Detection of clinically relevant serrated polyps during screening colonoscopy: results from seven cooperating centers within the German colorectal screening program

Endoscopy ◽  
2018 ◽  
Vol 50 (10) ◽  
pp. 993-1000 ◽  
Author(s):  
Christoph Schramm ◽  
Katharina Janhsen ◽  
Jan-Hinnerk Hofer ◽  
Hans Toermer ◽  
Annette Stelzer ◽  
...  
Keyword(s):  
Detection Rate ◽  
Screening Program ◽  
Simultaneous Detection ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Detection Rates ◽  
Serrated Polyps ◽  
Adenoma Detection ◽  
Increased Risk ◽  
The Individual

Abstract Background Serrated polyps have been recognized as precursors of colorectal cancer (CRC) via the serrated pathway. Endoscopic detection and histopathological evaluation of serrated polyps are challenging. The aims of this study were to determine detection rates of the recently proposed entity of clinically relevant serrated polyps (crSPs) and to identify factors that influence their detection in a primary colonoscopy screening cohort. Methods We retrospectively analyzed average-risk screening colonoscopies performed at a tertiary academic hospital and six community-based private practices in Germany between 01/01/2012 and 14/12/2016. Exclusion criteria were age < 50 years, conditions with increased risk for CRC (e. g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), and incomplete procedures. CrSPs were defined as serrated polyps ≥ 10 mm and/or > 5 mm located proximally to the splenic flexure. Conventional adenomas were defined as adenomas excluding serrated polyps. Results A total of 4161 colonoscopies from average-risk individuals were included (median age 62 years [interquartile range 56 – 69]; 48.6 % male). CrSPs were detected in 6.9 %, with a mean detection rate of 4.7 % (95 % confidence interval 2.3 % – 7.2 %). Detection rates ranged from 0 % to 16.2 %. In multivariate analysis, simultaneous detection of conventional adenomas and an endoscopist adenoma detection rate of ≥ 25 % were significantly associated with increased detection of crSPs, with odds ratios of 1.43 (95 %CI 1.11 – 1.85; P = 0.01) and 7.35 (95 %CI 4.43 – 12.19; P < 0.001). The individual endoscopist’s detection rate for conventional adenomas and crSPs were significantly correlated (r = 0.54, P = 0.02). Conclusion Detection rates for crSPs differed between participating endoscopists. However, individual skills to detect polypoid lesions have a relevant bearing on the detection rate of crSPs.

scholarly journals Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Martin Buerger ◽  
Philipp Kasper ◽  
Gabriel Allo ◽  
Johannes Gillessen ◽  
Christoph Schramm
Keyword(s):  
Detection Rate ◽  
Adenoma Detection Rate ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Cecal Intubation ◽  
Serrated Polyps ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Increased Risk ◽  
Ileal Intubation

Abstract Background High cecal intubation rate (CIR) is associated with significant improved adenoma detection rate (ADR), however, self-reported CIR may be overestimated and inadequate documentation of cecal intubation is associated with a lower polyp detection rate compared to clear documentation. We aimed to investigate if ileal intubation may be associated with higher detection rates (DR) for right-sided conventional adenomas (cAD) and serrated polyps (SP) compared to cecal intubation in a large screening colonoscopy cohort. Material and methods Retrospective analysis of individuals ≥50 years with average risk for colorectal cancer (CRC) who underwent screening colonoscopy between 01/01/2012 and 14/12/2016 at a tertiary academic hospital and six community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e.g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures. Right-sided colon was defined as caecum and ascending colon. Results 4.138 individuals were analysed (mean age 62 years, 52.1% female). DR for right-sided cADs and SPs were significantly higher after ileal compared to cecal intubation in univariate (12.5% vs. 6.8%, p < 0.001, and 6.3% vs. 3.3%, p < 0.001), but not in multivariate analysis (OR 1.025, 95%-CI 0.639–1.646, p = 0.918, and OR 0.937, 95%-CI 0.671–1.309, p = 0.704). DRs did not differ between ileal and cecal intubation for endoscopists with ADR ≥25 and < 25%, respectively. ADR ≥25% was significantly associated with ileal intubation (OR 21.862, 95%-CI 18.049–26.481, p < 0.001). Conclusion Ileal intubation may not provide any benefit over cecal intubation concerning the detection of cADs and SPs in the right-sided colon.

scholarly journals Comparison of Flexible Sigmoidoscopy Screening in Average Risk Patients Performed by Nurses Versus Gastroenterologists

2018 ◽  
Vol 1 (2) ◽  
pp. 82-86 ◽  
Author(s):  
Anas Makhzoum ◽  
Jacob Louw ◽  
William G Paterson
Keyword(s):  
Colorectal Cancer ◽  
Detection Rate ◽  
Flexible Sigmoidoscopy ◽  
Screening Program ◽  
Low Risk ◽  
Adenoma Detection Rate ◽  
Average Risk ◽  
Detection Rates ◽  
Screening Programs ◽  
Adenoma Detection

Abstract Background Screening sigmoidoscopy is effective in reducing mortality from colorectal cancer. In 2009, Cancer Care Ontario (CCO) launched a nurse-performed screening flexible sigmoidoscopy program at Hotel Dieu Hospital, Kingston, Ontario. Prior to this program, there was a pilot sigmoidoscopy screening program by gastroenterologists in a similar average risk cohort. Aim To compare neoplasia detection rates and associated costs of screening sigmoidoscopy performed by nurses and gastroenterologists. Method A retrospective chart review was conducted on flexible sigmoidoscopies performed as part of two average risk screening programs performed by gastroenterologists and nurse-endoscopists. Detected polyps were categorized as hyperplastic, low-risk adenomas or high-risk adenomas. Average cost per procedure was estimated based on physician fee for service charges, nurse wage and benefits, physician supervisory fees, pathology costs and administrative expenses. Results There were 538 procedures performed by nurses and 174 by physicians. Adenomas were detected in 18% of nurse-performed procedures versus 9% in physician-performed procedures (p=0.003), with the higher adenoma detection rate restricted to low risk adenomas. One cancer was found in the physician group. Seven physicians performed the 174 sigmoidoscopies, with one physician performing the majority. This physician’s adenoma detection rate was 4.5%, whereas detection rate for the remaining physicians combined was 16.5%. Nurses biopsied more polyps per case (0.96 versus 0.18). Average estimated cost per case was greater for nurses ($387.54 versus $309.37). Conclusion Well-trained nurse-endoscopists can provide an effective service for colorectal cancer screening, but as currently structured in Ontario, the associated cost is higher for nurse-performed procedures.

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

2021 ◽  
Vol 09 (04) ◽  
pp. E610-E620
Author(s):  
Madhav Desai ◽  
Joseph C. Anderson ◽  
Michael Kaminski ◽  
Viveksandeep Thoguluva Chandrasekar ◽  
Jihan Fathallah ◽  
...  
Keyword(s):  
Publication Bias ◽  
Detection Rate ◽  
Prediction Interval ◽  
Screening Colonoscopy ◽  
Significant Heterogeneity ◽  
Average Risk ◽  
Risk Screening ◽  
Detection Rates ◽  
Serrated Polyps ◽  
Serrated Lesion

Abstract 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.

scholarly journals Surveying ADR knowledge and practices among US gastroenterologists

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Michael Peng ◽  
Douglas Rex, MD, MACG
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Online Survey ◽  
Screening Colonoscopy ◽  
Current Evidence ◽  
Serrated Polyps ◽  
The Past ◽  
Adenoma Detection ◽  
Age And Sex

Background:   The adenoma detection rate (ADR) is of primary importance to the quality of screening colonoscopy. An online survey was conducted to assess knowledge and practices on ADR.  Methods:  Paid questionnaire distributed by email. Eligible respondents were board certified gastroenterologists who perform >80 colonoscopies per month with 3 to 35 years after fellowship.  Results:  39% were unaware that ADR applies only to screening colonoscopies and 76% incorrectly answered that ADR includes sessile serrated polyps/adenomas.  51% of respondents incorrectly believe the threshold is set at 25% because 25% is a national ADR average. Many also believe the threshold depends on the patient population (current evidence suggests adjusting ADR for factors other than age and sex is unnecessary). 75% ranked ADR as highly important. 80% reported tracking ADR. A busy practice was the most common reason for not tracking ADR. Caps, chromoendoscopy, and good bowel preparation were viewed as valuable for improving ADR (this is true except for caps). HD colonoscopes and education were considered less valuable (although evidence suggests HD and education are associated with improved ADR). 57% reported not sharing ADR information with their patients, and 59% reported no patients in the past 6 months asking for their ADR. Conclusion:  The importance of ADR as a validated quality measure is well understood, but there are misconceptions among gastroenterologists regarding the definition and measurement of ADR and which methods are proven to increase ADR.  Patients are having very little impact on ADR measurement.

scholarly journals Comparing the Real-World Effectiveness of High- Versus Low-Volume Split Colonoscopy Preparations: An Experience Through the British Columbia Colon Cancer Screening Program

2020 ◽  
Author(s):  
Joseph G H Lee ◽  
Jennifer J Telford ◽  
Cherry Galorport ◽  
Jordan Yonge ◽  
Christopher A Macdonnell ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Bowel Preparation ◽  
Detection Rate ◽  
Screening Program ◽  
High Volume ◽  
Colon Cancer Screening ◽  
Detection Rates ◽  
Cancer Screening Program ◽  
Adenoma Detection ◽  
Low Volume

Abstract Background The British Columbia Colon Screening Program (BCCSP) is a population-based colon cancer screening program. In December 2018, physicians in Vancouver, Canada agreed to switch from a low-volume split preparation to a high-volume polyethylene glycol preparation after a meta-analysis of studies suggested superiority of the higher volume preparation in achieving adequate bowel cleansing and improving adenoma detection rates. Aims To compare the quality of bowel preparation and neoplasia detection rates using a high-volume split preparation (HVSP) versus a low-volume split preparation (LVSP) in patients undergoing colonoscopy in the BCCSP. Methods A retrospective review of patients undergoing colonoscopy through the BCCSP at St. Paul’s Hospital from July 2017 to November 2018 and December 2018 to November 2019 was conducted. Inclusion criteria included age 50 to 74 and patients undergoing colonoscopy through the BCCSP. Variables collected included patient demographics and bowel preparation quality. Rates of bowel preparation and neoplasia detection were analyzed using chi-squared test. Results A total of 1453 colonoscopies were included, 877 in the LVSP group and 576 in the HVSP group. No statistically significant difference was noted between rates of inadequate bowel preparation (LVSP 3.6% versus HVSP 2.8%; P = 0.364). Greater rates of excellent (48.4% versus 40.1%; P = 0.002) and optimal (90.1% versus 86.5%; P = 0.041) bowel preparation were achieved with HVSP. The overall adenoma detection rate was similar between the two groups (LVSP 53.1% versus HVSP 54.0%; P = 0.074). LVSP demonstrated higher overall sessile serrated lesion detection rate (9.5% versus 5.6%; P = 0.007). Conclusions Compared to LVSP, HVSP was associated with an increase in excellent and optimal bowel preparations, but without an improvement in overall neoplasia detection.

Are adenoma and serrated polyp detection rates correlated with endoscopists’ sensitivity of optical diagnosis?

Endoscopy ◽  
2020 ◽  
Vol 52 (09) ◽  
pp. 763-772 ◽  
Author(s):  
Maxime E. S. Bronzwaer ◽  
Jasper L. A. Vleugels ◽  
Sascha C. van Doorn ◽  
Marcel G. W. Dijkgraaf ◽  
Paul Fockens ◽  
...  
Keyword(s):  
Detection Rate ◽  
Lesion Detection ◽  
Optical Diagnosis ◽  
Polyp Detection ◽  
Detection Rates ◽  
Serrated Polyps ◽  
Serrated Polyp ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Post Hoc

Abstract Introduction Endoscopists with a high adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) detect these polyps more frequently, which may be attributable to better recognition of their endoscopic features. Little is known about the association between endoscopic lesion detection and differentiation skills. Therefore, we evaluated the correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps. Methods We performed an exploratory post-hoc analysis of the DISCOUNT-2 study, including complete colonoscopies after a positive fecal immunochemical test (FIT) performed by endoscopists who performed ≥ 50 colonoscopies. The correlations between the ADR, PSPDR, and the sensitivity of optical diagnosis were calculated using Pearson’s rho correlation coefficient. Results 24 endoscopists performed ≥ 50 colonoscopies, resulting in a total of 2889 colonoscopies. The overall ADR was 84.5 % (range 71.4 % – 95.3 %) and overall PSPDR was 13.7 % (4.3 % – 29.0 %). The sensitivity of optical diagnosis for adenomas and serrated polyps were 94.5 % (83.3 % – 100 %) and 74.0 % (37.5 % – 94.1 %), respectively. No correlation could be demonstrated between the ADR and the sensitivity of optical diagnosis for adenomas (−0.20; P = 0.35) or between the PSPDR and the sensitivity of optical diagnosis for serrated polyps (−0.12; P = 0.57). Conclusions In a homogeneous FIT-positive population, no correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps could be demonstrated. These exploratory results suggest that lesion detection and differentiation require different endoscopic skills. Further prospective studies are needed; until then, monitoring of both performance indicators is important to secure optimal efficacy of FIT-based colorectal cancer screening.

scholarly journals Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial

2020 ◽  
Vol 9 (10) ◽  
pp. 3286
Author(s):  
Youn I Choi ◽  
Jong-Joon Lee ◽  
Jun-Won Chung ◽  
Kyoung Oh Kim ◽  
Yoon Jae Kim ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Controlled Trial ◽  
Screening Colonoscopy ◽  
Control Group ◽  
Case Group ◽  
Detection Rates ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Bowel Cleansing

Although adequate bowel preparation is essential in screening colonoscopy, patient intolerability to bowel cleansing agents is problematic. Recently, a probiotic mixture solution with bisacodyl emerged to improve patient tolerability. We investigated the efficacy, safety, and patient tolerability profiles of probiotics with bisacodyl versus conventional polyethylene glycol (PEG) solution for bowel preparation for screening colonoscopies in healthy patients in this prospective, randomized, case-control study. In total, 385 volunteers were randomly assigned to receive 2 L of water + 200 mL of probiotic solution (case group, n = 195) or 4 L of PEG solution (control group, n = 190). The efficacy of the bowel cleansing was evaluated using the Ottawa scale system, polyp detection rate, and adenoma detection rate, and the patient tolerability profiles were assessed using a questionnaire. The demographics were not significantly different between groups. When the Ottawa score for each bowel segment was stratified into an adequate vs. inadequate level (Ottawa score ≤ 3 vs. >3), there were no statistical differences between groups in each segment of the colon. There were no significant differences in the polyp and adenoma detection rates between groups (38.42% vs. 32.42, p = 0.30; 25.79% vs. 18.97%, p = 0.11). The case group showed significantly fewer events than the control group, especially nausea, vomiting, and abdominal bloating events. Regarding the overall satisfaction grade, the case group reported significantly more “average” scores (95% vs. 44%, p < 0.001) and were more willing to use the same agents again (90.26% vs. 61.85%, p < 0.001). As patient compliance with bowel preparation agents is associated with an adequate level of bowel cleansing, a probiotic solution with bisacodyl might be a new bowel preparation candidate, especially in patients who show a poor compliance with conventional bowel preparation agents.

scholarly journals Does deep sedation with propofol affect adenoma detection rates in average risk screening colonoscopy exams?

2017 ◽  
Vol 9 (4) ◽  
pp. 177 ◽  
Author(s):  
Selvi Thirumurthi ◽  
Gottumukkala S Raju ◽  
Mala Pande ◽  
Joseph Ruiz ◽  
Richard Carlson ◽  
...  
Keyword(s):  
Deep Sedation ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Risk Screening ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Adenoma Detection Rates
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