The impact of colonoscopy indication on polyp detection rate

Abstract

Background Adenoma/polyp detection rates are considered to be among the most important quality indicators of colonoscopy and are key measures of a quality procedure. However, they are designed for use in the screening setting and are not amenable to other colonoscopy indications. Little is known about their significance in other colonoscopy indications. We aimed to evaluate the impact of the various indications on polyp detection rate (PDR). Methods This was a retrospective, single-center study. Electronic reports of index colonoscopy procedures with adequate bowel preparation over a 10-year period were reviewed. Patients were divided into 7 groups based on the study indication. PDR was determined for each group and was compared to that of a control group, the screening indication group. Adjustment was made for potential confounders such as age, sex, and procedural setting. Results A total of 13,054 patients were considered suitable for the study. PDR was greatest in the positive fecal occult blood test group, with a value of 33.1% (P<0.01). Overall, the remaining groups showed similar PDRs compared with screening (22.1% vs. 20.4%; P=0.15). This trend persisted in a multivariate analysis, which showed the odds ratio in the positive fecal occult blood test group to be significantly higher, with a value of 1.955 (1.759-2.172, P<0.001) compared with the screening group. Conclusion PDR was highest for the positive fecal occult blood test indication, but was not affected significantly by most indications. Further randomized studies are warranted to confirm these findings and help calculate recommended thresholds for “overall” PDR.

Caffeine reverses the unconsciousness produced by light anesthesia in the continued presence of isoflurane in rats

“…Power spectra (dB) were computed over 2-minute long epoch of EEG, partitioned into 512-point epochs, and averaged, yielding a temporal resolution of 2 Hz. Normalized power was calculated as the fraction of a specific frequency power, including delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), spindle (12)(13)(14)(15), beta (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and gamma (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), in the total power over all frequency bands from 0.5-40 Hz. The mean powers in percent for pre (1), post saline or caffeine injection (2), during 1.2% isoflurane (3) and before RORR (4) were computed by the MATLAB program.…”

“…Our earlier studies in rats showed that caffeine was equally effective at accelerating emergence from propofol anesthesia as it was in isoflurane anesthesia [15]. Light propofol anesthesia is commonly used in a variety of procedures including colonoscopies and to prevent movement in MRI exams [18][19][20][21]. It will be important to determine whether caffeine can reverse the effects of other anesthetics, like propofol and dexmedetomidine, in a similar manner to that observed for isoflurane, as these drugs and their effects can stay in the body long after the termination of the anesthetic agent.…”

“…Light propofol anesthesia (i.e. sedation) is commonly used in a variety of procedures including colonoscopies and to prevent movement in MRI exams in adults and children [18][19][20][21]. In other procedures, moderate to heavy doses of anesthetic are employed during the beginning and midportion of the procedure with a lighter plane of anesthesia applied at the end.…”

Safety, Efficacy and High-Quality Standards of Gastrointestinal Endoscopy Procedures in Personalized Sedoanalgesia Managed by the Gastroenterologist: A Retrospective Study

“…In the case of polyps, each one was excised and histologically evaluated. With regard to the quality indices of the examination, for colonoscopies we calculated the adenoma detection rate (ADR), the adenoma detection index (ADI), the polyp detection rate (PDR), the polyp detection index (PDI) [ 13 ] and the cecal intubation rate on the general patient population, on the patient population divided by gender and the patient population that underwent a screening colonoscopy through the regional program to screen for colorectal cancer. After the procedures, each patient was safely discharged if his Aldrete [ 14 ] score ( Table 3 ) was higher than 8.…”

Assessment of quality benchmarks in adenoma detection in Mexico

“…Secondary outcomes included the polyp detection rate (PDR), the mean number of adenomas per colonoscopy (APC) and, the advanced adenoma detection rate (AADR). ADR, PDR and AADR are defined by the proportion of patients aged 50 years or older undergoing screening or diagnostic colonoscopy with at least one histologically proven adenoma, polyp, or advanced adenoma, respectively 5 9 10 . Advanced adenoma was defined as a lesion with villous features, high-grade dysplasia, or size greater than 10 mm.…”