Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry

Published:March 08, 2022DOI:https://doi.org/10.1016/j.gie.2022.03.001

      Background and Aims

      Higher adenoma detection rates reduce the risk of postcolonoscopy colorectal cancer (PCCRC). Clinically significant serrated polyps (CSSPs; defined as any sessile serrated polyp, traditional serrated adenoma, large [≥1 cm] or proximal hyperplastic polyp >5 mm) also lead to PCCRC, but there are no data on associated CSSP detection rates (CSSDRs). We used data from the New Hampshire Colonoscopy Registry (NHCR) to investigate the association between PCCRC risk and endoscopist CSSDR.

      Methods

      We included NHCR patients with 1 or more follow-up events: either a colonoscopy or a colorectal cancer (CRC) diagnosis identified through linkage with the New Hampshire State Cancer Registry. We defined our outcome, PCCRC, in 3 time periods: CRC diagnosed 6 to 36 months, 6 to 60 months, or all examinations (6 months or longer) after an index examination. We excluded patients with CRC diagnosed at or within 6 months of the index examination, with incomplete examinations, or with inflammatory bowel disease. The exposure variable was endoscopist CSSDR at the index colonoscopy. Cox regression was used to model the hazard of PCCRC on CSSDR controlling for age, sex, index findings, year of examination, personal history of colorectal neoplasia, and having more than 1 surveillance examination.

      Results

      One hundred twenty-eight patients with CRC diagnosed at least 6 months after their index examination were included. Our cohort included 142 endoscopists (92 gastroenterologists). We observed that the risk for PCCRC 6 months or longer after the index examination was significantly lower for examinations performed by endoscopists with CSSDRs of 3% to <9% (hazard ratio [HR], .57; 95% confidence interval [CI], .39-.83) or 9% or higher (HR, .39; 95% CI, .20-.78) relative to those with CSSDRs under 3%.

      Conclusions

      Our study is the first to demonstrate a lower PCCRC risk after examinations performed by endoscopists with higher CSSDRs. Both CSSDRs of 9% and 3% to <9% had statistically lower risk of PCCRC than CSSDRs of <3%. These data validate CSSDR as a clinically relevant quality measure for endoscopists.

      Graphical abstract

      Abbreviations:

      ADR (adenoma detection rate), CRC (colorectal cancer), CSSDR (clinically significant serrated polyp detection rate), CSSP (clinically significant serrated polyp), HP (hyperplastic polyp), HR (hazard ratio), NHCR (New Hampshire Colonoscopy Registry), PCCRC (postcolonoscopy colorectal cancer), SSP (sessile serrated polyp), TSA (traditional serrated adenomas)
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      Linked Article

      • Setting a benchmark for serrated polyp detection rate: defining the target and terminology comes first
        Gastrointestinal EndoscopyVol. 96Issue 2
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          Some experts recommend the term “postcolonoscopy colorectal cancer” (PCCRC) be used to define a colorectal cancer (CRC) that occurs after a colonoscopy in which no cancer was diagnosed. PCCRC can be subtyped into “interval” cancer (diagnosed before the next recommended screening or surveillance colonoscopy) and “noninterval” cancer (identified at or after the next recommended screening or surveillance interval, or when no repeated colonoscopy was recommended, up to 10 years).1 In a review of 17 studies of nearly 150,000 cases of CRC, 5% were found to be interval PCCRCs, and these have been estimated to occur in 1 out of 3174 colonoscopies.
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