Females, Younger Persons and Persons With a Negative Family History More Often Have a False Positive FIT result

Abstract

G A A b st ra ct s that we are missing adenomas behind these folds. Objective Assuming polyps are evenly distributed on the front and back of folds (cecal/anal), we attempted to document fold side distribution. An increased number of polyps/adenomas on the anal side vs. the cecal side would suggest polyps/adenomas missed on the cecal side of the fold. Methods We prospectively collected data on all outpatient colonoscopies performed at Walter Reed Army Medical Center from December 2009 May 2010. An educational session instructed all endoscopists in this study on the data that needed to be collected. Quality indicators to include preparation quality, withdrawal time, cecal intubation rate, and adenoma detection rate were recorded. All endoscopists noted size, location in colon, and location in relation to colonic fold for all polyps identified. The histology of all polyps removed was retrieved at a later time. Results During this period, 1111 patients (56% male, 53% white, 56 years (18-91) median age (range)) underwent outpatient colonoscopy. Majority of patients (66%) had screening or surveillance colonoscopy. Quality indicators included 79% of bowel preparations were of good-to-excellent quality, 12 minute mean withdrawal time, 97% cecal intubation rate, and an appropriate adenoma detection rate (19% female, 25% male). Of 1092 polyps (560 adenomas) identified, 502 polyps (46%) were on a fold and 590 (54%) were not on a fold. Of the 502 polyps on a fold, 144 polyps (75 adenomas) were located on the tip of the fold and 358 polyps (192 adenomas) were distributed on either side of the folds. When comparing polyps and adenoma distribution on anal vs. cecal side; there were significantly more polyps (250 (70%) vs. 108 (30%), P<0.05) and adenomas (117 (61%) vs. 75 (39%), p<0.05) on the anal vs. cecal side. Conclusions The results of this study show fewer polyps and adenomas within the colon noted on the cecal side of the fold compared to the anal side of the fold. Based on the assumption that colonic polyps/adenomas are distributed evenly on either side of the fold, we may be missing 12% of polyps and 7% of adenomas behind these folds. This finding suggests that developing endoscopic technology and techniques to enhance cecal side polyp/adenoma detection may increase the yield of colonoscopy.