The colonoscopic miss rate for neoplastic polyps — A prospective study of back-to-back colonoscopies

Cutler, Christopher S.; Clark, Douglas; Lehman, Glen A.; Rex, DK

doi:10.1016/s0016-5107(05)80358-x

Cited by 10 publications

(3 citation statements)

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“…In the right side of the colon compared with the left side significantly more polyps 5-9 mm in diameter were sessile (p<0-001) and elongated (p<005). At inclusion, seven of 58 patients receiving placebo had only hyperplastic polyps, 29 patients had one adenoma, 17 patients had two to three adenomas, and five patients had four to five adenomas. There was no relation between age or family history of colorectal cancer and multiplicity of adenomas.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years.

Hofstad

Vatn

Andersen

et al. 1996

Gut

267

147

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Background, Aims, and Patients-In a prospective follow up and intervention study of colorectal polyps, leaving all polyps less than 10 mm in situ for three years, analysis ofredetection rate, growth, and new polyp formation was carried out in 116 patients undergoing annual colonoscopy. The findings in relation to growth and new polyp formation were applied to 58 subjects who received placebo. Results-Redetection rate varied from 75-90% for each year, and was highest in the rectum and sigmoid colon. There was no net change in size of all polyps in the placebo group, however, polyps less than 5 mm showed a tendency to net growth, and polyps 5-9 mm a tendency to net regression in size, both for adenomas and hyperplastic polyps. In a prospective intervention study of growth of colorectal polyps over three years, polyps less than 10 mm in maximal diameter were left in situ.4 Redetection rate, growth, and new detected polyps were evaluated at the first year follow up examination.5The purpose of this study was to evaluate whether the macroscopic growth pattern during the first year could be verified during the second and third year. In our previous report5 we were neither aware of the histological classification of the polyps, nor did we know which intervention medication the patients used. In this study we wanted to evaluate growth and new polyp formation only in the adenomatous polyps in the patients using placebo, to avoid a possible effect of the intervention medication. Moreover, as this is the first study leaving polyps more than 5 mm in situ, we also needed to assess the safety aspect and the feasibility of such a study after completion. MethodsStudy subjects and design The total study included 116 patients (male/ female 59/57) aged 50-76 years at entry.4 Polyps .10 mm were removed, while the rest were left in situ for a follow up period of three years with annual colonoscopic follow up examinations or removed if they reached a size beyond 9 mm. No biopsy specimens of the polyps were taken before the end of the study. The patients received placebo or a mixture consisting of calcium and antioxidants, stratified according to the size of the polyps and block randomised, to test if the active medication was able to reduce polyp growth.4Placebo was given to 58 patients. Included in the intervention trial (published later) was a medical and family history, which showed that non-steroidal anti-inflammatory drugs (NSAIDs) and aminosalicylic acid were used Medical Department,

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Section: Resultsmentioning

confidence: 99%

“…and different endoscopists. [27][28][29] A repeat colonoscopy within a short time, would reduce the number of overlooked polyps at inclusion in our study, but was considered a too heavy burden on the patients, who were scheduled for annual endoscopic follow up colonoscopies, diet registration, and intervention medication.…”

Section: Discussionmentioning

confidence: 99%

Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years.

Hofstad

Vatn

Andersen

et al. 1996

Gut

267

147

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“…The concern that significant polyps could potentially be missed on the index examination was addressed in two tandem colonoscopy studies. 28,29 In both trials two experienced endoscopists performed back-to-back colonoscopies on patients at the same endoscopy session. It was found that these endoscopists rarely missed clinically significant polyps, leading to increased confidence that a single, quality colonoscopy was sufficient to detect more that 90% of important lesions and that a second examination 1 year later was not necessary in most patients.…”

Section: Postpolypectomy Surveillancementioning

confidence: 99%

Colorectal Cancer Screening and Surveillance

Jaffe¹

2001

Clinics in Colon and Rectal Surgery

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The use of colonoscopy as a screening tool to detect malignancy as well as to identify and remove neoplastic lesions within in the colon is now well established. It is widely used throughout the world and is gaining in acceptance due in large part to the efforts of professional medical organizations and most recently by political and media personalities such as Hillary Rodham Clinton and Katie Couric. These factors have gone a long way to demystify and popularize the procedure, and this, along with word-of-mouth recommendations from the thousands of patients who have undergone colonoscopy, has likely led to further general willingness to consider undergoing the test. The recent publicity surrounding colorectal cancer prevention has actually led to many physicians being faced with the unlikely situation of increasing numbers of asymptomatic, average-risk individuals either requesting the colonoscopy or presenting for advice on the optimal method of preventing colorectal cancer.Colorectal cancer is an enormous public health problem, with nearly 130,00 new cases diagnosed in 1999 and over 56,000 deaths related to it in the same year, making it the second leading cause of cancerrelated death in the United States. 1 The cost of colorectal cancer in 1998 has been estimated at $3.1 billion for direct medical expenses and over $100 million for indirect losses related to this condition. 2 It is estimated that 5% of all Americans will develop colorectal cancer in their lifetimes, and 40% of these will ultimately die from the disease. 3 The postsurgical survival is directly 359 ABSTRACT Data from prospective and large retrospective studies indicate that colonoscopy is highly effective in screening average-and high-risk populations as well for surveillance in those with a prior history of colorectal polyps, cancer, or chronic colitis. Screening colonoscopy has been shown to be safe and important in detecting polyps and cancers that would have gone undetected had traditional screening measure been employed and appears to be cost-effective at levels at or below costs for other cancer screening programs. Colonoscopy with polypectomy leads to a greater than 75% reduction in colorectal cancer development when compared with historical controls. Surveillance intervals for patients with a history of adenomatous colon polyps can be extended to at least 3 to 5 years under most circumstances. Colonoscopy following curative colorectal cancer surgery should follow typical postpolypectomy recommendations given the major goal of preventing a second primary colorectal cancer in this group.Objectives: On completion of this article the reader should be able to summarize the role of colonoscopy as a screening and surveillance tool for colorectal neoplasia. The reader should be able to distinguish between screening and surveillance and understand how these concepts are applied to measures aimed at preventing colorectal cancer.

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Colon Polyps: Prevalence Rates, Incidence Rates, and Growthc Rates

Hofstad

2003

Colonoscopy

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The colonoscopic miss rate for neoplastic polyps — A prospective study of back-to-back colonoscopies

Cited by 10 publications

References 0 publications

Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years.

Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years.

Colorectal Cancer Screening and Surveillance

Colon Polyps: Prevalence Rates, Incidence Rates, and Growthc Rates

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