scholarly journals Expert endoscopists with high adenoma detection rates frequently detect diminutive adenomas in proximal colon

2020 ◽  
Vol 08 (06) ◽  
pp. E775-E782
Author(s):  
Osamu Toyoshima ◽  
Toshihiro Nishizawa ◽  
Shuntaro Yoshida ◽  
Kazuma Sekiba ◽  
Yosuke Kataoka ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Detection Rate ◽  
Patient Characteristics ◽  
Proximal Colon ◽  
Polyp Detection ◽  
Detection Rates ◽  
Serrated Polyps ◽  
Adenoma Detection ◽  
Important Quality

Abstract Background and study aims Adenoma detection rate (ADR) is an important quality indicator in colonoscopy, and improved ADR decreases the incidence of colorectal cancer. We investigated differences in polyp detection according to the endoscopist’s ADR. Patients and methods We performed a propensity-score matching study using baseline patient characteristics of age, sex, body mass index, family history of colorectal cancer, smoking, drinking, indication for colonoscopy, bowel preparation, and colonoscope type. We compared polyp detection and colonoscopy procedures between patients who underwent colonoscopy by high-ADR endoscopists (high ADR group) and by low-ADR endoscopists (low ADR group). Results We matched 334 patients in the high ADR group with 334 in the low ADR group. The ADR was 44.0 % and 26.9 % for the high-ADR and low-ADR endoscopists, respectively. Proximal, nonprotruding, and diminutive adenomas were more frequently detected by high-ADR endoscopists than by low-ADR endoscopists (all P < 0.001); similarly, more high-risk adenomas were detected by high-ADR endoscopists (P = 0.028). Furthermore, more sessile serrated polyps detected by high-ADR endoscopists (P = 0.041). High-ADR endoscopists more frequently performed pancolonic chromoendoscopy (P < 0.001). Conclusions Expert detectors often found nonprotruding and diminutive adenomas in the proximal colon along with increased detection rate of high-risk adenomas. Low-ADR endoscopists need to recognize the features of missed adenomas to improve their ADRs.

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 Artificial Intelligence in Colonoscopy: Improving Medical Diagnostic of Colorectal Cancer

2020 ◽  
Vol 9 (1) ◽  
pp. 27
Author(s):  
Stefanus Bernard ◽  
Arli Aditya Parikesit
Keyword(s):  
Artificial Intelligence ◽  
Colorectal Cancer ◽  
Survival Rate ◽  
High Risk ◽  
Detection Rate ◽  
Adenoma Detection Rate ◽  
Polyp Detection ◽  
Adenoma Detection ◽  
Study Results ◽  
Medical Diagnostic

Introduction- Colorectal cancer (CRC) is a development of abnormal cells either in colon or rectum. CRC considered being the 3rd leading cause of death in 2018 only behind lung and breast cancer. It first arises during pre-cancerous stages called as polyps. The detection and removal of polyp is important to increase the survival rate of patient. Various method of polyp detection are available. However, only colonoscopy remains the gold standard in detection and removal of polyps. Several studies showed how Artificial Intelligence (AI) used in colonoscopy area particularly in detecting polyps, assessing physicians and predicting patient with high risk of CRC. The aim of this study is to describe the involvement of AI in colonoscopy and its impact in reducing the Materials and methods– Search for journal articles conducted between May and June 2016 from various resources including PubMed and Google Scholar.  6 research journals were reviewed and all the advantages and limitations were discussed throughout this study. Results– Various study showed that AI able to improve medical diagnostic of CRC in several ways, including in the improvement of adenoma detection rate (ADR) in terms of medical diagnostic, finding physicians associated with high Adenoma Detection Rate (ADR) and predicting patients with high risk of CRC. In addition, the use of AI in colonoscopy also associated with limitations including require large amount of datasets and advance computational resources in order to generate accurate output. Conclusion– The utilization of AI in colonoscopy shows how it able to improve the diagnosis accuracy and survival rate of patients associated with CRC despite several limitations that were identified during the study. However in the future, instead of allowing it to fully automatically conducting diagnosis, it still needs to be accompanied by physicians conducting the operation as there is no hundred percent perfect algorithms.  

scholarly journals Melanosis Coli: A Helpful Contrast Effect or a Harmful Pigmentation?

2018 ◽  
Vol 11 ◽  
pp. 117955221881732 ◽  
Author(s):  
Fadi Abu Baker ◽  
Amir Mari ◽  
Dan Feldman ◽  
Muhammad Suki ◽  
Oren Gal ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Detection Rate ◽  
Control Group ◽  
P Value ◽  
Polyp Detection ◽  
Detection Rates ◽  
Benign Condition ◽  
Melanosis Coli ◽  
Polyp Detection Rate ◽  
Adenoma Detection

Background: Melanosis coli, a brown discoloration of colonic mucosa, is considered as a benign condition mainly observed in patients under chronic anthranoid laxatives. Recent data link this condition with an increased adenoma detection rate. Moreover, its tumorigenic potential and possible association with the development of colorectal cancer remains uncertain. We conducted this study to compare the polyp detection rate and colorectal cancer diagnosis in patients with melanosis against matched control group without melanosis. Patients and methods: A retrospective single-center study. Patients diagnosed with melanosis coli on colonoscopy over a 15-year period were included. Each melanosis coli patient was matched with three controls by age, gender, setting (inpatient/outpatient), and procedure’s indication. Polyp detection rate and diagnosis of colorectal cancer were recorded and compared between the groups before and after adjustment for bowel preparation. Results: A cohort of 718 patients with melanosis and 2154 controls were included. The polyp detection rates were 33.4% and 21.8% of melanosis and control groups, respectively ( P < .001). Melanosis coli, however, was associated with less diagnosis of colorectal cancer than controls (0.3% vs 3.9%; P < .001). In multivariate analysis, melanosis diagnosis on endoscopy was significantly associated with higher polyp detection rate (odds ratio [OR] = 1.986, 95% confidence interval [CI]: 1.626-2.425; P value < .01). Conclusions: Melanosis coli is not associated with increased diagnosis of colorectal cancer. It is associated, however, with enhanced polyp detection likely due to chromo-endoscopy-like effect.

scholarly journals Gaze patterns hold key to unlocking successful search strategies and increasing polyp detection rate in colonoscopy

Endoscopy ◽  
2018 ◽  
Vol 50 (07) ◽  
pp. 701-707 ◽  
Author(s):  
Mariam Lami ◽  
Harsimrat Singh ◽  
James Dilley ◽  
Hajra Ashraf ◽  
Matthew Edmondon ◽  
...  
Keyword(s):  
Eye Tracking ◽  
Detection Rate ◽  
Surrogate Marker ◽  
Polyp Detection ◽  
Gaze Patterns ◽  
Successful Search ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Important Quality ◽  
Visual Gaze

Abstract Background The adenoma detection rate (ADR) is an important quality indicator in colonoscopy. The aim of this study was to evaluate the changes in visual gaze patterns (VGPs) with increasing polyp detection rate (PDR), a surrogate marker of ADR. Methods 18 endoscopists participated in the study. VGPs were measured using eye-tracking technology during the withdrawal phase of colonoscopy. VGPs were characterized using two analyses – screen and anatomy. Eye-tracking parameters were used to characterize performance, which was further substantiated using hidden Markov model (HMM) analysis. Results Subjects with higher PDRs spent more time viewing the outer ring of the 3 × 3 grid for both analyses (screen-based: r = 0.56, P = 0.02; anatomy: r = 0.62, P < 0.01). Fixation distribution to the “bottom U” of the screen in screen-based analysis was positively correlated with PDR (r = 0.62, P = 0.01). HMM demarcated the VGPs into three PDR groups. Conclusion This study defined distinct VGPs that are associated with expert behavior. These data may allow introduction of visual gaze training within structured training programs, and have implications for adoption in higher-level assessment.

scholarly journals Adenoma and Polyp Detection Rates in Colonoscopy according to Indication

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Erika S. Boroff ◽  
Molly Disbrow ◽  
Michael D. Crowell ◽  
Francisco C. Ramirez
Keyword(s):  
Distal Colon ◽  
Proximal Colon ◽  
Screening Colonoscopy ◽  
Bowel Habit ◽  
Polyp Detection ◽  
Age And Gender ◽  
Detection Rates ◽  
Adenoma Detection ◽  
And Gender ◽  
Colon Data

Background. Adenoma detection rate (ADR) is a validated quality measure for screening colonoscopy, but there are little data for other indications. The distribution of adenomas is not well described for these indications. Aim. To describe ADR and the adenoma distribution in the proximal and distal colon based on colonoscopy indication. Methods. Outpatient colonoscopies are subdivided by indication. PDR and ADR for the entire colon and for proximal and distal colon. Data were compared using generalized estimating equations to adjust for clustering amongst endoscopists while controlling for patient age and gender. Results. 3436 colonoscopies were reviewed (51.2%: men (n=1759)). Indications are screening 49.2%, surveillance 29.3%, change in bowel habit 8.4%, bleeding 5.8%, colitides 3.0%, pain 2.8%, and miscellaneous 1.5%. Overall ADR was 37% proximal ADR 28%, and distal ADR 17%. PDR and ADR were significantly higher in surveillance than in screening (PDR: 69% versus 51%; ADR: 50% versus 33%; p=0.0001). Adenomas were more often detected in the proximal than in the distal colon, for all indications. Conclusions. Prevalence of polyps and adenomas differs based on colonoscopy indication. Adenoma detection is highest in surveillance and more commonly detected in the proximal colon. For quality assurance, distinct ADR and PDR targets may need to be established for different colonoscopy indications.

scholarly journals 1302 Ratio of Adenoma Detection Rate to Polyp Detection Rate

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Rajain ◽  
A Adam ◽  
T Amarnath
Keyword(s):  
Colorectal Cancer ◽  
Detection Rate ◽  
Adenoma Detection Rate ◽  
Care Hospital ◽  
Polyp Detection ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Primary Care Hospital ◽  
Minimal Rate ◽  
The Uk

Abstract Introduction Colorectal cancer is the 3rd most common cancer in the UK. The higher Adenoma Detection Rate during colonoscopy is associated with reduction in the mortality incidence of colorectal cancer. Endoscopists with less than 20% ADR is directly proportional to higher risk of the development of an interval Colorectal cancer. The aim of this study was to calculate the Adenoma Detection Rate and Polyp Detection Rate for each endoscopist to assess the performance of the unit as well as individuals. Method A retrospective analysis was conducted for patients who had colonoscopy in a period of 3 consecutive months at a primary care hospital in England. This study included collecting the data through patient’s histology reports and medical records. The primary outcome was total Adenoma Detection Rate and Polyp Detection Rate and its ratio for each endoscopist. Results 913 colonoscopies were done by 16 different endoscopists out of which 279 patients with polyps were considered for the study. It was observed that half of the total endoscopists were found to have ADR more than 20%. 4 endoscopists had ADR between 15-20% whereas below minimal rate (less than 15%) ADR was recorded by the other 4 endoscopists. Conclusions Lower ADRs are associated with higher rates of interval cancers. An improvement of the ADR of 1% prevents 3% people from colon cancer which can be achieved by maintaining the aspirational adenoma detection rate more than 20%.

scholarly journals A120 NO EVIDENCE OF A FRIDAY EFFECT ON COLONOSCOPY QUALITY OUTCOMES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 101-102
Author(s):  
Z Hindi ◽  
L Guizzetti ◽  
S cocco ◽  
M Brahmania ◽  
A Wilson ◽  
...  
Keyword(s):  
Detection Rate ◽  
Hospital Setting ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Detection Rates ◽  
Adjusted Risk ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Significant Difference ◽  
Colonoscopy Quality

Abstract Background Colonoscopy quality may be influenced by operator fatigue. Prior studies have shown lower adenoma detection rates for procedures performed at the end of the day. However, it is unknown if colonoscopy quality is impaired at the end of the work week. Aims We investigated whether colonoscopy quality-related metrics differ at the end of the work week using the South West Ontario Colonoscopy Cohort. Methods Between April 2017 to February 2018, 45,510 consecutive colonoscopies from 20 academic and community hospitals in our health region were captured to form the cohort. In Canada, outpatient endoscopies are generally performed between Monday to Friday, taking Friday, or the last business day, as the last day of the work week compared to the rest of the work week. When a statutory holiday occurred on a Friday, Thursday was designated the last day of the work week. The primary outcome was adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and failed cecal intubation. Outcomes were presented as unadjusted and adjusted risk ratios derived from modified Poisson regression and adjusting for physician-level clustering, and characteristics of the patient (age, sex, severity), procedure (hospital setting, trainee presence, indication, sedation, bowel preparation quality) and physician (experience and specialty). Results During the observation period, 9,132 colonoscopies were performed on the last day of the work week compared to 36,378 procedures during the rest of the work week. No significant difference was observed for ADR (26.4% vs. 26.6%, p=0.75), ssPDR (4.5% vs. 5.0%, p=0.12), PDR (44.1% vs. 43.1%, p=0.081), or failed cecal intubation (2.8% vs. 2.9%, p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of the week, respectively. After adjusting for potential confounders, there were no significant differences in the ADR (RR 1.01, 95% CI [0.88, 1.15], p=0.94), ssPDR (RR 0.90, 95% CI [0.70, 1.14], p=0.38), PDR (RR 1.00, 95% CI [0.92, 1.09], p=0.94), or failed cecal intubation (RR 0.92, 95% CI [0.72, 1.18], p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of week, respectively. Conclusions Colonoscopy quality metrics, including ADR, ssPDR, PDR, and failed cecal intubation are not significantly different at the end of the week. Funding Agencies None

BowelScope: Accuracy of Detection Using Endocuff Optimisation of Mucosal Abnormalities (the B-ADENOMA Study): a multicentre, randomised controlled flexible sigmoidoscopy trial

Gut ◽  
2020 ◽  
Vol 69 (11) ◽  
pp. 1959-1965
Author(s):  
Colin J Rees ◽  
Andrew Brand ◽  
Wee Sing Ngu ◽  
Clive Stokes ◽  
Zoe Hoare ◽  
...  
Keyword(s):  
Detection Rate ◽  
Flexible Sigmoidoscopy ◽  
Controlled Trial ◽  
Polyp Detection ◽  
Detection Rates ◽  
Link Type ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Participant Experience ◽  
Randomised Controlled

ObjectivesAdenoma detection rate (ADR) is an important quality marker at lower GI endoscopy. Higher ADRs are associated with lower postcolonoscopy colorectal cancer rates. The English flexible sigmoidoscopy (FS) screening programme (BowelScope), offers a one-off FS to individuals aged 55 years. However, variation in ADR exists. Large studies have demonstrated improved ADR using Endocuff Vision (EV) within colonoscopy screening, but there are no studies within FS. We sought to test the effect of EV on ADR in a national FS screening population.DesignBowelScope: Accuracy of Detection Using ENdocuff Optimisation of Mucosal Abnormalities was a multicentre, randomised controlled trial involving 16 English BowelScope screening centres. Individuals were randomised to Endocuff Vision-assisted BowelScope (EAB) or Standard BowelScope (SB). ADR, polyp detection rate (PDR), mean adenomas per procedure (MAP), polyp characteristics and location, participant experience, procedural time and adverse events were measured. Comparison of ADR within the trial with national BowelScope ADR was also undertaken.Results3222 participants were randomised (53% male) to receive EAB (n=1610) or SB (n=1612). Baseline demographics were comparable between arms. ADR in the EAB arm was 13.3% and that in the SB arm was 12.2% (p=0.353). No statistically significant differences were found in PDR, MAP, polyp characteristics or location, participant experience, complications or procedural characteristics. ADR in the SB control arm was 3.1% higher than the national ADR.ConclusionEV did not improve BowelScope ADR when compared with SB. ADR in both arms was higher than the national ADR. Where detection rates are already high, EV is unable to improve detection further.Trial registration numbersNCT03072472, ISRCTN30005319 and CPMS ID 33224.

scholarly journals Effect of combined cap-assisted, water-aided, and prone position colonoscopy for adenoma detection: A retrospective study

2020 ◽  
Author(s):  
Jihwan Ko ◽  
Byung Gu Ko ◽  
Seong Ho Han ◽  
Hyung Wook Kim
Keyword(s):  
Prone Position ◽  
Detection Rate ◽  
Occult Blood ◽  
Proximal Colon ◽  
Fecal Occult Blood ◽  
Polyp Detection ◽  
Exact Test ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Significant Difference

AbstractBackgroundThe efficacy of cap-assisted, water-aided, and 12 o’clock-prone position colonoscopy as individual techniques for adenoma detection is well documented. However, the efficacy of the combination of the three colonoscopy methods is unclear. Therefore, the present study aimed to retrospectively compare the efficacy between combined-method colonoscopy (CMC) and standard colonoscopy (SC).Methods and FindingsA total of 746 patients who underwent either CMC or SC, performed by two board-certified gastroenterologists between December 2019 and March 2020 at Baekyang Jeil Internal Medicine Clinic, were retrospectively evaluated. We evaluated polyp detection rate (PDR), adenoma detection rate (ADR), and mean number of adenomas detected per procedure (MAP). Statistical analysis for comparison between the groups was performed using the Student’s t-test, and ADR and PDR were analyzed using Fisher’s exact test. The study population was predominantly women (55.4%). The mean patient age (standard deviation) was 62.87 (±7.83) years. There was no significant difference in sex, number of fecal occult blood test-positive patients, and age between the two groups. The PDR, ADR, and proximal colon MAP were significantly higher in the CMC group than in the SC group (PDR: 59.8% vs. 84.9%, p < 0.001; ADR: 49.2% vs. 70.1%, p < 0.001; proximal colon MAP: 0.55 vs. 1.24, p < 0.001).ConclusionsCompared with SC, CMC increases PDR, ADR, and MAP, especially proximal colon MAP. Therefore, CMC may be more useful than SC in clinical settings. This study is the first to evaluate the efficacy of the three techniques in combination.

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.

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