Advanced Adenoma Detection Rate Research Articles

Tu1132 ASSOCIATION BETWEEN THE ADENOMA DETECTION RATE AND A COMPOSITE QUALITY INDICATOR OF CAECAL INTUBATION, PATIENT COMFORT AND SEDATION IN FIT-POSITIVE COLONOSCOPIES

The Performance Indicator of Colonic Intubation (PICI) has been introduced as a new measure of high-quality colonic intubation, taking three key parameters into account. An adequate PICI was defined as caecal intubation without significant discomfort and use of less than the median midazolam dose in the UK. In an UK national audit, adequate PICI was achieved in 54.1% of colonoscopies. It was associated with higher polyp detection rates, but an association with the adenoma detection rate (ADR) was not assessed. In this study, we determined the association between PICI, using the UK and Dutch median sedation dose, and detection rates of (advanced) adenomas in colonoscopies for the Dutch FIT-based colorectal cancer (CRC) screening program. Furthermore, we assessed the feasibility of PICI as quality indicator in this population. This study was conducted within the Dutch FIT-based screening program. Colonoscopy and pathology data is prospectively collected in a national database, providing data on ADR. Data between 01-01-2016 and 01-01-2018 were analyzed. Achieving an adequate PICI was defined as a procedure with caecal intubation, a Gloucester Comfort Scale (GCS) between 1 and 3 (no to mild discomfort) and use of a maximum dose of 2.5 mg midazolam. Besides, we studied the PICI when using the median dose of midazolam given in this Dutch population. During the study period, 107.328 colonoscopies were performed in FIT-positive participants. The mean ADR was 64.2%. No to mild discomfort (GCS: 1-3) was recorded in 95.6% of the colonoscopies and the median midazolam dose was 5 mg (IQR: 2.5-5 mg). Adequate PICI, using the cut-off of 2.5 mg midazolam was achieved in 49.500 (46.1%) colonoscopies. In 87.8% of the colonoscopies in which PICI was inadequate, this was solely due to a higher dose of midazolam or use of propofol. Adequate PICI was associated with higher ADR (OR: 1.05; 95%CI: 1.03-1.08), but not with advanced adenoma detection rates (OR: 1.01; 95%CI: 0.99-1.04). When using the cut-off of 5 mg, the median midazolam dose in this Dutch population, adequate PICI was achieved in 95.410 colonoscopies (88.9%) and it was associated with both higher ADR (OR: 1.52; 95%CI: 1.46-1.58) and advanced adenoma detection rates (OR: 1.19; 95%CI: 1.14-1.24). Adequate PICI, using the UK and Dutch median sedation dose, was associated with higher ADRs. However, in this FIT-positive population, the UK-defined PICI was inadequate in more than half of all colonoscopies. This was mainly due to sedation practice in the Netherlands with a higher median midazolam dose of 5 mg. PICI appears to be an indicator that is heavily dependent on sedation practice, which is not the same across countries. Therefore, the PICI should be considered in the light of regional sedation practices and related to outcome parameters, like ADR.

Mo1636 THE IMPORTANCE OF RIGHT COLON ADENOMA DETECTION RATE AND ITS CORRELATION WITH OTHER QUALITY METRICS

Right sided lesions are often missed during colonoscopy and could contribute to interval colon cancer development. This has led to the importance of Right Colon Adenoma Detection Rate (r-ADR) and its consideration as a colonoscopy quality metric. This is a retrospective analysis of a well-defined database at a tertiary academic facility of adult patients who had undergone an average risk screening colonoscopy between 2005 and 2015. Data were extracted for each endoscopist including: overall ADR, right and left colon ADR, sessile serrated ADR (SDR), advanced ADR and adenomas per colonoscopy (APC). The primary goal of the analysis was to determine the r-ADR and assess its correlation to overall ADR and APC. Standard pair matched analysis was performed using Pearson correlation coefficient (r) and was calculated using statistical software SAS. P- value of 0.05 was considered statistically significant. A total of 3,356 patients were included in the analysis; mean age 60.7 +/- 10.3 years; 95% male. The overall ADR was 60%, r-ADR 43.2%, advanced ADR was 16.9%, serrated ADR was 4.2% and documented cecal intubation rate was 98%. The mean APC was 1.7±2.4. A trainee was present for 67.4% of these procedures. There was high correlation of r-ADR (r=0.80; p=0.054); overall ADR (r=0.72; p=0.107), and advanced ADR (r=0.80; p=0.05) to APC respectively. The correlation of r-ADR to overall ADR was high (r=0.97; p<0.01). However, correlation of r-ADR to advanced ADR (r=0.33;p=0.52) and SDR (r=0.45; p=0.37) was modest . Right sided adenomas account for at least 70% of the overall ADR. r-ADR detection has high correlation with total adenomas per colonoscopy and overall ADR. If r-ADR is linked to interval colon cancer development, it can be considered as a new quality metric for colonoscopy.

Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials.

Background To improve patients’ comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas.ObjectiveThis meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas.MethodsWe searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes.ResultsWe included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I2=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I2=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively.ConclusionsThe current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data.

Adenoma and Advanced Adenoma Detection Rates of Water Exchange, Endocuff, and Cap Colonoscopy: A Network Meta-Analysis with Pooled Data of Randomized Controlled Trials.

A network meta-analysis showed that low-cost optimization of existing resources was as effective as distal add-on devices in increasing adenoma detection rate (ADR). We assessed the impacts of water exchange (WE), Endocuff, and cap colonoscopy on ADR and advanced adenoma detection rate (AADR). We hypothesized that WE may be superior at improving ADR and AADR. The literature was searched for all randomized controlled trials (RCTs) that reported ADR as an outcome and included the keywords colonoscopy, and water exchange, Endocuff, or cap. We performed traditional network meta-analyses with random effect models comparing ADR and AADR of each method using air insufflation (AI) as the control and reported the odds ratios with 95% confidence interval. Performances were ranked based on P-score. Twenty-one RCTs met inclusion criteria. Fourteen RCTs also reported AADR. Both WE [1.46 (1.20-1.76)] and Endocuff [1.39 (1.17-1.66)] significantly increase ADR, while cap has no impact on ADR [1.00 (0.82-1.22)]. P-scores for WE (0.88), Endocuff (0.79), cap (0.17), and AI (0.17) suggest WE has the highest ADR. WE [1.38 (1.12-1.70)], but not Endocuff [0.96 (0.76-1.21)] or cap [1.06 (0.85-1.32)], significantly increases AADR. P-scores for WE (0.98), cap (0.50), AI (0.31), and Endocuff (0.21) suggest WE is more effective at increasing AADR. The results did not change after adjusting for age, proportion of males, and withdrawal time. WE may be the modality of choice to maximally improve ADR and AADR.

Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis.

Background and study aims Choice of sedation (propofol vs opioid/benzodiazepine) has been studied in the literature and has shown variable outcomes. The majority of recent studies have evaluated propofol sedation (PS) versus opioids, benzodiazepines, or a combination of both. We performed a systematic review and meta-analysis of studies comparing PS to other sedation methods to assess the impact on colonoscopy outcomes. Methods Multiple databases were searched and studies of interest were extracted. Primary outcome of the study was adenoma detection rate (ADR) and secondary outcomes included polyp detection rate (PDR), advanced adenoma detection rate (AADR), and cecal intubation rate (CIR). Results A total of 11 studies met the inclusion criteria with a total of 177,016 patients (148,753 and 28,263 in the opioids/benzodiazepine group and PS group, respectively). Overall, ADR (RR: 1.07, 95 % CI 0.99–1.15), PDR (RR: 1.01, 95 % CI 0.93–1.10), and AADR (RR: 1.17, 95 % CI 0.92–1.48) did not improve with the use of PS. The CIR was slightly higher for propofol sedation group (RR 1.02, 95 % CI 1.00–1.03). Conclusion Based on our analysis, PS and opioid/benzodiazepine sedation seem to have comparable ADR. Our results do not favor use of a particular sedation method and the choice of sedation should be individualized based on patient preference, risk factors and resource availability.

Morning versus afternoon adenoma detection rate: a systematic review and meta-analysis.

Adenoma detection rate (ADR) is a quality marker of colonoscopy and operator performance. Prior studies evaluating the effect of an extended workday on the ADR reported variable outcomes that remain controversial. Given the variable results of prior studies and the potential legal implications of reduced ADR in the afternoon, we aimed to further evaluate this parameter and its effect on ADR. We performed a systematic review of the PubMed, CINAHL and Scopus electronic databases. Studies were included if they reported ADR in patients undergoing colonoscopy in the morning session and the afternoon session. Afternoon sessions included both sessions following a morning shift and half-day block shifts. Subgroup analyses were performed for ADR comparing morning and afternoon colonoscopies in a continuous workday, advanced ADRs (AADRs) and polyp detection rates (PDRs) were also compared. Thirteen articles with 17 341 (61.2%) performed in the morning session and 10 994 (38.8%) performed in the afternoon session were included in this study. There was no statistical significance in the ADR or AADR between morning and afternoon sessions, respectively [relative risk (RR) 1.06, 95% confidence interval (CI) 0.99-1.14] and (RR 1.19, 95% CI 0.95-1.5). Afternoon procedures had a significantly higher PDR than morning procedures (RR 0.93, 95% CI 0.88-0.98). ADR was not significantly influenced in the afternoon session when operators continued to perform procedures throughout the day or on a half-day block schedule.

The anti-spasmodic effect of peppermint oil during colonoscopy: a systematic review and meta-analysis.

Multiple pharmacological agents have been studied in literature with antispasmodic effect during colonoscopy. Peppermint oil, with its relaxing effect on colon has demonstrated varying results. We therefore conducted a systematic review and meta-analysis of the available literature to evaluate its role during colonoscopy. Literature search of the following databases was undertaken: PubMed\Medline, Embase, Cochrane, Web of Science, and CINAHL. Outcomes that were evaluated included incidence of any spasticity, severe spasticity, and peristalsis during examination. Adenoma detection rate (ADR) was evaluated as a quality outcome metric. Risk ratios (RR), risk difference (RD) and mean difference (MD) were calculated using the DerSimonian-Laird method and random effects where applicable. Overall, six studies (with one abstract) were included in this review. Peppermint oil resulted in overall lower incidence for spasticity (RD: -0.39, P=0.02), severe spasticity (RD: -0.15, P=0.04), and peristalsis (-0.27, P≤0.001) during colonoscopy examination. An improved ADR (RR: 1.31, P=0.01) was also noted, however only two studies evaluated this effect. Peppermint oil resulted in relaxation of colon during colonoscopy with decrease incidence of spasticity, severe spasticity, peristalsis and improved ADR. These results are encouraging however results are limited due to significant heterogeneity found in the outcomes. Larger studies with standardized dosing are needed to evaluate this effect. Furthermore, studies evaluating additional colonoscopy outcomes such as polyp detection rate, advanced adenoma detection rate, and serrated adenoma detection rate are needed.

Water Exchange (WE) and Quality Improvement—Enhanced Advanced Adenoma Detection

Advanced adenomas (≥10 mm in diameter, >25% villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed. The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI. Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled. A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7% vs. 8.3%, P=0.001) and overall ADR (20.9% vs. 27.4%, P=0.001). In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.

Author commentary on Jagpal S. Klair et al.

Jagpal S. Klair et al. Serrated polyp detection rate and advanced adenoma detection rate from a US multicenter cohort

Serrated polyp detection rate and advanced adenoma detection rate from a US multicenter cohort.

Interval colorectal cancers may be associated with a low serrated polyp detection rate (SDR) and advanced adenoma detection rate (AADR). We aimed to determine the SDR and AADR for endoscopists in a United States multicenter cohort. We included average-risk screening colonoscopies from five medical centers in the United States. Endoscopists with data on at least 100 average-risk screening colonoscopies were included. We calculated median SDR and AADR for endoscopists with adequate adenoma detection rates (ADRs) > 25 %. We analyzed the relationship between ADR and SDR, and between ADR and AADR using nonparametric Spearman correlation coefficients, scatter plots, and linear regression. We included 3513 screening colonoscopies performed by 26 gastroenterologists. The mean age of patients was 56.8 years (SD 7.4) and 1585 (45 %) were male. All but one endoscopist had an ADR above 25 %. There was a significant positive but modest correlation between ADR and SDR (rho = 0.67, P < 0.01), and between ADR and AADR (rho = 0.56, P < 0.01). For endoscopists with an adequate ADR, median (interquartile range) ADR was 43 % (32.0 % - 48.6 %), median SDR was 8.4 % (7.3 % - 11.4 %), and median AADR was 9.3 % (6.4 % - 12.6 %). A significant percentage of endoscopists have either a low SDR or low AADR despite an adequate ADR, justifying the need for separate SDR and AADR benchmarks. Based on our multicenter cohort, endoscopists with adequate ADRs had a median SDR and median AADR of about 8 % and 9 %, respectively.

Location of colorectal adenomas and serrated polyps in patients under age 50.

The incidence of colorectal cancer, especially located in distal colorectum, is rising markedly in young patients. Conventional adenomas and serrated polyps have been widely recognized as precursors of colorectal cancer. To investigate the correlation of polyp feature with polyp location in patients under age 50. Patients under age 50 who had received colonoscopy were included from 2010 to 2018. Clinical data including number, location, size, and histopathology of polyps were collected. Odd ratios and 95% confidence interval of adenomas with their location were calculated. In total, 25,636 patients aged 18-49 were enrolled, among which 4485 patients had polyps, with polyp detection rate of 17.5%. A total of 2484 and 2387 patients had conventional adenomas and serrated polyps, respectively. 76.0% advanced adenomas and 69.5% ≥ 10-mm serrated polyps were located in the distal colorectum. The detection rate of advanced adenomas was higher in patients aged 45-49. Patients with adenomas especially advanced adenomas in the distal colorectum were more likely to have advanced adenoma in the proximal colon. Among patients under age 50, advanced adenomas and ≥ 10-mm serrated polyps were predominantly in the distal colorectum. Advanced adenomas tended to be found in patients aged 45-49. Our results might explain the rising trend of distal colorectal cancer and emphasize the necessity for colonoscopy screening among these populations.

Multidirectional Colonoscopy Quality Improvement Increases Adenoma Detection Rate: Results of the Seoul National University Hospital Healthcare System Gangnam Center Colonoscopy Quality Upgrade Project (Gangnam-CUP).

To prevent colorectal cancer, high-quality colonoscopy is advocated, undertaken by endoscopists with high adenoma detection rates (ADRs). Despite reports that various factors may impact ADRs, the significance of such factors is still unclear. The analysis was aimed at quality-oriented interventions for boosting ADRs. Study enrollees were adults subjected to screening colonoscopy between September 2013 and August 2016 at the Gangnam Center of Seoul National University Hospital Healthcare System. The investigation entailed six periods (P1-6) of 6months each, during which serial multidirectional quality improvement efforts were instituted. In particular, we sought to further educate endoscopists, provide feedback on individual ADRs, and introduce a split-dose regimen, gauging results via the Boston Bowel Preparation Score. Changes in polyp detection rates (PDRs) and ADRs were then analyzed. A total of 13,430 colonoscopies were undertaken by 15 experienced endoscopists. Overall, the ADR increased from 45.6% (P1) to 48.2% (P6, p < 0.001). The PDR, ADR, and advanced adenoma detection rate (AdvADR) showed the greatest increases between P3 and P4 [PDR 67.8% → 71.2% (p < 0.001); ADR 44.1% → 47.7% (p = 0.001); AdvADR 2.3% → 3.3% (p = 0.028)] in keeping with the introduction of a split-dose regimen. The sessile serrated adenoma detection rate (SSADR) increased substantially from 2.1% (P1) to 7.9% (P6, p < 0.001), with the largest gain between P1 and P2, just after education (p = 0.023). Successful quality improvement in colonoscopy was achieved through comprehensive multidirectional efforts in education, feedback, and enhanced bowel preparation. Achieving high-level bowel preparation was paramount in ADR improvement. The SSADR was improved through education.

Analysis of colorectal cancer screening results in Kunming from 2014 to 2017

This study analyzed the distribution of high-risk population, the compliance and detected lesions of colorectal cancer screening from the Cancer Screening Program in urban areas of Kunming,Yunnan Province from 2014 to 2017. A total of 127 960 residents were included,of which 14 791 (11.70%) cases were diagnosed with high risk of colorectal cancer by the National Cancer Center High Risk Population Assessment System. A total of 3 484 cases completed colonoscopy clinical screening and the rate of participation was 23.55%. The screening results showed that 592 positive cases were detected, and the positive rate was 17.17%. The detection rates of polyps,adenomas,advanced adenomas,precancerous lesions and colorectal cancer were 16.27%,13.12%,7.18%,7.63% and 0.26%, with 567, 457, 250, 266 and 9 cases, respectively.

Quality of Preoperative Colonoscopy Affects Missed Postoperative Adenoma Detection in Colorectal Cancer Patients.

Despite thorough preoperative screening, 19-30% of synchronous polyps or adenomas are detected after colon cancer surgery. Remnant synchronous lesions require additional colonoscopy procedures or surgery. To investigate factors of preoperative colonoscopy potentially affecting the detection of missed lesions in patients subjected to colorectal cancer surgery. Of 1147 colorectal cancer patients subjected to curative open or laparoscopic colectomy and colonoscopy at the Chungnam National University Hospital from January 2012 to December 2016, 518 patients underwent pre- and postoperative colonoscopy. The index colonoscopy was defined as the last preoperative endoscopy performed. We analyzed pre- and postoperative medical charts for colonoscopy and pathological data. The effects of patient, procedure, and tumor factors on the postoperative adenoma detection rate, advanced adenoma detection rate, and adenoma miss rate (AMR) were analyzed. The overall AMR was 25.7% (95% confidence interval, 22.2-29.8%). Comparing optimal and non-optimal bowel preparation groups, the latter had greater postoperative polyp missed rate (PMR), AMR (p < 0.01), and AAMR (p = 0.272). The optimal preparation group allowed identification of more synchronous adenomas than in the fair (OR 5.72) and poor (OR 11.39) preparation groups. On univariate analysis, patient age and left-sided colectomy (p < 0.01) influenced AMR. Multivariate analysis showed that age, preoperative bowel preparation, and left colon resection influenced postoperative AMR. A better quality of index colonoscopy had a positive effect on lowering the detection rate of postoperative adenoma. Older age and suboptimal bowel preparation at the index colonoscopy and left-sided colectomy had negative effects on lowering the postoperative AMR.

Training interventions to improve adenoma detection rates during colonoscopy: a systematic review and meta-analysis.

Colonoscopies are effective means of detecting and removing precancerous adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy quality and an independent predictor of colorectal cancer incidence. Focused training interventions may improve an endoscopist's ADR, but the supporting research is limited. This systematic review and meta-analysis identified, critically appraised, and meta-analyzed data from randomized trials (RCTs) evaluating the effect of training interventions on ADRs. Ovid Medline, EMBASE, CENTRAL, Eric, CINAHL, Scopus, Web of Science, and ClinicalTrials.gov were searched for RCTs investigating the effect of an educational intervention on ADRs. Two reviewers independently screened, identified, and extracted trial-level data. Internal validity was assessed in duplicate using the Risk of Bias tool. Our primary outcome was the ADR. Secondary outcomes were advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were post-polypectomy bleeding rate and colonoscopy-related perforation rate. From 2837 screened citations, we identified 3 trials (119 endoscopists) meeting our inclusion criteria. Training interventions were associated with a trend toward increased ADRs (odds ratio 1.16, 95% confidence interval (CI) 1.00-1.34; I2 83%; 3 trials; 119 endoscopists). When limited to screening colonoscopies, the odds ratio for ADRs associated with training interventions was 1.17 (95% CI 1.00-1.36; I2 80%; 3 trials; 119 endoscopists). There was a high level of heterogeneity between the trials' training interventions. Training intervention improved the advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were not reported. A focused training intervention was associated with a strong trend toward increased ADRs among certified endoscopists. While the described training interventions definitely show promise, further efforts around continuing professional developments activities are needed to more consistently improve ADRS among certified endoscopists.

551 Comparing Advanced Adenoma Detection Rate of Water Exchange, Cap, and Endocuff Colonoscopy: Pooled Data of Randomized Controlled Trials With Air Insufflation as the Common Comparator

INTRODUCTION: Advanced adenomas, defined as adenomas ≥10mm, significant villous features (&gt;25%), or high-grade dysplasia, are important targets for colorectal cancer screening. They represent the subpopulation of adenomas that are most likely to progress into carcinoma and are associated with increased risk for future CRC incidence. Advanced adenoma detection rate (AADR) is therefore an important measure in assessing new screening methods. Water exchange (WE) colonoscopy has been shown to improve AADR consistently while modern accessories, such as cap and endocuff, have variable impacts on AADR. We assessed the impact on AADR between WE, cap and Endocuff by indirect comparison with standard air insufflation (AI) as the common comparator. METHODS: A literature search was done to identify all relevant RCTs comparing WE, Cap and Endocuff with AI colonoscopy published since 2000 as full text in English and included AADR among the outcomes. EMBASE, Medline, SCOPUS, and Cochrane Library were searched systematically using the following terms in their titles, abstracts, or keyword lists: colonoscopy, and water exchange, cap, or Endocuff. Two investigators screened the articles manually and separately. The results were compared, and a discussion was held with a third investigator to resolve any discrepancies. RESULTS: 1,453 articles resulted from keywords search and were manually screened. 14 RCTs met criteria and were included in the analysis. A total of 12,085 subjects underwent AI, WE, cap (CC) or Endocuff-assisted (EC) colonoscopy. AADR of WE, CC, and EC were compared against AI. Table 1 shows that WE significantly increases AADR compared to AI (8.1% vs 6.0%, P = 0.0001, Fisher exact test). CC does not significantly change AADR compared to AI (8.7% vs 8.2%, P = 0.585). No significant difference in AADR exists between EC and AI (16.6% vs 17.0%, P = 0.815). AADR in WE, CC, and EC as a percentage change of AI are 35.0%, 6.1% and -2.4%, respectively. While WE significantly increases AADR, CC and EC do not significantly impact AADR. Compared to CC and EC, WE has a higher percentage increase in AADR (vs the common comparator of AI). This may be related to the low AADR in the AI group in the WE trials. CONCLUSION: WE appears to significantly increase AADR, especially in patient cohort with lower AADR. Cap and Endocuff does not have significant impact on AADR.

315 Can Adenoma Detection Rates Predict a Benchmark for Serrated Polyp and Advanced Adenoma Detection Rates in a Diverse Urban Population?

INTRODUCTION: Adenoma detection rate (ADR) benchmark of &gt;25% has been shown to reduce interval colorectal cancer (CRC). Serrated polyp detection rate (SDR) and advanced adenoma detection rate (AADR) can also serve as additional benchmarks to reduce interval CRC, although a standardized benchmark for AADR and SDR doesn’t exist. Recent studies have shown correlation between ADR, SDR and AADR, but in a homogenous patient population. Our study evaluated the correlation between ADR, SDR and AADR and approximated a benchmark for SDR and AADR in a diverse urban population, while attempting to identify any patient variables affecting detection rates. METHODS: We reviewed screening colonoscopies performed at our midwest urban, safety-net health care system over a period of one year (2017). We calculated ADR, SDR and AADR for individual providers and established correlation using non-parametric Spearman correlation coefficients between the 3 entities. Logistic regression analysis was used to calculate predictors of adenomas, advanced adenomas and serrated polyps. RESULTS: Of the 3000 colonoscopies reviewed, 1488 were screening colonoscopies performed by 9 experienced staff gastroenterologists. The patient population included 48% African-Americans, 42% Caucasians, and 10% others. Median (Interquartile range) ADR of all providers was 42.5 (27-61), SDR 8.4 (3.6-23), and AADR was 2.9 (0.6-4.8). All providers had an overall ADR above 25%. There was a weak positive correlation for ADR and SDR (rho = 0.13), and ADR and AADR (rho = 0.13). Logistic regression analysis identified male gender (P &lt; 0.01) and body mass index (P = 0.02) as predictors of adenomas, while longer withdrawal time was a significant predictor for all types of polyps. We did not find statistical significance for gender or body mass index and SDR. CONCLUSION: Based on our study, previously suggested benchmark SDR of 7% seems appropriate. Our AADR of 2.9 was lower than suggested AADR of &gt;6%. Additionally, a weak positive correlation was noted between ADR and SDR, and ADR with AADR although the patient population was heterogeneous and diverse making the results more generalizable for the real world.

Younger Physicians and Longer Withdrawal Times Are Associated With Detection of Advanced Neoplasia in a Large Community Practice

Studies assessing colonoscopic practice have demonstrated variation in adenoma detection rate,1 detection rates of advanced adenomas,2,3 and detection rates of sessile serrated lesions (SSLs).4,5 Our aims were to study the patient-, provider-, and procedure-level variables associated with detection rates of adenoma, SSLs, and advanced neoplasia in screening colonoscopies performed in large community practice.

The impact of full-spectrum endoscopy on pathological lesion detection in different regions of the colon: a randomised, controlled trial

IntroductionColonoscopy is crucial for detecting and localising pathological lesions within the colon. Colonoscopy quality is defined by the caecal intubation rate, withdrawal time, adenoma detection rate, and polyp detection rate. The newly introduced full-spectrum endoscope (FUSE®) provides a 330° field of view, allowing endoscopists to observe more colonic anatomy. It is intended to increase detection of pathological lesions, especially those situated behind the haustral folds of the bowel. This diagnostic modality should increase the adenoma detection rate (ADR), especially in the right hemicolon. The aim of this study was to explore the efficacy of FUSE for detecting pathologic lesions in different colonic regions.Material and methodsThe study enrolled 408 patients who were randomised to either a standard frontal view (SFV) or the novel full-spectrum colonoscopy. Analysis was performed among three broad regions of the colon: right, transverse, and left colon, according to the Boston Bowel Preparation Scale.ResultsFUSE yielded a higher diverticula detection rate (DDR) in the right and middle colon (DDR-R (p < 0.05), DDR-T (p < 0.05), DDR-L (p = 0.862)). ADR (p = 0.761), advanced ADR (aADR) (p = 0.950), and DDR (p = 0.967) in respective regions of the colon were similar between the groups; however, the total number of adenomas detected with FUSE was higher in the right and middle regions of the colon compared with those detected by SFV (p < 0.05).ConclusionsFull-spectrum colonoscopy allows for effective recognition of pathological lesions in the right and middle regions of the colon. Although full-spectrum colonoscopy did not statistically affect ADR, the absolute number of adenomas detected was higher compared with classical endoscopy.

Impact of adenoma detection rate on detection of advanced adenomas and endoscopic adverse events in a study of over 200,000 screening colonoscopies

Adenoma detection rate (ADR) is the best established quality parameter for screening colonoscopy. Guidelines recommend a target ADR >25% because previous studies have shown that patients of endoscopists with higher ADRs have a lower risk of postcolonoscopy interval cancers. However, studies have shown that improvement in ADR mainly results in increased detection of clinically irrelevant nonadvanced adenomas (NAAs). The impactof ADR on the detection of advanced adenomas (AAs) as well as adverse event rates has yet to be determined. A total of 218,193 screening colonoscopies performed between 2007 and 2010 by 262 endoscopists within the Austrian quality assurance program were analyzed. We divided endoscopists into quintiles based on ADRs and calculated mean advanced ADRs (AADRs), NAA detection rates (NAADRs), and adverse event rates for each quintile. Spearman rank-order was used to calculate overall correlations between ADRs and AADRs as well as adverse event rates. Endoscopists with an ADR<25% were compared with those with an ADR >25%. Fifty-one percent of patients were women. Mean ADR was 23.03% (95% confidence interval [CI], 21.93-24.13), AADRs 7.72% (95% CI, 7.19-8.25), and NAADRs 15.31% (95% CI, 14.36-16.27). Overall, there was a significant correlation between ADR and AADR (rho= .51; P< .001). When ADR was divided into quintiles, mean AADR increased with increasing ADR. Even in the highest ADR group (ADR, 31.36%-52.27%) there was a further increase in AADR with a mean of 10.75% (95% CI, 9.31-12.19). Importantly, NAADRs increased continuously with improvement in ADRs but never dissociated from a simultaneous improvement in AADRs. However, there was also a significant correlation of ADRs and endoscopic adverse events (rho= .26, P< .001), even if the perforation rate of .028% (95% CI, .004-.052) in the highest ADR group still remained within the accepted limits based on guidelines. Increasing ADR is associated with improved detection of AAs and therefore is likely to prevent more cases of colorectal cancer. However, higher ADR was also associated with a higher rate of adverse events, although the adverse event rate was low.