Sessile Serrated Polyp Detection Research Articles

S0278 Adenoma and Sessile Serrated Detection Rates in Patients Undergoing Screening Colonoscopy Are Higher in Those Prepped With High-Volume Colonic Water Irrigation Than With Standard Oral Bowel Preparations

INTRODUCTION: Adenoma detection rate (ADR) is defined as the percentage of patients age 50 and older, with an average risk for colorectal cancer (CRC) who have adenomas detected on initial screening colonoscopy. ADR is an indicator of the adequacy of colonic preparation and skill level of the colonoscopist. Conventional adenomas have historically been considered to be the only screening-relevant CRC precursor lesion. However, sessile serrated polyps (SSPs) are considered to be a disproportionate contributor to interval CRC (subsequent to a colonoscopy). Quality of colonoscopy is critically dependent on the adequacy of colonic preparation. This study evaluated the adequacy of using high volume colonic water irrigation bowel prep (BP) on the detection rates of neoplastic polyps at the index screening exam. METHODS: ADR and detection rates of SSPs were collected at Austin Gastroenterology (Austin, TX) between October 1, 2018 and June 31, 2019. Study participants included 112 eligible and average risk patients. The high-volume colon irrigation was performed using an FDA-cleared system and under stringent standard operating procedures (SOP) by nurses and technicians trained by the managing operator. The study participants were examined by 18 gastroenterologists. RESULTS: ADRs of patients undergoing high-volume water irrigation BP was 34% in females and 60% in males. The detection rate for SSPs in patients who underwent high-volume water irrigation BP was 12.5%. The average Boston Bowel Prep Score (BBPS) was 8.3 (n = 112). CONCLUSION: When using a high-volume colonic water irrigation BP performed under stringent standard operating procedures the ADRs of patients was 34% in females and 60% for male, significantly exceeding the national guidelines for oral prep, 20% and 30%, respectively. The SSPs detection rate was also higher than the 5%–7% previously recorded in literature. Detection rate of colonic lesions is inversely related to the patient’s post-colonoscopy CRC risk, and improvement in methods and techniques to increase their detection rate will improve patient care. The FDA cleared high-volume colonic water irrigation, has outstanding BBPS scores, ADR, and SSP detection rates. Due to the increased quality of detection of neoplastic polyps, this approach should be considered a prep of choice for improved quality and outcomes.

Patient, Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Practice.

Variability in colon polyp detection impacts patient outcomes. However, the relative influence of physician, patient, and procedure-specific factors on polyp detection is unclear. Therefore, determining how these factors contribute to adenoma and sessile serrated polyp (SSP) detection is important to contextualize measures of colonoscopy quality such as adenoma detection rate and patient outcomes. To determine the relative contribution of physician, patient, and procedure-specific factors in total polyp, adenoma, and SSP detection rates. We performed a retrospective study of patients undergoing screening colonoscopy and used a two-level generalized linear mixed regression model to identify factors associated with polyp detection. 7799 average risk screening colonoscopies were performed between July 2016 and October 2017. The patient factor most strongly associated with increased risk of adenoma and sessile serrated polyp detection was white race (OR 1.21, 95% CI 1.05-1.39 and OR 3.17, 95% CI 2.34-4.30, respectively). Adenomatous (OR 1.92, 95% CI 1.04-3.57) and sessile serrated polyps (OR 5.56, 95% CI 1.37-20.0) were more likely to be found during procedures performed with anesthesia care as compared to those with moderate sedation. Physician with a luminal gastrointestinal focus had increased odds of adenoma detection (OR 1.61, 95% CI 1.02-2.50). In a multi-level model accounting for clustering effects, we identified patient, provider and procedural factors independently influence adenoma and sessile serrated polyp detection. Our findings suggest that to compare polyp detection rates between endoscopists, even at the same institution, risk adjustment by characteristics of the patient population and practice is necessary.

Latest Generation High-Definition Colonoscopy Increases Adenoma Detection Rate by Trainee Endoscopists.

Adenoma detection rate (ADR) is an important quality indicator of colonoscopy. High-definition (HD) colonoscopy has been reported to increase ADR compared to standard-definition (SD) colonoscopy. Although there are few reports comparing the latest generation and the previous generation of HD colonoscopy equipment, there are reports that the latest generation colonoscopy equipment improves ADR. However, there are no reports on the impact of the latest generation HD colonoscopy on the ADR of trainee endoscopists. The aim of this study was to investigate whether the latest generation HD colonoscopy increases the ADR of trainee endoscopists compared with the previous generation HD colonoscopy. We conducted a retrospective review of medical records of patients aged 40-79years old, who underwent screening or surveillance colonoscopy performed by nine gastroenterology fellows at Dong-A University Hospital from March 2019 to February 2020. We calculated the overall ratios of the ADR: the ADRs of the group using the older generation HD colonoscopy equipment and the group using the latest HD colonoscopy equipment. Polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and advanced neoplasia detection rate (ANDR) were calculated for each group. Factors related to adenoma detection were identified using logistic regression analysis. Altogether, 2189 patients were included in the study (the older HD colonoscopy group comprising 1183 and the latest HD colonoscopy group comprising 1006). We found that PDR (45.98 vs. 51.69%, p = 0.008) and ADR (35.67 vs. 40.85%, p = 0.013) were significantly higher in the latest generation HD colonoscopy group. The generational differences were not statistically significant for SSPDR (1.94 vs. 2.78%, p = 0.195) or ANDR (4.65 vs. 4.97%, p = 0.726). In the multivariate regression analysis, age, male sex, the latest generation HD colonoscopy, and long withdrawal time were the most significant factors affecting adenoma detection. The latest generation HD colonoscopy improved PDR and ADR by trainee endoscopists. These findings suggest that latest generation, higher-resolution colonoscopy equipment can improve the quality of colonoscopy for less experienced endoscopists.

Do Water-aided Techniques Improve Serrated Polyp Detection Rate During Colonoscopy?: A Systematic Review With Meta-Analysis.

The utility of water-aided techniques (WT): water exchange (WE) and water immersion (WI) have been studied extensively in the literature for improving colonoscopy outcome metrics such as adenoma detection rate. Serrated polyps owing to their location and appearance have a high miss rate. The authors performed a systematic review and meta-analysis of studies comparing WT with the standard gas-assisted (GA) method to determine if there was any impact on serrated polyp detection rate (SPDR) and sessile serrated polyp detection rate. The following databases were queried for this systematic review: Medline, EMBASE, Cochrane Library, CINAHL, and Web of Sciences. The authors only included randomized controlled trials (RCTs). The primary outcome was SPDR and secondary outcomes were sessile serrated polyp detection rate and cecal intubation rate. Risk ratios (RRs) were calculated for each outcome. A P-value <0.05 was considered to be statistically significant. A total of 4 RCTs (5 arms) with 5306 patients (2571 in the GA group and 2735 in the WT group) were included. The SPDR was significantly increased for the WT group compared with GA (6.1% vs. 3.8%; RR, 1.63; 95% confidence interval, 1.24-2.13; P<0.001; I2=22.7%). A subgroup analysis for WE technique also demonstrated improved SPDR compared with the GA method (4.9% vs. 3.2%; RR, 1.57; 95% confidence interval, 1.15-2.14; P=0.004; I2=6.1%). WT, particularly, the WE method results in improved SPDR. This technique should be encouraged in a clinical setting to detect these polyps to prevent interval colorectal cancer.

Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy

BackgroundThe audit process may help improve performance indicators for colonoscopy quality but it is unclear whether this is sustained over several years.Methods44138 procedures for 28 endoscopists from 2004 to 2019...

Mo1646 IS ENDOSCOPIST PERFORMANCE STABLE ACROSS COLONOSCOPY INDICATIONS AND TYPES OF COLORECTAL CANCER (CRC) PRECURSORS? IMPLICATIONS FOR QUALITY ASSURANCE

The adenoma detection rate (ADR) during first-time screening colonoscopy is inversely correlated with the interval CRC rate, and it has therefore become the key colonoscopy quality performance metric. However, first-time screening is only one of the colonoscopy indications related to CRC prevention and control, a large procedure volume is needed for a precise ADR estimate, and ADR does not measure advanced or sessile serrated polyp (SSP) detection. To explore correlations across detection rates for any and advanced adenomatous polyps and SSPs, and the range of colonoscopy indications related to CRC control. The Stanford Colonoscopy Quality Assurance Program database was queried for Oct,2017–Aug,2019. The database relies on standardized procedure report documentation and standardized pathology result letters. Data for 10 endoscopists whose metrics were not reliable because of known documentation deficiencies were excluded. Correlations (Pearson correlation coefficient, r) were explored between 1) adenoma detection rates during colonoscopies for first-time screening and colonoscopies for: a) screening not first-time, b) post-polypectomy surveillance, and c) family history of CRC; and 2) detection rates at colonoscopies for all these indications combined between any adenoma and: a) SSP, b) advanced adenoma, and c) advanced SSP. A minimum of 10 procedures per category were required for inclusion in a particular analysis. The Table shows the correlation coefficients and p-values. Adenoma detection at colonoscopy for first-time screening was not significantly correlated with adenoma detection at colonoscopy for screening not first-time, surveillance or family history of CRC (Table). When combining colonoscopies with any of the four indications, adenoma detection was correlated with SSP detection (r=0.65, p<0.0001, Figure), but not advanced adenoma or advanced SSP detection (Table). In the current era, ADR over broadened indications beyond first-time screening may also reflect SSP detection, but not necessarily lesion detection during screening not first-time, surveillance or screening for family history of CRC, or advanced lesion detection. The contributions of chance, patient characteristics, or endoscopist performance to these results remain to be determined, including whether endoscopist performance is affected by particular vigilance to ADR during first-time screening. More comprehensive monitoring across the range of colonoscopy indications and lesion types could improve the assessment of endoscopist performance, and possibly improve CRC control efforts.Significant correlation between adenoma and sessile serrated polyp detection rates during colonoscopy for four screening and surveillance indicationsView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mo1695 WATER EXCHANGE (WE) INCREASES SESSILE SERRATED POLYP DETECTION RATE (SSPDR) COMPARED WITH AIR (AI) OR CARBON DIOXIDE (CO2) INSUFFLATION - POOLED DATA ANALYSIS OF FOUR RECENT REPORTS

A net-work meta-analysis (GIE. 2018;88:589) showed water exchange (WE) provided the highest adenoma detection rate (ADR). The impact on sessile serrated polyp detection rate (SSPDR) was not addressed. SSP have increased malignant potential (Curr Treat Options Gastroenterol. 2015;13:156). They have subtle appearance (AJG. 2012;107:1315). They cluster in the proximal colon (61%) (Arch Pathol Lab Med. 2015;139:388) co-localizing with interval cancers (64% to 68%) (Gastro. 2014;146:950; Cancer. 2012;118:3044). The finding of SSPs was mentioned in several RCTs comparing WE with air (AI) or carbon dioxide (CO2) insufflation. We test the hypothesis that compared with air (AI) or carbon dioxide (CO2) insufflation, water exchange (WE) could enhance the real-time detection of SSP. The aim is to assess the impact of WE (vs. AI or CO2) on SSPDR. Four reports with data on SSP and WE vs. AI or CO2 insufflation were identified. Demographic, procedural and SSP data were extracted, pooled and analyzed. By pooling the data in four RCTs the pitfall of type II error due to small sample size could be avoided. Table 1 summarizes the salient demographic and procedural features. Table 2 shows that the pooled SSPDR of WE (8.0%) was significantly higher than that of air or CO2 insufflation combined (5.0%) (p=0.0017, Fisher exact test). The combined data showed WE significantly increased SSPDR by 3%. With an estimated 19 million colonoscopies in the US in 2018 (https://idataresearch.com/an-astounding-19-million-colonoscopies-are-performed-annually-in-the-united-states/), 3.0% of 19 million (570,000) is clinically meaningful. The improved outcomes of increased SSPDR add value to WE colonoscopy. The improved value appears to justify consideration to incorporate WE into colorectal cancer prevention programs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prevalence and Clinical Features of Sessile Serrated Polyps: A Systematic Review

Sessile serrated polyps (SSPs) could account for a substantial proportion of colorectal cancers. We aimed to increase clarity on SSP prevalence and clinical features. We performed a systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases for original studies published in English since 2000. We included studies of different populations (United States general or similar), interventions (colonoscopy, autopsy), comparisons (world regions, alternative polyp definitions, adenoma), outcomes (prevalence, clinical features), and study designs (cross-sectional). Random-effects regression was used for meta-analysis where possible. We identified 74 relevant colonoscopy studies. SSP prevalence varied by world region, from 2.6% in Asia (95% confidence interval [CI], 0-5.9) to 10.5% in Australia (95% CI, 2.8-18.2). Prevalence values did not differ significantly between the United States and Europe (P= .51); the pooled prevalence was 4.6% (95% CI, 3.4-5.8), and SSPs accounted for 9.4% of polyps with malignant potential (95% CI, 6.6-12.3). The mean prevalence was higher when assessed through high-performance examinations (9.1%; 95% CI, 4.0-14.2; P= .04) and with an alternative definition of clinically relevant serrated polyps (12.3%; 95% CI, 9.3-15.4; P < .001). Increases in prevalence with age were not statistically significant, and prevalence did not differ significantly by sex. Compared with adenomas, a higher proportion of SSPs were solitary (69.0%; 95% CI, 45.9-92.1; P= .08), with diameters of 10 mm or more (19.3%; 95% CI, 12.4-26.2; P= .13) and were proximal (71.5%; 95% CI, 63.5-79.5; P= .008). The mean ages for detection of SSP without dysplasia, with any or low-grade dysplasia, and with high-grade dysplasia were 60.8 years, 65.6 years, and 70.2 years, respectively. The range for proportions of SSPs with dysplasia was 3.7%-42.9% across studies, possibly reflecting different study populations. In a systematic review, we found that SSPs are relatively uncommon compared with adenoma. More research is needed on appropriate diagnostic criteria, variations in detection, and long-term risk.

A149 COMPARING THE REAL-WORLD EFFECTIVENESS OF 4L VERSUS 2L SPLIT COLONOSCOPY PREPARATIONS: PRELIMINARY DATA OF A SINGLE CENTRE EXPERIENCE THROUGH THE BRITISH COLUMBIA COLONOSCOPY SCREENING PROGRAM

Abstract Background The British Columbia Colon Screening Program (CSP) is a population-based program offering biennial fecal immunochemical test (FIT) to individuals age 50–74 years with follow-up colonoscopy for a positive FIT as well as individuals with a personal history of neoplastic polyps or a high risk family history of colorectal cancer. Over 20,000 colonoscopies are performed annually. In December 2018, program colonoscopists in Vancouver, Canada agreed to switch from a 2L polyethylene glycol (PEG) preparation to a 4L PEG preparation after studies suggested superiority of the higher volume preparation in achieving adequate bowel cleansing and improving adenoma detection rates (ADR). High quality bowel cleansing is critical to minimize repeat procedures and maximize neoplasia detection. Aims To compare the quality of bowel preparation and neoplasia detection rates using the 4L high volume split preparation (HVSP) versus the 2L low volume split preparation (LVSP) in patients undergoing colonoscopy in the BC CSP. Methods A retrospective review of consecutive patients undergoing colonoscopy through the CSP at St. Paul’s Hospital from Dec 2017-Apr 2018 and Dec 2018-Apr 2019 was conducted. Inclusion criteria included: age 50–74, patients undergoing colonoscopy for any reason through the BC CSP. Variables collected included: patient demographics, bowel preparation qualty and pathologic findings. ADR and sessile serrated polyp detection rate (SSDR) were analyzed. Results 462 colonoscopies were included, 280 in the LVSP group and 182 in the HVSP group. 8/280 (2.9%) had poor bowel preparation in the LVSP group, while 10/182 (5.5%) had poor bowel preparation in the HVSP group. The ADR and SSDR were 53.6% in LVSP vs. 50.0% in HVSP and 8.2% in LVSP vs. 8.8% in HVSP, respectively. Conclusions In this preliminary evaluation, the high volume PEG-based split preparation did not reduce the proportion of inadequate bowel preparations. Further evaluation of a larger number of colonoscopies is planned. Funding Agencies None

Does Colon Polyp Surveillance Improve Patient Outcomes?

Colon polyp surveillance now accounts for 25% of all colonoscopies performed. The evidence that colonoscopy surveillance reduces colorectal cancer (CRC) incidence or mortality is weak. The biology of the baseline lesions and quality of the baseline exam are two primary factors contributing to post-colonoscopy CRC. Prior recommendations for surveillance were based largely on the likelihood that patients with adenomas would develop advanced adenomas, a surrogate for CRC. There is now evidence that baseline colonoscopy findings are strongly associated with the risk of incidence or death from CRC. This evidence provides a basis for updated evidence-based recommendations for surveillance. In addition, there is also growing evidence that the quality of the baseline exam is an important predictor of the likelihood of developing post-colonoscopy CRC.

252 Patient and Provider Risk Factors for Sessile Serrated Polyp and Adenoma Detection on Screening Colonoscopy

INTRODUCTION: Sessile serrated polyps (SSPs) have been increasingly recognized as precursors to colorectal cancer (CRC). Unlike adenoma detection rate (ADR), there is currently no agreed-upon benchmark for SSP detection rate (SSPDR), and data on factors that impact SSP detection are limited. We aimed to identify patient, endoscopist, and procedural factors associated with SSP and adenoma detection. METHODS: We used a single-center electronic endoscopy database to identify all patients ages ≥50 years who underwent outpatient screening colonoscopy from January 1, 2012 to June 30, 2018. We excluded patients with a personal history of inflammatory bowel disease or colorectal neoplasia, or who underwent colonoscopy performed by a provider with fewer than 50 colonoscopies over the study period. Univariate chi-square analysis was used to determine patient, endoscopist, and procedural-related factors associated with SSP or adenoma detection on colonoscopy. RESULTS: We identified 10,538 unique patients who underwent colonoscopy performed by 28 endoscopists. SSPs were detected in 233 cases (2.2%), and adenomas were detected in 3,066 cases (29.1%). On univariate analysis, race and any smoking history were significantly associated with SSP detection (P = 0.044 and P = 0.054, respectively; see Table 1). Higher endoscopist ADR and greater mean withdrawal time were also associated with higher likelihood of SSP detection (P = 0.019 and P = 0.007, respectively). There was a significant trend towards increased SSP detection in colonoscopies performed in more recent years (P &lt; 0.001). While endoscopist gender was not associated with SSP detection on univariate analysis, female endoscopists had significantly higher ADR (35.5%) compared to male endoscopists (28.2%, P &lt; 0.001). ADR for cases with trainees present was 33.6% compared to 28.1% in cases without trainees (P &lt; 0.001). CONCLUSION: In patients undergoing screening colonoscopy, SSPDR was significantly higher in procedures performed by physicians with higher ADR or greater mean withdrawal time, and in procedures performed in more recent years. Patient tobacco use history and race were also associated with SSP detection. These findings may help in establishing SSPDR as a quality metric for screening colonoscopy.

1560 Sessile Serrated Polyposis Syndrome (SPS) and Sessile Serrated Polyps (SSPs): Features, Variations in Detection Rate, and the Associated Risk of Both Synchronous and Metachronous Neoplasia

INTRODUCTION: Colorectal cancer (CRC) is the second most common cancer worldwide, accounting for 8% of all cancer related deaths. Sessile serrated polyposis syndrome (SPS) is a genetically inherited disease. The actual prevalence is unknown but is estimated to be 1 in 2000 to 3000 CASE DESCRIPTION/METHODS: 63 year old female with no family history of colon cancer, presented for a diagnostic colonoscopy after a positive fecal occult blood test (FOBT). FOBT was done for screening purposes. Patient had a negative FOBT X 3 a year ago. Colonoscopy showed 10 polyps. All polyps were resected with different techniques based on size, features and location. All polyps came back as sessile serrated polyps. 6 polyps showed features of cytologic dysplasia. 5 were proximal to the Sigmoid colon (1 was &gt;20 mm in size and 3 were &gt;10 mm in size). DISCUSSION: Based on a growing body of data, sessile serrated polyps (SSPs) have a higher prevalence than previously thought. Whether sporadic or part of the sessile serrated polyposis syndrome (SPS), SSPs are associated with increased risk of synchronous and metachronous neoplasia. A recent study looked at the synchronous burden of large (≥ 20 mm) SSPs in patients without SPS. The study found that 67/146 patients (45.9 %) had SPS, 53/146 (36.3 %) had a solitary SSP, and 26/146 (17.8 %) were categorized as oligo-SSP. Dysplasia in large SSPs was frequent in all groups (41.1 % overall). SPS was recognized by referring endoscopists in only 9.0 % of cases. Patients meeting the World Health Organization criteria who elect long-term endoscopic surveillance should receive annual colonoscopy after the diagnosis is established. Surgery is indicated when CRC is diagnosed or the number of polyps makes endoscopic control unfeasible. White-light endoscopy is considered the gold standard for detection and removal of colorectal lesions to prevent CRC development. However, detection of small adenomas (&lt;5 mm) and SSPs is difficult as conventional endoscopy relies on the experience of the endoscopist. As a result, the reported adenoma detection miss rate for the general population is relatively high (27%). This underscores the necessity of improving endoscopic detection strategies. In a randomized controlled trial, 86 patients with SPS underwent tandem high-definition (HD) colonoscopies from February 2015 through July 2016 at 7 centers in Spain. It was found that panchromoendoscopy increases detection of polyps (mostly of small serrated lesions) and should be considered in patients with SPS.

264 The Differences in Prevalence, Distribution, and Detection Rates of Colonic Polyps Between Genders

INTRODUCTION: Gender disparities in colorectal cancer (CRC) incidence and mortality are well recognized in the literature with polyp characteristics and location being amongst some of the most important factors contributing to these disparities. Prior studies have shown an increased prevalence of proximal adenomas and CRC in women. We aimed in this study to compare the distribution and the prevalence of colonic polyps between both genders, as well as evaluating gender-specific lesion detection rates. METHODS: A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good and fair bowel preparation were included. Overall, gender-specific, and segment-specific adenoma detection rates (ADR), sessile serrated polyp detection rates (SSPDR) and polypectomy rates (PR) were calculated and compared using t-tests. Proximal colon was defined as the cecum, ascending, and the transverse colon. RESULTS: A total of 4151 patients were included in the analysis. Average patient age was 60.0 ± 7.7 years and 53.2% were females. A total of 652 (15.7%) had excellent preparation, 2675 (64.4%) had good preparation, while 824 (19.9%) had fair preparation (Table 1). Of the 3476 polyps found, 1660 (47%) polyps were found in the proximal colon. Generally, males had more polyps and adenomas all throughout the colon (Table 2). Compared to males, females had less proximal polyps per patient (0.35 ± 0.24 vs. 0.50 ± 0.33; P &lt; 0.001), less proximal adenomas per patient (0.22 ± 0.18 vs. 0.35 ± 0.26, P &lt; 0.001), and less overall large adenomas (&gt;1 cm) per patient (0.05 ± 0.07 vs. 0.09 ± 0.13, P &lt; 0.008). In males, endoscopists had better overall ADR (32.7 ± 14.7 vs. 22.0 ± 12.7, P &lt; 0.001), PR (51.9 ± 17.9 vs. 40.3 ± 18.8, P &lt; 0.001), and SSPDR (22.6 ± 15.7 vs. 16.6 ± 13.7, P &lt; 0.001) (Table 3). CONCLUSION: Our study demonstrates a significant difference in polyp distribution based on patient sex. This is contradictory to what has previously been reported in the literature with more proximal polyps noted in female patients. We believe the advancement in colonoscopy techniques and training in addition to the increased awareness of female sex association with right-sided tumors contributed to this topographic distribution shift of colonic polyps. Although the involved endoscopists met the recommended national ADR benchmarks, women had lower ADR reflecting the differences in the adenoma prevalence in these populations.

261 Sessile Serrated Polyp Detection Rate as a Screening Colonoscopy Quality Metric

INTRODUCTION: Adenoma detection rate (ADR) is an established colonoscopy quality metric primarily used to prevent interval colorectal cancer (CRC). Likewise, higher sessile serrated polyp detection rates (SSPDR) were linked to reduced interval CRC. Recently, some studies suggested the use SSPDR as a quality indicator with proposed benchmarks mimicking that seen in ADR where 25% of all procedures should yield adenomas (20% for females and 30% for males). We aimed in our study to examine the utility of SSPDR as a quality metric for screening colonoscopies with proposed new target benchmarks. METHODS: A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our tertiary center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good, or adequate bowel preparation were included. Overall and segment specific ADR and SSPDR were calculated and compared using t-tests. Data is presented as mean ± standard deviation or frequency (%). The adjusted R-Squared statistic (R2) was used to test the correlation variability. The P-value corresponds to the correlation between ADR and SSPDR. All analyses were done using SAS (version 9. 4, The SAS Institute, Cary, NC) and a P-value &lt; 0. 05 was considered statistically significant. RESULTS: A total of 4151 patients were included in the analysis. Average patient age was 60.0 ± 7.7 years and 53.2% were females. Colonoscopies were performed by 54 (64.3%) gastroenterologists and 30 (35.7%) non-gastroenterologists (General Surgeons = 9; Colorectal Surgeons = 21) (Table 1). Overall ADR was 26.4 ± 11.0, overall SSPDR was 19.3 ± 11.4. Overall SSPDR that corresponds to a predicted ADR of 25% was 16% (adjusted R2 = 0.16, P-value &lt; 0.001). SSPDR in females that corresponds to an ADR of 20% was 10% (adjusted R2 = 0.11, P-value = 0.001) (Figure 1). These findings reflect a significant but poor correlation between ADR and SSPDR. CONCLUSION: Based on a large screening colonoscopy registry-based analysis, our results support the use of SSPDR as an ancillary rather than independent colonoscopy quality metric. The current study suggests a cut-off values of 16% for overall SSPDR and 10% for the female papulation. SSPDR above these values may be congruous with adequate serrated polyp detection rates. Further multicenter studies are needed to validate our findings.

CF290 for pancolonic chromoendoscopy improved sessile serrated polyp detection and procedure time: a propensity score-matching study.

Background and study aims The benefits of the new-generation CF290 (Olympus, Tokyo, Japan) for pancolonic chromoendoscopy (PCC) for colorectal polyp detection and its procedure time remain questionable. We compared the CF290 with the previous CF260 for PCC. Methods We performed a propensity score-matching study using baseline characteristics such as age, sex, indications, endoscopist, and bowel preparation. We compared the detection of adenomas and sessile serrated polyps (SSPs) and procedure times of two expert endoscopists who performed PCC using the CF290 series (high-quality system with flushing pump) and the CF260 series (high-definition system). Results We matched 374 patients who underwent PCC using the CF290 and 187 patients who underwent PCC using the CF260. The adenoma detection rate of the 290 series was higher than that of the 260 series, but not significantly. The SSP detection rate for the 290 series was higher than that for the 260 series ( P = 0.01). Insertion time required for the 290 series was shorter than that required for the 260 series ( P < 0.0001). Withdrawal time of the 290 series was shorter than that of the 260 series ( P < 0.0001). Conclusion Advanced technology can provide accuracy and help save time, and therefore, should be applied whenever possible.

Impact of a ring-fitted cap on insertion time and adenoma detection: a randomized controlled trial

Devices for flattening colon folds can improve polyp detection at colonoscopy. However, there are few data on the endoscopic ring-fitted cap (EndoRings; EndoAid, Caesarea, Israel). We sought to compare adenoma detection with EndoRings with that of standard high-definition colonoscopy. This was a single-center, randomized controlled trial of 562 patients (284 randomized to EndoRings and 278 to standard colonoscopy) at 2 outpatient endoscopy units in the Indiana University Hospital system. Adenoma detection was the primary outcome measured as adenoma detection rate (ADR) and adenomas per colonoscopy (APC). We also compared sessile serrated polyp detection rate, insertion times, withdrawal times, and ease of passage through the sigmoid colon. EndoRings was superior to standard colonoscopy in terms of APC (1.46 vs 1.06, P= .025), but there were no statistically significant differences in ADR or sessile serrated polyp detection rate. Mean withdrawal time (in patients with no polyps) was shorter and insertion time (all patients) was longer in the EndoRings arm by 1.8 minutes and 0.75 minutes, respectively. One provider had significantly higher detection with Endo-Rings and contributed substantially to the overall results. EndoRings can increase adenoma detection without a significant increase in procedure time, but the effect varies between operators. The use of EndoRings slows colonoscope insertion. (Clinical trial registration number: NCT03418662.).

Sa1042 MULTI-TARGET STOOL DNA TESTING ENRICHES DETECTION OF COLORECTAL NEOPLASIA BY COLONOSCOPY BUT YIELD IS INFLUENCED BY BASELINE POLYP DETECTION RATES

Adenomatous polyp detection rates (ADR) are inversely correlated with the incidence of post-colonoscopy colorectal cancers. To measure colonoscopy quality, a minimum ADR of 25% and sessile serrated polyp detection rate (SDR) of 5% have been proposed as quality standards. Colonoscopy appears to have higher ADR after a positive (+) MT-sDNA among providers aware of stool test results versus those blinded in a clinical trial. The interaction between endoscopists’ baseline polyp detection rates and MT-sDNA yield in practice has not been explored.

Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rates With Endoscopist Characteristics

Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. To assess the association between endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Seven characteristics of endoscopists performing colonoscopy. The ADR and pSSPDR, with a hypothesis created after data collection began. A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years; P < .001) and number of annual colonoscopies performed (odds ratio, 1.05 [95% CI, 1.01-1.09] per 50 colonoscopies/year; P = .02). The differences in ADRs that were associated with 7 of 7 endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.

The Efficacy of Split-Dose Bowel Preparations for Polyp Detection: A Systematic Review and Meta-Analysis.

Split-dose bowel preparation leads to superior colon cleansing for colonoscopy. However, the magnitude of benefit in detecting colonic polyps is uncertain. We performed a systematic review to synthesize the data on whether using a split-dose bowel preparation regimen improves the detection of polyps when compared with other dosing methods or regimen products. We searched MEDLINE, EMBASE, and CENTRAL databases (from the inception to June 2017) for randomized controlled trials that assessed the following: split-dose vs day-before, split-dose vs same-day (as colonoscopy), or different types of split-dose regimens for patients undergoing colonoscopy. We excluded studies limited to inpatients, children, or individuals with inflammatory bowel disease. We compared the number of patients undergoing colonoscopy with recorded detection of polyps, adenomas, advanced adenomas, sessile serrated polyps (SSPs), right colonic adenomas, right colonic polyps, or right colonic SSPs. Twenty-eight trials fulfilled the inclusion criteria (8,842 participants). Of the seven trials comparing split-dose vs day-before bowel preparation regimens, there was an increased detection rate of adenomas (risk ratio (RR) 1.26, 95% confidence intervals (CIs): 1.10-1.44; 4 trials; 1,258 participants), advanced adenomas (RR 1.53, 95% CI: 1.22-1.92; 3 trials; 1,155 participants), and SSPs (RR 2.48, 95% CI: 1.21-5.09; 2 trials; 1,045 participants). Pooled estimates from 8 trials (1,587 participants) evaluating split-dose vs same-day bowel preparations yielded no evidence of statistical difference. For various split-dose vs split-dose trials, 14 fulfilled the criteria (5,496 participants) and no superior split-regimen was identified. Compared with day-before bowel preparation regimens, split-dose bowel preparations regimens increase the detection of adenomas, advanced adenomas, and have the greatest benefit in SSP detection.

Endocuff Vision Reduces Inspection Time Without Decreasing Lesion Detection: A Clinical Randomized Trial

Mucosal exposure devices improve detection of lesions during colonoscopy and have reduced examination times in uncontrolled studies. We performed a randomized trial of Endocuff Vision vs standard colonoscopy to compare differences in withdrawal time (the primary end point). We proposed that Endocuff Vision would allow complete mucosal inspection in a shorter time without impairing lesion detection. Adults older than 40 years undergoing screening or surveillance colonoscopies were randomly assigned to the Endocuff group (n=101, 43.6% women) or the standard colonoscopy group (n=99; 57.6% women). One of 2 experienced endoscopists performed the colonoscopies, aiming for a thorough evaluation of the proximal sides of all haustral folds, flexures, and valves in the shortest time possible. Inspection time was measured with a stopwatch and calculated by subtracting washing, suctioning, polypectomy and biopsy times from total withdrawal time. There were significantly fewer women in the Endocuff arm (P = .0475) but there were no other demographic differences between groups. Mean insertion time with Endocuff was 4.0 min vs 4.4 min for standard colonoscopy (P = .14). Mean inspection time with Endocuff was 6.5 min vs 8.4 min for standard colonoscopy (P < .0001). Numbers of adenomas detected per colonoscopy (1.43 vs 1.07; P = .07), adenoma detection rate (61.4% vs 52%; P = .21), number of sessile serrated polyps per colonoscopy (0.27 vs 0.21; P = .12), and sessile serrated polyp detection rate (19.8% vs 11.1%; P = .09) were all higher with Endocuff Vision. Results did not differ significantly when we controlled for age, sex, or race. In a randomized trial, we found inclusion of Endocuff in screening or surveillance colonoscopies to decrease examination time without reducing lesion detection. ClinicalTrials.gov, Number: NCT03361917.