The Impact of Reporting Non-neoplastic Detection Rates in Addition to ADR and SSDR on Lesion Detection in a Colonoscopy Screening Program: 2017 Presidential Poster Award

Abstract

Introduction: Non-neoplastic polypectomy occurs when tissue is removed during colonoscopy but is absent of neoplasia on pathology. In the current era of emphasis on quality metrics, non-neoplastic polypectomy rates (NNPR) may be increasing in an effort to improve adenoma detection rates (ADR). NNP adds costs but does not reduce colorectal cancer risk and thus should be minimized. We sought to evaluate whether informing a group of endoscopists of their neoplastic and non-neoplastic detection rates would reduce future NNPR without adversely impacting ADR. Methods: Screening colonoscopy data was obtained from 11 gastroenterologists. The study was divided into three phases. Phase 1 was “pre-monitoring” (n=2024) in which no reporting of detection metrics occurred. In Phase 2, “neoplastic informing” (n=854), ADR, SSDR, and polyp detection rates (PDR) were reported. In Phase 3, “neoplastic and non-neoplastic informing” (n=499), ADR, SSDR, PDR, and NNPR were reported. Exclusion criteria included history of CRC/polyps, prior resection, poor prep, IBD. NNPR included polypoid tissue that was non-adenomatous, non-hyperplastic on pathology. APDRQ was defined as ADR/PDR. Each phase had ≥ 25 cases per colonoscopist. Differences between groups were calculated by two sided Fisher's Exact test. Results: Following phase 2, cohort ADR increased from 33% to 38.8% (P=0.003) however NNPR also increased from 8.0% to 13.3% (P=0.0001). Following phase 3, ADR continued to increase from 38.8% to 44.4% (P=0.045). NNPR informing led to a non-significant reduction in NNPR from phase 2=13.3% to phase 3=10.14% (P=0.12). SSDR increased from phase 1=3.5%, phase 2=7.0%, phase 3=8.4% (P=0.0001), PDR increased from phase 1=47.4%, phase 2=58.7%, phase 3=66.1% (P=0.0001). APDRQ did not significantly change, phase 1=0.696, phase 2=0.660, phase 3=0.671. (Table 1, Figure 1).FigureConclusion: When initiating ADR monitoring, NNPR increased significantly as did ADR and SSDR. However, the NNPR increased in proportion to the ADR as evident by the similar APDRQ. When nonneoplastic rates were also reported, the NNPR did not significantly change, however the ADR continued to increase. In summary, reporting of NNPR led to a statistically significant increase in the total ADR, SSDR, and PDR, with no significant change in NNPR. This suggests that knowledge of NNPR appears not to harm ADR or SSDR. Informing of NNPR does not appear to be sufficient to significantly reduce the NNPR and improve efficiency of colonoscopy.Figure