Proximal Serrated Polyp Detection Rate Research Articles

Comparison of adenoma detection rate and proximal serrated polyp detection rate and their effect on post-colonoscopy colorectal cancer mortality in screening patients.

Patients with serrated polyps are at increased risk for post-colonoscopy colorectal cancer (PCCRC); however, evidence for a dedicated serrated polyp detection rate is lacking. The aim of this study was to investigate the association of the proximal serrated polyp detection rate (PSDR) and adenoma detection rate (ADR) with PCCRC death. This was a retrospective analysis within the Austrian quality assurance program for screening colonoscopy. Spearman's rank coefficient was calculated for the assessment of association between ADR and PSDR. Whether ADR or PSDR were associated with colorectal cancer mortality was assessed by Cox proportional hazards model. 229/729 screening colonoscopies performed by 308 endoscopists were analyzed. The ADR (hazard ratio [HR] per 1 percentage point increase 0.98, 95 %CI 0.96-0.99) as well as the PSDR (HR per 1 percentage point increase 0.97, 95 %CI 0.94-0.99) were significantly associated with PCCRC death. The correlation coefficient of the ADR and PSDR calculated at every colonoscopy was 0.70 (95 %CI 0.70-0.71), and the corresponding PSDR value for an ADR performance standard of 25 % was 11.1 %. At the end of the study period, 86 endoscopists (27.9 %) reached an ADR of > 25 % and a PSDR of > 11.1 %. The ADR as well as the PSDR were associated with PCCRC death. Striving for a high PSDR in addition to a high ADR might reduce the risk for PCCRC mortality in patients undergoing screening colonoscopy.

Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study

Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy and is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. However, interval post-colonoscopy colorectal cancers frequently develop from serrated polyps, which are not included in the ADR. Therefore, the proximal serrated polyp detection rate (PSPDR) has been proposed as a quality indicator, but its association with interval post-colonoscopy colorectal cancer has not been studied. We aimed to evaluate this potential association based on data collected in the Dutch colorectal cancer screening programme. In this population-based study, using colonoscopy data from the Dutch faecal immunochemical test-based colorectal cancer screening programme and cancer data from the Netherlands Cancer Registry, we evaluated the association between endoscopists' individual PSPDR and their patients' risk of interval post-colonoscopy colorectal cancer with a shared frailty Cox proportional-hazard regression analysis. Participants in the screening programme who were eligible for inclusion were aged 55-76 years, had a positive faecal immunochemical test (cutoff 15 μg Hb/g faeces at start and changed mid-2014 to 47 μg Hb/g faeces), were asymptomatic, and underwent a colonoscopy between Jan 1, 2014, and Dec 31, 2020. The PSPDR was defined as the proportion of colonoscopies in which at least one serrated polyp proximal to the descending colon was detected, confirmed by histopathology. The ADR was defined as the proportion of all colonoscopies in which at least one conventional adenoma was detected, confirmed by histopathology. Detection rates were determined for each endoscopist individually. We additionally evaluated the risk of interval post-colonoscopy colorectal cancer for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median. This study is registered with the Netherlands Trial Registry, NL8350. During the study period, 329 104 colonoscopies were done, of which 277 555, done by 441 endoscopists, were included in the PSPDR calculations. The median PSPDR was 11·9% (IQR 8·3-15·8) and median ADR was 66·3% (61·4-69·9). The correlation between the PSDPR and ADR was moderate (r=0·59; p<0·0001). During a median follow-up of 33 months (IQR 21-42), 305 interval post-colonoscopy colorectal cancers were detected. For each percentage point increase in PSPDR, the adjusted interval post-colonoscopy colorectal cancer hazard was 7% lower (hazard ratio [HR] 0·93, 95% CI 0·90-0·95; p<0·0001). Compared with endoscopists with a PSPDR greater than 11·9% and ADR greater than 66·3%, the HR of interval post-colonoscopy colorectal cancer for endoscopists with a low PSPDR and high ADR was 1·79 (95% CI 1·22-2·63), for endoscopists with a high PSPDR and low ADR was 1·97 (1·19-3·24), and for endoscopists with a low PSPDR and low ADR was 2·55 (1·89-3·45). The PSPDR of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. Implementation of PSPDR monitoring, in addition to ADR monitoring, could optimise colorectal cancer prevention. None.

Serrated polyp detection rate in colonoscopies performed by gastrointestinal fellows.

Clinically significant serrated polyp detection rate (CSSDR) and proximal serrated polyp detection rate (PSDR) have been suggested as the potential quality benchmarks for colonoscopy (CSSDR = 7% and PSDR = 11%) in comparison to the established benchmark adenoma detection rate (ADR). Another emerging milestone is the detection rate of lateral spreading lesions (LSLs). This study aimed to evaluate CSSDR, PSDR, ADR, and LSL detection rates among gastrointestinal (GI) fellows performing a colonoscopy. A secondary aim was to evaluate patient factors associated with the detection rates of these lesions. A retrospective review of 799 colonoscopy reports was performed. GI fellow details, demographic data, and pathology found on colonoscopy were collected. Multiple logistic regression analysis was performed to identify the factors associated with CSSDR, PSDR, ADR, and LSL detection rates. A p value < 0.05 was considered statistically significant. For our patient population, the median age was 58 years; 396 (49.8%) were male and 386 (48.6%) were African American. The 15 GI fellows ranged from first (F1), second (F2), or third (F3) year of training. We found an overall CSSDR of 4.4%, PSDR of 10.5%, ADR of 42.1%, and LSL detection rate of 3.2%. Female gender was associated with CSSDR, while only age was associated with PSDR. GI fellow level of training was associated with LSL detection rate, with the odds of detecting them expected to be four times higher in F2/F3s than F1s. Although GI fellows demonstrated an above-recommended ADR and nearly reached target PSDR, they failed to achieve target CSSDR. Future studies investigating a benchmark for LSL detection rate are needed to quantify if GI fellows are detecting these lesions at adequate rates.

Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature.

Background and study aims Sessile serrated lesion (SSL) detection rate has been variably reported and unlike adenoma detection rate (ADR) is not currently a quality indicator for screening colonoscopy. Composite detection rates of SSL in patients undergoing average risk screening colonoscopy are not available. Methods Electronic database search (Medline, Embase and Cochrane) was conducted for studies reporting detection rates of serrated polyps (SSL, Hyperplastic polyp, traditional serrated adenoma) among average risk subjects undergoing screening colonoscopy. Primary outcomes were pooled SDR (SSL detection rate) and proximal serrated polyp detection rate (PSPDR). Pooled proportion rates were calculated with 95 %CI with assessment of heterogeneity (I 2 ). Publication bias, regression test and 95 %prediction interval were calculated. Results A total of 280,370 screening colonoscopies among average risk subjects that were eligible with 48.9 % males and an average age of 58.7 years (± 3.2). The pooled SDR was available from 16 studies: 2.5 % (1.8 %–3.4 %) with significant heterogeneity (I 2 = 98.66 %) and the 95 % prediction interval ranging from 0.6 % to 9.89 %. When analysis was restricted to large (n > 1000) and prospective studies (n = 4), SDR was 2 % (1.1 %–3.3 %). Pooled PSPDR was 10 % (8.5 %–11.8 %; 12 studies). There was evidence of publication bias ( P < 0.01). Conclusion Definitions of SSL have been varying over years and there exists significant heterogeneity in prevalence reporting of serrated polyps during screening colonoscopy. Prevalence rate of 2 % for SSL and 10 % for proximal serrated polyps could serve as targets while robust high-quality data is awaited to find a future benchmark showing reduction in colorectal cancer arising from serrated pathway.

PROXIMAL SERRATED POLYP DETECTION RATE: A COMPLEMENTARY QUALITY INDICATOR FOR ADENOMA DETECTION RATE?

The effectiveness of colonoscopy for colorectal cancer (CRC) screening depends on quality indicators, which adenoma detection rate (ADR) being the most important. Proximal serrated polyp detection rate (pSPDR) has been studied as a potential quality indicator for colonoscopy. The aim is to analyze and compare the difference in ADR and pSPDR between patients undergoing screening colonoscopy and an unselected population with other indications for colonoscopy, including surveillance and diagnosis. This is a historical cohort of patients who underwent colonoscopy in the digestive endoscopy service of a tertiary hospital. Out of 1554 colonoscopies performed, 573 patients were excluded. The remaining 981 patients were divided into two groups: patients undergoing screening colonoscopy (n=428; 43.6%); patients with other indications including surveillance and diagnosis (n=553; 56.4%). Adenoma detection rate of the group with other indications (50.6%) was higher than that of the screening group (44.6%; P=0.03). In regarding pSPDR, there was no difference between pSPDR in both groups (screening 13.6%; other indications 13.7%; P=0.931). There was no significant difference in the mean age (P=0.259) or in the proportion of men and women (P=0.211) between both groups. Proximal serrated polyp detection rate showed an insignificant difference between groups with different indications and could be used as a complementary indicator to adenoma detection rate. This could benefit colonoscopists with low colonoscopy volume or low volume of screening colonoscopies.

S3119 Detection Rates of Adenoma, Clinically Significant Serrated Polyp, Proximal Serrated Polyp, and Laterally Spreading Tumors in Gastrointestinal Medicine (GI) Fellows

INTRODUCTION: Adenoma detection rate (ADR) is a widely accepted benchmark on quality for screening colonoscopy with studies suggesting 25% goal detection rates. Newer quality metrics like clinically significant serrated polyp detection rates (CSSDR) and proximal serrated polyp detection rates (PSDR) are being evaluated with suggested benchmarks of 7% and 11% respectively. CSSDR is defined as ≥1 sessile serrated adenoma or polyp, traditional serrated adenoma, hyperplastic polyp (HP) ≥ 1cm anywhere in the colon or any HP ≥ 5mm proximal to the sigmoid. PSDR is defined as a serrated polyp of any size proximal to the sigmoid colon. Another emerging milestone is the detection rate of laterally spreading tumors (LSTs). In this study, we evaluated the ADR, CSSDR, PSDR, and LSTs detection rates among GI fellows. METHODS: A retrospective analysis of 795 screening colonoscopy reports was performed at an urban academic hospital. The demographic data, GI fellow training years, and pathology results were collected by chart review. Statistical analysis using multiple linear regression models were used to evaluate effects of categorized covariates and logistic regression models to examine factors associated with ADR, CSSDR, PSDR, and LSTs. RESULTS: For our patient population, median age was 58, 49.8% were males, 46.3% Caucasians and 48.6% African Americans. 27.3% colonoscopies were done by first year fellows (F1s) and the rest by upper level fellows (ULs). Overall detection was 42.1% for ADR, 4.4% for CSSDR, 10.5% for PSDR, and 3.2% for LSTs. Between F1s and ULs, there was no statistical significance in ADR, CSSDR and PSDR. Detection of LSTs, however, showed trend toward significance with 0.9% detection rate in F1s and 4.0% in ULs (P = 0.05). The odds of detecting LSTs are expected to be 4 times higher for ULs compared to F1s (OR = 4.37, P = 0.048). CONCLUSION: In our study, GI fellows met the quality measure with an ADR of 42.1%. PSDR of 10.5% was comparable to the reported 11% in previous studies. CSSDR of 4.4% did not meet the 7% suggested by previous studies. The ability to detect ADR, CSSDR and PSDR did not significantly change between levels of training. The borderline significance of training level on LST detection rate could be attributed to more awareness of these lesions and higher volume of colonoscopies performed by upper levels. Similar studies in the future can help GI programs prioritize education in detecting these subtypes of polyps to improve screening.

Are adenoma and serrated polyp detection rates correlated with endoscopists’ sensitivity of optical diagnosis?

We performed an exploratory post-hoc analysis of the DISCOUNT-2 study, including complete colonoscopies after a positive fecal immunochemical test (FIT) performed by endoscopists who performed ≥ 50 colonoscopies. The correlations between the ADR, PSPDR, and the sensitivity of optical diagnosis were calculated using Pearson's rho correlation coefficient. 24 endoscopists performed ≥ 50 colonoscopies, resulting in a total of 2889 colonoscopies. The overall ADR was 84.5 % (range 71.4 % - 95.3 %) and overall PSPDR was 13.7 % (4.3 % - 29.0 %). The sensitivity of optical diagnosis for adenomas and serrated polyps were 94.5 % (83.3 % - 100 %) and 74.0 % (37.5 % - 94.1 %), respectively. No correlation could be demonstrated between the ADR and the sensitivity of optical diagnosis for adenomas (-0.20; P = 0.35) or between the PSPDR and the sensitivity of optical diagnosis for serrated polyps (-0.12; P = 0.57). In a homogeneous FIT-positive population, no correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps could be demonstrated. These exploratory results suggest that lesion detection and differentiation require different endoscopic skills. Further prospective studies are needed; until then, monitoring of both performance indicators is important to secure optimal efficacy of FIT-based colorectal cancer screening.

Simple proxies for detection of clinically significant serrated polyps and data for their benchmarks.

Serrated polyp detection rate (SDR) is a potential quality indicator for preventing colorectal cancer associated with the serrated pathway. Using clinically significant SDR (CSSDR) has been suggested based on clinically significant serrated polyp's ability to be colorectal cancer precursors. Correlations between CSSDR and simpler SDRs, other than proximal SDR, have not yet been studied. We aimed to investigate which simpler SDR indicator is most relevant to CSSDR or adenoma detection rate (ADR) and provide benchmark data. We analyzed 26627 colonoscopies performed by 30 endoscopists. Clinically significant serrated polyps were defined as any sessile serrated adenoma/polyp or traditional serrated adenoma, hyperplastic polyps≥5mm in the proximal colon, or hyperplastic polyps≥10mm anywhere in the colon. Correlation of CSSDR and ADR with other simple SDRs, SDR-pathology (sessile serrated adenoma/polyp or traditional serrated adenoma), SDR-size (≥10mm), and SDR-location (proximal location) was analyzed using Pearson's correlation test and Steiger's z-test. The CSSDR was 1.7% to 13.2% (mean=6.1%). The correlation coefficient of CSSDR/SDR-size was 0.91 (P<0.01), which was higher than that of CSSDR/SDR-location (0.64, P<0.01) (0.91 vs 0.61, P<0.01). The correlation coefficient of ADR/CSSDR and ADR/SDR-location was 0.41 (P<0.01) and 0.81 (P<0.01), respectively. For ADR≥25%, endoscopists' median screening CSSDR was 5.4%, while SDR-location and SDR-size were 10.9% and 2.2%, respectively. Large SDR could be a simple proxy for CSSDR, in addition to proximal SDR. Large SDR and proximal SDR benchmarks of 2.2% and 10.9% may guide adequate serrated polyp detection with uniform definitions and simpler calculations.

Significant Variation in the Detection Rates of Proximal Serrated Polyps Among Academic Gastroenterologists, Community Gastroenterologists, and Colorectal Surgeons in a Single Tertiary Care Center.

Recent studies have demonstrated that the protective effect of colonoscopy against colorectal cancer is lower in the proximal colon. Proximal serrated polyps, including sessile serrated adenomas and proximal hyperplastic polyps, can be frequently missed and pose a risk of interval cancers. To investigate the overall adenoma detection rate (ADR) and the proximal serrated polyp detection rate (PSPDR) among academic gastroenterologists, community gastroenterologists, and colorectal surgeons from a single institution, all of whom have received formal training in colonoscopy during their fellowship. All complete screening colonoscopies for patients aged 50 or older with a good to excellent bowel preparation performed by different endoscopists at Medstar Washington Hospital Center (Washington, DC) from July 2015 to December 2017 were reviewed. Pathology reports of the resected polyps were manually reviewed. A total of 2850 screening colonoscopies meeting the inclusion criteria were performed by 18 endoscopists (6 academic, 7 community, and 5 colorectal surgeons). There was no significant difference in the mean ADR among the three groups of endoscopists: academic gastroenterologists, community gastroenterologists, and colorectal surgeons (40.3% vs 36.0% vs 39.6%, respectively). However, academic gastroenterologists had a significantly higher PSPDR compared to community gastroenterologists or colorectal surgeons (12.3% vs 5.4% vs 4.5%, respectively, ANOVA p = 0.006). Our novel data show that academic gastroenterologists had a significantly higher PSPDR compared to community gastroenterologists or colorectal surgeons despite a comparable overall ADR among the three groups. PSPDR may be considered as an important quality indicator for colonoscopy, apart from ADR.

Detection of proximal serrated polyps: a single-center retrospective analysis

Objective To investigate the prevalence and endoscopic detection rate of proximal serrated polyps and to screen the risk factors. Methods The data of 9 010 colonoscopies performed by 22 endoscopists between September 2016 and September 2017 were reviewed. The adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSDR) were calculated, and the correlation between ADR and PSDR was estimated by Pearson correlation coefficients. Multivariate logistic regression was used to analyze PSDR among endoscopists. Results For all subjects, the mean ADR was 30.07% (ranged from 20.00% to 40.78%) and mean PSDR was 4.70% (ranged from 1.52% to 9.28%). PSDR of males was 1.38 times of that of females (OR=1.38, 95%CI: 1.13-1.69, P<0.01). For 3 560 cases (39.51%) of 50 years and older subjects, the mean ADR was 45.01% (28.99%-57.78%) and mean PSDR was 6.08% (2.07%-10.56%). PSDR was moderately correlated with ADR (r=0.48, P=0.02). PSDR of males was 1.36 times of that of females (OR=1.36, 95%CI: 1.04-1.80, P=0.03). Endoscopist was a significant risk factor for detection of proximal serrated polyps (P<0.01). Compared with endoscopist with the highest PSDR, odds ratio of other endoscopists ranged from 0.16 (95%CI: 0.06-0.40, P<0.01) to 0.83 (95%CI: 0.53-1.32, P=0.44). Conclusion Proximal serrated polyps are more common in males, who are over 50 years old. The PSDR is highly variable and dependent on endoscopists. It is possible that a certain proportion of proximal serrated polyps are missed during colonoscopy. Key words: Colonoscopy; Adenoma; Serrated polyps, proximal; Detection rate

Screening Colonoscopy Withdrawal Time Threshold for Adequate Proximal Serrated Polyp Detection Rate.

For adequate adenoma detection rate (ADR), guidelines recommend a mean withdrawal time (MWT) of ≥ 6min. ADR has been shown to correlate strongly with proximal serrated polyp detection rate (PSP-DR), which is another suggested quality measure for screening colonoscopy. However, the impact of directly measured withdrawal time on PSP-DR has not been rigorously studied. We examined the relationship between MWT to ADR and PSP-DR, with the aim of identifying a functional threshold withdrawal time associated with both increased ADR and PSP-DR. This was a retrospective study of endoscopy and pathology data from average-risk screening colonoscopy examinations performed at a large system with six endoscopy laboratories. A natural language processing tool was used to determine polyp location and histology. ADR and PSP-DR were calculated for each endoscopist. MWT was calculated from colonoscopy examinations in which no polyps were resected. In total, 31,558 colonoscopy examinations were performed, of which 10,196 were average-risk screening colonoscopy examinations with cecal intubation and adequate prep by 24 gastroenterologists. When assessing the statistical significance of increasing MWT by minute, the first significant time mark for PSP-DR was at 11min at a rate of 14.2% (p = 0.01). There was a significant difference comparing aggregated MWT < 11min compared to ≥ 11min looking at the rates of adenomas [OR 1.65 (1.09-2.51)] and proximal serrated polyps [OR 1.81 (1.06-3.08)]. While ADR linearly correlated well with MWT (R = 0.76, p < 0.001), the linear relationship with PSP-DR was less robust (R = 0.42, p = 0.043). In this large cohort of average-risk screening colonoscopy, a MWT of 11min resulted in a statistically significant increase in both ADR and PSP-DR. Our data suggest that a longer withdrawal time may be required to meet both quality metrics.

702 - Adenoma Detection Rates Correlate Very Strongly with Proximal Colon Adenoma Detection Rates but not with Proximal Serrated Polyp Detection Rates: A Multicenter Study

702 - Adenoma Detection Rates Correlate Very Strongly with Proximal Colon Adenoma Detection Rates but not with Proximal Serrated Polyp Detection Rates: A Multicenter Study

Impact of differences in adenoma and proximal serrated polyp detection rate on the long-term effectiveness of FIT-based colorectal cancer screening

BackgroundBoth the adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) vary among endoscopists. It is unclear how these variations influence colorectal cancer (CRC) screening effectiveness. We evaluated the effect of variation in these detection rates on the long-term impact of fecal immunochemical test (FIT) based screening.MethodsThe Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model was set up to simulate the Dutch national biennial FIT-based CRC screening program between 2014 and 2044. Adherence to FIT and colonoscopy was 73 and 92%. Besides a ‘no screening scenario’, several screening scenarios varying in ADR and PSPDR were evaluated. Using the available literature on colonoscopy miss rates led to a base-case ADR of 59% and PSPDR of 11%, which were varied with intervals of 3 and 2%.ResultsCompared to no screening, FIT-screening in the base-case scenario reduced long-term mortality with 51.8%. At a fixed PSPDR of 11%, an increase in ADR from 44 to 62% would result in a 10.7% difference in mortality reduction. Using a fixed ADR of 59%, changing the PSPDR from 3 to 15% did not substantially influence long-term mortality (51.0 to 52.3%).ConclusionsAn increase in ADR gradually reduces CRC burden in a FIT-based screening program, whereas an increase in PSPDR only minimally influences long-term outcomes at a population-level. The limited effect of the PSPDR can be explained by the limited sensitivity of FIT for serrated polyps (SPs). Other triage modalities aiming to detect relevant SPs should be explored.

Factors Affecting Proximal Serrated Polyp Detection Rate During Screening Colonoscopy

Introduction: Recently, the serrated polyp-neoplasia pathway has been identified as an alternative to adenoma-carcinoma pathway for the development of sporadic colorectal cancer. It may account for 15-20% of incident colorectal cancers and potentially, majority of the interval cancers. Serrated polyps are frequently flat or sessile, located in the proximal colon and may be overlooked during colonoscopy. In this study, we assessed the factors associated with proximal serrated polyp detection rate (PSPDR) during screening colonoscopy.Table: Table. Factors Affecting Proximal Polyp Detection RateTable: Table. Characteristics of Patients and EndoscopistsMethods: A retrospective review of all screening colonoscopies, in patients ≥50 years of age performed between 2012 and 2014 was done. Patients who had a complete colonoscopy with excellent, good and adequate bowel preparation were included. Serrated polyps included hyperplastic polyps and sessile serrated adenomas. Proximal colon was defined as cecum to splenic flexure. PSPDR according to gender, race (Caucasians vs African Americans), timing of colonoscopy (morning vs afternoon), fellow participation, quality of bowel preparation as per the Aronchick scale (excellent vs. good vs adequate), gender and specialty of the endoscopist (gastroenterologist vs. non-gastroenterologist) was calculated and compared using t-tests. Data are presented as mean ± standard deviation. All analyses were done using SAS (version 9.4, The SAS Institute, Cary, NC) and a P value of <0.05 was considered significant. Results: A total of 4151 patients were included in the analysis. Average patient age was 60.0±7.7 years and 53.2% patients were females. 63.5% physicians were gastroenterologists and 36.5% were nongastroenterologists. Average PSPDR was 6.1±5.5%. Caucasians had significantly higher PSPDR than African Americans (6.6±6.5 vs 3.2±7.4; P<0.05). A trend of higher PSPDR was observed for gastroenterologists as compared to non-gastroenterologists (P=0.09) and female endoscopists as compared to male endoscopists (P=0.05). Timing of the colonoscopy and fellow participation had no impact on PSPDR. A trend for lower PSPDR was noted in patients with excellent bowel preparation as compared to those with good or adequate bowel preparation. Conclusion: Proximal serrated polyps are more prevalent in Caucasians as compared to African Americans. A trend for higher PSPDR was noted for gastroenterologists and female endoscopists. Interestingly, excellent bowel preparation was associated with lower PSPDR, likely from clearing of the overlying mucous cap.

Serrated Colorectal Neoplasia: From Sideshow to Center Stage

Serrated Colorectal Neoplasia: From Sideshow to Center Stage

Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry

Similar to achieving adenoma detection rate (ADR) benchmarks to prevent colorectal cancer (CRC), achieving adequate serrated polyp detection rates (SDRs) may be essential to the prevention of CRC associated with the serrated pathway. Previous studies have been based on data from high-volume endoscopists at single academic centers. Based on a hypothesis that ADR is correlated with SDR, we stratified a large, diverse group of endoscopists (n= 77 practicing at 28 centers) into high performers and low performers, based on ADR, to provide data for corresponding target SDR benchmarks. By using colonoscopies in adults aged≥50 years (4/09-12/14), we stratified endoscopists by high and low ADRs (<15%, 15%-<25%, 25%-<35%,≥35%) to determine corresponding SDRs by using 2 SDR measures, for screening and surveillance colonoscopies separately: (1) Clinically significant SDR (CSSDR), meaning colonoscopies with any sessile serrated adenoma/polyp (SSA/P), traditional serrated adenoma (TSA), or hyperplastic polyp (HP) >1 cm anywhere in the colon or HP >5mm in the proximal colon only divided by the total number of screening and surveillance colonoscopies, respectively. (2) Proximal SDR (PSDR) meaning colonoscopies with any serrated polyp (SSA/P, HP, TSA) of any size proximal to the sigmoid colon divided by the total number of screening and surveillance colonoscopies, respectively. A total of 45,996 (29,960 screening) colonoscopies by 77 endoscopists (28 facilities) were included. Moderately strong positive correlation coefficients were observed for screening ADR/CSSDR (P= .69) and ADR/PSDR (P= .79) and a strong positive correlation (P= .82) for CSSDR/PSDR (P< .0001 for all) was observed. For ADR≥25%, endoscopists' median (interquartile range) screening CSSDR was 6.8% (4.3%-8.6%) and PSDR was 10.8% (8.6%-16.1%). Derived from ADR, the primary colonoscopy quality indicator, our results suggest potential SDR benchmarks (CSSDR= 7% and PSDR= 11%) that may guide adequate serrated polyp detection. Because CSSDR and PSDR are strongly correlated, endoscopists could use the simpler PSDR calculation to assess quality.

Proximal Serrated Polyp Detection Rate Does Not Differ Among Morning or Afternoon Colonoscopy: Analysis of a Large, Single, High-Volume Center Using Natural Language Processing

Introduction: Proximal Serrated Polyp Detection Rate (PSP-DR) has been shown to correlate with Adenoma Detection Rate (ADR), which is a common quality indicator for effectiveness of colonoscopy. The time of day for colonoscopy and its effect specifically on PSP-DR has not been rigorously studied. We examine differences in PSP-DR and ADR of colonoscopy performed in the morning vs. afternoon. Methods: We retrospectively obtained endoscopy and pathology data from average-risk screening colonoscopy performed at a large healthcare system with six endoscopy labs from Jan 2014 - May 2015. These dates reflect standardized pathology nomenclature to accurately capture PSP-DR. Diagnostic, surveillance, and high-risk screening colonoscopy was excluded from the analysis. A previously validated natural language processing tool was used to determine polyp location and histology (adenoma, sessile serrated polyp, hyperplastic polyp). ADR and PSP-DR were calculated for each endoscopist, with a minimum of 100 colonoscopies performed during the study period. Morning colonoscopy was defined as insertion start time before 12:00PM and afternoon colonoscopies as those that started after 12:00PM. Results: 26,153 total colonoscopy exams were performed by 24 Gastroenterologists, of which 9,987 were screening colonoscopies. Mean ± SD age for the patient population was 60.1 ± 1.7, of which 45.9% were male. 81.2% of procedures were performed in the morning. Characteristics including age, gender, cecal intubation and bowel prep was similar between morning and afternoon cases. Endoscopist insertion (time to cecum) and withdrawal times (time from cecum) were similar as well. Withdrawal time was calculated from colonoscopies in which no polyps were resected. (Table 1) Amongst each individual gastroenterologist, the average rate (95% CI) of PSP-DR was 10.3 (9.7 - 10.9) and ADR was 36.3 (35.3 - 37.2). Rates for AM and PM exams did not differ from each other or the total population. (Table 2).Table 1a: Patient Characteristics and Procedure Times (*Calculated with 4876 Normal Colonoscopies)Table 1b: Individual Endoscopist Detection Rate Averages (95% CI)Conclusion: In our large community-based cohort, our endoscopists surpassed suggested benchmarks for both ADR and PSP-DR, and their performance did not differ between morning and afternoon procedures. Our results accounted for insertion and withdrawal times, population characteristics, and prep quality. These findings suggest that greater lab utilization in the afternoon can be considered without loss of high quality outcomes.

Screening Colonoscopy Withdrawal Time and Proximal Serrated Polyp Detection Rate: Analysis of a Large, Single, High-Volume Center Using Natural Language Processing: ACG Fellows-In-Training Award

Screening Colonoscopy Withdrawal Time and Proximal Serrated Polyp Detection Rate: Analysis of a Large, Single, High-Volume Center Using Natural Language Processing: ACG Fellows-In-Training Award

The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps

The adenoma detection rate (ADR) is the most important surrogate quality parameter for colorectal cancer (CRC) prevention. However, serrated polyps also are precursors of CRC. Large, prospective studies comparing the detection rate of serrated polyps among endoscopists in an era of awareness about the malignant potential of serrated polyps have not yet been performed. We aimed to compare the proximal serrated polyp (PSP) detection rate and the clinically relevant serrated polyp (RSP) detection rate among endoscopists and to analyze the association between these parameters and the ADR. Colonoscopy data were retrieved in one expert center between January 2011 and July 2014 by using a structured reporting system, enabling prospective and automatic quality assessment. Endoscopists who performed at least 50 colonoscopies within the timeframe were included for analysis. Multivariate logistic regression was used to compare the ADR, PSP detection rate, and RSP detection rate among endoscopists. The association among these parameters was calculated by using the Pearson r correlation coefficient. All lesions were assessed by an expert pathologist. In total, 16 endoscopists and 2088 colonoscopies were included for analysis. The PSP detection rate ranged from 2.9% to 18.6% (mean 10.4%) among endoscopists. Corrected for confounders, the odds ratio to detect≥1 PSP, compared with endoscopists with the highest detection rate, ranged from 0.79 (95% confidence interval [CI], 0.41-1.52) to 0.12 (95% CI, 0.03-0.55). The PSP detection rate was highly correlated with the RSP detection rate (ρ 0.94; P< .001), ranging from 4.3% to 20.9% (mean 13.9%). The PSP detection rate moderately correlated with the ADR (0.55; P= .03), which ranged from 23.2% to 49.2% (mean 35.2%). The PSP detection rate is widely variable among endoscopists, strongly correlated with the RSP detection rate, and moderately correlated with the ADR. These results suggest a high miss rate of RSPs among endoscopists with low rates of PSP detection. Future research should determine the association between endoscopists' PSP detection rates and the risk of interval cancer.

Sa1421 Effect of Functional Relaxation on Patients Undergoing Colonoscopy: A Prospective Randomized Controlled Trial

Sa1421 Effect of Functional Relaxation on Patients Undergoing Colonoscopy: A Prospective Randomized Controlled Trial