Mo1690 ENDOSCOPIST-RELATED FEATURES ASSOCIATED WITH METACHRONOUS ADENOMA DETECTION ON SURVEILLANCE COLONOSCOPIES

Abstract

Patients with a history of a colon adenoma are at risk of showing metachronous adenomas on surveillance colonoscopies. The risk of such a finding - and thus the interval of time in which surveillance colonoscopy should be carried out – is estimated upon the number and histologic type of resected adenomas. However, other factors could influence the risk of metachronous adenoma detection on surveillance colonoscopies. To describe the prevalence of metachronous colon adenomas and the potential factors associated with it. Endoscopy database of our institution was reviewed from January 2017 to March 2019. Patients undertaking a surveillance colonoscopy were enrolled. The prevalence of metachronous adenomas on patients fulfilling inclusion criteria was described. The following variables were assessed: age, gender, number of adenomas on index colonoscopy, at least one advanced adenoma on index colonoscopy, smoking, obesity, diabetes, family history of colorectal cancer, adequate bowel cleansing on both index and surveillance colonoscopy, adenoma detection rate and multiple adenoma detection rate of the endoscopist who performed index colonoscopy. We included 544 patients who fulfilled inclusion criteria. Both index and surveillance colonoscopies were performed by twelve experienced endoscopists. Overall, 46.32% had at least one metachronous adenoma. There were no differences in terms of age and gender when comparing patients with and without metachronous adenomas. Smoking was more frequent among the former (15.07% versus 6.16%, p=0.02). An advanced adenoma on index colonoscopy (36.51% versus 24.66%, p=0.03) and more than three adenomas on index colonoscopy (28.57% versus 15.07%, p=0.007) were also more prevalent in the metachronous adenoma group. When analysing endoscopists performance-related features, we found that an adenoma detection rate of less than 25 among endoscopists who performed index colonoscopies was more frequent in the metachronous adenoma group (43.65% versus 32.19%, p=0.05). Additionally, a multiple adenoma detection rate of less than 2 was also more frequent in the metachronous adenoma group (56.35% versus 41.78%, p=0.02). On multivariate analysis, advanced adenoma on index colonoscopy [OR 1.73 (1.01-3.02)], more than three adenomas on index colonoscopy [OR 2.29 (1.21-4.32)] and a multiple adenoma detection rate of less than 2 [OR 1.75 (1.01-2.32)] were significantly associated with an increased odds of metachronous adenoma. Some endoscopist performance-related features may have an influence on the odds of identifying metachronous adenomas on surveillance colonoscopies. Further evidence is needed to determine whether these features should be taken into account when deciding time of endoscopic surveillance after adenoma resection.