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Polyp Detection Rate Correlates Strongly with Adenoma Detection Rate in Trainee Endoscopists

  • Sandy Ng
  • Aditya K. Sreenivasan
  • Jillian Pecoriello
  • Peter S. LiangEmail author
Original Article
  • 22 Downloads

Abstract

Background

The adenoma detection rate (ADR) is a widely accepted quality benchmark for screening colonoscopy but can be burdensome to calculate. Previous studies have shown good correlation between polyp detection rate (PDR) and ADR, but this has not been validated in trainees. Additionally, the correlation between PDR and detection rates for sessile serrated polyps (SSPDR) and advanced neoplasia (ANDR) is not well studied.

Aims

We investigated the relationship between PDR and ADR, SSPDR, and ANDR in trainees.

Methods

We examined 1600 outpatient colonoscopies performed by 24 trainees at a VA hospital from 2014 to 2017. Variables collected included patient demographics, year of fellowship, colonoscopy indication, and endoscopic and histologic findings. We calculated the overall ratios of PDR to ADR, SSPDR, and ANDR to assess the correlation between measured and calculated ADR, SSPDR, and ANDR, which is equivalent to the correlation between PDR and measured ADR, SSPDR, and ANDR.

Results

The overall PDR, ADR, SSPDR, and ANDR were 72%, 52%, 2%, and 14%. PDR (48%) was highest in the left colon, while ADR (32%) and ANDR (7%) were highest in the right colon (p < 0.001 for all). The overall ADR/PDR, SSPDR/PDR, and ANDR/PDR ratios were 0.73, 0.03, and 0.20. Correlation between PDR and ADR was highly positive overall (r = 0.87, p < 0.0001) and stronger in the right (r = 0.91) and transverse (r = 0.94) colon than the left colon (r = 0.80). Correlation between PDR and overall SSPDR and ANDR were not statistically significant.

Conclusions

PDR can serve as a surrogate measure of ADR to monitor colonoscopy quality in gastroenterology fellowship.

Keywords

Colorectal cancer screening Quality metric Quality improvement Gastroenterology fellow 

Notes

Author’s contribution

SN: study design, data collection and interpretation, drafted and approved manuscript; AKS: study design, data collection and interpretation, approved manuscript; JP: study design, data collection, approved manuscript; PSL: study design, data collection and interpretation, drafted and approved manuscript.

Funding

Peter S. Liang is supported by Grant K08CA230162 from the National Cancer Institute.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA A Cancer J Clin. 2019;69:7–34.CrossRefGoogle Scholar
  2. 2.
    Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369:1095–1105.CrossRefGoogle Scholar
  3. 3.
    Kahi CJ, Pohl H, Myers LJ, et al. Colonoscopy and colorectal cancer mortality in the veterans affairs health care system: a case–control study. Ann Intern Med. 2018;168:481–488.CrossRefGoogle Scholar
  4. 4.
    Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2015;110:72–90.CrossRefGoogle Scholar
  5. 5.
    Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298–1306.CrossRefGoogle Scholar
  6. 6.
    Wieszczy P, Regula J, Kaminski MF. Adenoma detection rate and risk of colorectal cancer. Best Pract Res Clin Gastroenterol. 2017;31:441–446.CrossRefGoogle Scholar
  7. 7.
    Francis DL, Rodriguez-Correa DT, Buchner A, et al. Application of a conversion factor to estimate the adenoma detection rate from the polyp detection rate. Gastrointest Endosc. 2011;73:493–497.CrossRefGoogle Scholar
  8. 8.
    Boroff ES, Gurudu SR, Hentz JG, et al. Polyp and adenoma detection rates in the proximal and distal colon. Am J Gastroenterol. 2013;108:993–999.CrossRefGoogle Scholar
  9. 9.
    Niv Y. Polyp detection rate may predict adenoma detection rate: a meta-analysis. Eur J Gastroenterol Hepatol. 2018;30:247–251.CrossRefGoogle Scholar
  10. 10.
    Peters SL, Hasan AG, Jacobson NB, et al. Level of fellowship training increases adenoma detection rates. Clin Gastroenterol Hepatol. 2010;8:439–442.CrossRefGoogle Scholar
  11. 11.
    Lee J, Park SW, Kim YS, et al. Risk factors of missed colorectal lesions after colonoscopy. Medicine. 2017;96:e7468.CrossRefGoogle Scholar
  12. 12.
    Okamoto M, Shiratori Y, Yamaji Y, et al. Relationship between age and site of colorectal cancer based on colonoscopy findings. Gastrointest Endosc. 2002;55:548–551.CrossRefGoogle Scholar
  13. 13.
    Lieberman DA, Williams JL, Holub JL, et al. Colonoscopy utilization and outcomes 2000 to 2011. Gastrointest Endosc. 2014;80:133–143.CrossRefGoogle Scholar
  14. 14.
    Sanaka MR, Gohel T, Podugu A, et al. Adenoma and sessile serrated polyp detection rates: variation by patient sex and colonic segment but not specialty of the endoscopist. Dis Colon Rectum. 2014;57:1113–1119.CrossRefGoogle Scholar
  15. 15.
    Kahi CJ, Hewett DG, Norton DL, et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol. 2011;9:42–46.CrossRefGoogle Scholar
  16. 16.
    Gohel TD, Burke CA, Lankaala P, et al. Polypectomy rate: a surrogate for adenoma detection rate varies by colon segment, gender, and endoscopist. Clin Gastroenterol Hepatol. 2014;12:1137–1142.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of MedicineNYU Langone HealthNew YorkUSA
  2. 2.Department of MedicineVA New York Harbor Health Care SystemNew YorkUSA

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