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

Klair, Jagpal S.; Ashat, Munish; Johnson, Dane; Arora, Sumant; Onteddu, Nirmal; Palacio, Jose G. Machain; Samuel, Ronald; Bilal, Mohammad; Buddam, Avanija; Gupta, Ashutosh; Gunderson, Alan; Guturu, Praveen; Soota, Kaartik; Chandra, Subhash; Murali, Arvind R.

doi:10.1055/a-1031-5672

Cited by 21 publications

(24 citation statements)

References 47 publications

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“…Another potential important benchmark is the clinically significant serrated polyp detection rate 5 since reporting SDR alone would not assist prescribing surveillance interval when only proximal HP > 5 mm is found. A recent study 47 examined correlation of ADR and clinically significant serrated polyp detection rate among endoscopists with ADR greater than 25 %. There was a significant positive but modest correlation between these two parameters.…”

Section: Discussionmentioning

confidence: 99%

Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature

et al. 2021

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Background and study aims Sessile serrated lesion (SSL) detection rate has been variably reported and unlike adenoma detection rate (ADR) is not currently a quality indicator for screening colonoscopy. Composite detection rates of SSL in patients undergoing average risk screening colonoscopy are not available. Methods Electronic database search (Medline, Embase and Cochrane) was conducted for studies reporting detection rates of serrated polyps (SSL, Hyperplastic polyp, traditional serrated adenoma) among average risk subjects undergoing screening colonoscopy. Primary outcomes were pooled SDR (SSL detection rate) and proximal serrated polyp detection rate (PSPDR). Pooled proportion rates were calculated with 95 %CI with assessment of heterogeneity (I2). Publication bias, regression test and 95 %prediction interval were calculated. Results A total of 280,370 screening colonoscopies among average risk subjects that were eligible with 48.9 % males and an average age of 58.7 years (± 3.2). The pooled SDR was available from 16 studies: 2.5 % (1.8 %–3.4 %) with significant heterogeneity (I2 = 98.66 %) and the 95 % prediction interval ranging from 0.6 % to 9.89 %. When analysis was restricted to large (n > 1000) and prospective studies (n = 4), SDR was 2 % (1.1 %–3.3 %). Pooled PSPDR was 10 % (8.5 %–11.8 %; 12 studies). There was evidence of publication bias (P < 0.01). Conclusion Definitions of SSL have been varying over years and there exists significant heterogeneity in prevalence reporting of serrated polyps during screening colonoscopy. Prevalence rate of 2 % for SSL and 10 % for proximal serrated polyps could serve as targets while robust high-quality data is awaited to find a future benchmark showing reduction in colorectal cancer arising from serrated pathway.

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Section: Discussionmentioning

confidence: 99%

Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature

et al. 2021

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“…Currently the ADR is the best quality indicator for colonoscopy and the only one strongly related to interval CRC risk 13 29 ; however, it is important to recognize that the ADR is an imperfect indicator 20 21 30 . For this reason, some reasonable alternative parameters have been proposed: advanced ADR, sessile serrated ADR, and mean number of adenomas per procedure 20 21 30 31 , among others. Until recently, however, no cut-off points had been established for these measures 20 21 30 , so we were not able to evaluate these results.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial

et al. 2021

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Background and study aims Efficacy and safety of NAAP for gastrointestinal endoscopy have been widely documented, although there is no information about the outcomes of colonoscopy when the endoscopist supervises the sedation. In this context, the aim of this trial was to determine the equivalence of adenoma detection rate (ADR) in colorectal cancer (CRC) screening colonoscopies performed with non-anesthesiologist-administered propofol (NAAP) and performed with monitored anesthesia care (MAC). Patients and methods This was a single-blind, non-randomized controlled equivalence trial that enrolled adults from a national CRC screening program (CRCSP). Patients were blindly assigned to undergo either colonoscopy with NAAP or MAC. The main outcome measure was the ADR in CRCSP colonoscopies performed with NAAP. Results We included 315 patients per group. The median age was 59.76 ± 5.81 years; 40.5 % of patients were women. The cecal intubation rate was 97 %, 81.8 % of patients had adequate bowel preparation, withdrawal time was > 6 minutes in 98.7 %, and the median global exploration time was 24.25 ± 8.86 minutes (range, 8–70 minutes). The ADR was 62.9 % and the complication rate (CR) was 0.6 %. Analysis by intention-to-treat showed an ADR in the NAAP group of 64.13 % compared with 61.59 % in the MAC group, a difference (δADR) of 2.54 %, 95 %CI: −0.10 to 0.05. Analysis by per-protocol showed an ADR in the NAAP group of 62.98 %, compared with 61.94 % in the MAC group, δADR: 1.04 %, 95 %CI: −0.09 to 0.07. There was no difference in CR (NAAP: 0,63 vs. MAC: 0.63); P = 1.0. Conclusions ADR in colorectal cancer screening colonoscopies performed with NAAP was equivalent to that in those performed with MAC. Similarly, there was no difference in complication rates.

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“…Lesions diagnosed as adenomas or clinically significant SPs (CSSPs) were removed. A CSSP was defined as any SSL, any traditional serrated adenoma, hyperplastic polyp ≥ 1 cm anywhere in the colon, or hyperplastic polyp ≥ 5 mm and proximal to the sigmoid colon 15 23 24 . We chose CSSP instead of SSL as SP definition because a short surveillance interval is recommended for CSSPs as well as SSLs, and all CSSPs were removed in clinical practice 25 .…”

Section: Methodsmentioning

confidence: 99%

Simple feedback of colonoscopy performance improved the number of adenomas per colonoscopy and serrated polyp detection rate

et al. 2021

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Background and study aims High-quality endoscopy requires improvement of not only the adenoma detection rate (ADR) but also the serrated polyp (SP) detection rate and the mean number of adenomas per positive procedure (MAP +). We evaluated whether a simple feedback of colonoscopy performance improves those quality indicators using propensity-score matching. Patients and methods Eleven endoscopists were evaluated regarding colonoscopy performance including ADRs, SP detection rates, mean numbers of adenomas per procedure (MAPs), and MAPs + with their ranking in the clinic. Endoscopic performance was compared before and after the feedback. Results Colonoscopies were performed for 874 patients before the feedback and 1,272 patients after the feedback. Using propensity-score matching, 803 patients before the feedback and 803 patients after the feedback were matched. ADR after the feedback was significantly higher than that before the feedback (50.8 % and 40.8 %, respectively). MAP after feedback was significantly larger than that before the feedback (0.92 and 0.69, respectively), as well as MAP + (1.96 and 1.69, respectively). Clinically significant SP detection rate was also improved from 10.0 % to 14.9 %. Conclusions Feedback including ADR, MAP, MAP +, and clinically significant SR detection rate could improve on those quality indicators. Further studies are needed to effectively prevent colorectal cancer in colonoscopy practice.

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

Cited by 21 publications

References 47 publications

Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature

Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature

Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial

Simple feedback of colonoscopy performance improved the number of adenomas per colonoscopy and serrated polyp detection rate

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