Background
Insufficient detection of proximal serrated polyps (PSP) might explain the occurrence
of a proportion of interval carcinomas in colonoscopy surveillance programs.
Objective
To compare PSP detection among endoscopists and to identify patient-related and endoscopist-related
factors associated with PSP detection.
Design
Prospective study in unselected patients.
Setting
Colonoscopy screening program for colorectal cancer at two academic medical centers.
Patients
Asymptomatic consecutive screening participants (aged 50-75 years).
Intervention
Colonoscopies were performed by 5 experienced endoscopists. All detected polyps were
removed. Multiple colonoscopy quality indicators were prospectively recorded.
Main Outcome Measurements
We compared PSP detection among endoscopists by calculating odds ratios (OR) with
logistic regression analysis. Logistic regression also was used to identify patient
features and colonoscopy factors associated with PSP detection.
Results
A total of 1354 patients underwent a complete screening colonoscopy: 1635 polyps were
detected, of which 707 (43%) were adenomas and 685 (42%) were serrated polyps, including
215 PSPs. In 167 patients (12%) 1 or more PSPs were detected. The PSP detection rate
differed significantly among endoscopists, ranging from 6% to 22% (P < .001). Longer withdrawal time (OR 1.12; 95% confidence interval, 1.10-1.16) was
significantly associated with better PSP detection, whereas patient age, sex, and
quality of bowel preparation were not.
Limitations
Limited number of highly experienced endoscopists.
Conclusion
The PSP detection rate differs among endoscopists. Longer withdrawal times are associated
with better PSP detection, but patient features are not. (Clinical trial registration
number: NTR1888.)
Abbreviation:
PSP (proximal serrated polyp)To read this article in full you will need to make a payment
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References
- American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected].Am J Gastroenterol. 2009; 104: 739-750
- Risk of developing proximal versus distal colorectal cancer after a negative colonoscopy: a population-based study.Clin Gastroenterol Hepatol. 2008; 6: 1117-1121
- Association of colonoscopy and death from colorectal cancer.Ann Intern Med. 2009; 150: 1-8
- BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum.Gut. 2004; 53: 1137-1144
- Extensive DNA methylation in normal colorectal mucosa in hyperplastic polyposis.Gut. 2006; 55: 1467-1474
- High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy.Gastroenterology. 2006; 131: 1400-1407
- Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas: concept of a ‘fusion’ pathway to colorectal cancer.Histopathology. 2006; 49: 121-131
- Role of the serrated pathway in colorectal cancer pathogenesis.Gastroenterology. 2010; 138: 2088-2100
- The presence of large serrated polyps increases risk for colorectal cancer.Gastroenterology. 2010; 139 (1510): 1503-1510
- Proximal and large hyperplastic and nondysplastic serrated polyps detected by colonoscopy are associated with neoplasia.Gastroenterology. 2010; 139: 1497-1502
- Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy.Clin Gastroenterol Hepatol. 2011; 9: 42-46
- Study protocol: population screening for colorectal cancer by colonoscopy or CT colonography: a randomized controlled trial.BMC Gastroenterol. 2010; 10: 47
- Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial.Lancet Oncol. 2012; 13: 55-64
- Quality indicators for colonoscopy.Gastrointest Endosc. 2006; 63: S16-S28
- Validation of a new scale for the assessment of bowel preparation quality.Gastrointest Endosc. 2004; 59: 482-486
- The Vienna classification of gastrointestinal epithelial neoplasia.Gut. 2000; 47: 251-255
- Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy.JAMA. 2011; 306: 1352-1358
- Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study.Gastrointest Endosc. 2005; 61: 378-384
- Influence of the insertion time and number of polyps on miss rate in colonoscopy.Scand J Gastroenterol. 2011; 46: 634-639
- Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.N Engl J Med. 2006; 355: 2533-2541
- Impact of wide-angle, high-definition endoscopy in the diagnosis of colorectal neoplasia: a randomized controlled trial.Gastroenterology. 2008; 135: 1062-1068
- Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology.Gastrointest Endosc. 2011; 74: 593-602
- High definition colonoscopy vs. standard video endoscopy for the detection of colonic polyps: a meta-analysis.Endoscopy. 2011; 43: 499-505
- Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates.Gastrointest Endosc. 2010; 72: 775-781
- Adenomas are detected more often in morning than in afternoon colonoscopy.Am J Gastroenterol. 2009; 104: 1659-1664
- Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators.Am J Gastroenterol. 2008; 103: 1122-1130
- Effects of hyosine N-butyl bromide on the detection of polyps during colonoscopy.Hepatogastroenterology. 2010; 57: 90-94
- BSG Guidelines on Safety and Sedation during Endoscopic Procedures.
- Inter-observer variation in the histological diagnosis of polyps in colorectal cancer screening.Histopathology. 2011; 58: 974-981
- Quality indicators for colonoscopy and the risk of interval cancer.N Engl J Med. 2010; 362: 1795-1803
- Colonoscopic withdrawal technique is associated with adenoma miss rates.Gastrointest Endosc. 2000; 51: 33-36
- Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study.Gut. 2010; 59: 1094-1100
- Surveillance guidelines should be updated to recognize the importance of serrated polyps.Gastroenterology. 2010; 139: 1444-1447
Article info
Publication history
Published online: January 14, 2013
Accepted:
October 13,
2012
Received:
May 30,
2012
Footnotes
DISCLOSURE: The study was funded by The Netherlands Organization for Health Research and Development of the Dutch Ministry of Health (ZonMW 120720012) and by the Center for Translational Molecular Medicine (CTMM DeCoDe-project). Norgine (Amsterdam, The Netherlands) provided the bowel preparation for colonoscopy. No other financial relationships relevant to this publication were disclosed.
See CME section; p. 636.
If you would like to chat with an author of this article, you may contact Dr Dekker at [email protected]
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© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
