colon cancer

Variability in, and factors associated with, sizing of polyps by endoscopists at a large community practice

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