Digestive Diseases and Sciences

, Volume 63, Issue 5, pp 1167–1172 | Cite as

Adenoma Detection Rate in Asymptomatic Patients with Positive Fecal Immunochemical Tests

  • Eugene Kligman
  • Wenfang Li
  • George J. Eckert
  • Charles Kahi
Original Article

Abstract

Background and Aims

The adenoma detection rate (ADR) is a powerful measure of screening colonoscopy quality. Patients who undergo colonoscopy for the evaluation of a positive fecal immunochemical test (FIT) have increased prevalence of colorectal neoplasia, but it is not known whether separate quality benchmarks are required. The aim of this study was to compare the conventional ADR to the ADR of colonoscopies performed for the evaluation of positive FIT, in asymptomatic average-risk patients.

Methods

Patients ≥ 50 years old who underwent colonoscopy for the evaluation of a positive FIT between January 1, 2013, and July 31, 2014, at a tertiary Veterans Affairs Medical Center were identified. FIT performed for any indication other than average-risk screening was excluded. The comparison group included average-risk patients ≥ 50 years old undergoing screening colonoscopy during the same time frame. The two groups were compared for ADR, advanced neoplasm [adenoma ≥ 10 mm, tubulovillous, high-grade dysplasia, CRC, sessile serrated polyp (SSP) ≥ 10 mm], CRC, and SSP detection after propensity score adjustment using a logistic regression model adjusted for endoscopist.

Results

There were 207 patients in the FIT group and 601 in the screening colonoscopy comparison group. After propensity score adjustment, ADR (72.9 vs. 50.0%, p = 0.003), number of adenomas per colonoscopy (3.3 ± 3.6 vs. 1.4 ± 2.3, p = 0.033), and advanced neoplasm detection rate (32.4 vs. 11.0%, p < 0.0001) were significantly higher in the FIT group. There were no significant differences in the number of CRC and the SSP detection rate.

Conclusions

In this cohort of average-risk Veterans, the ADR of colonoscopies performed for the evaluation of a positive FIT was higher than the ADR of screening colonoscopies. Patients with a positive FIT also had significantly more adenomas per colonoscopy and advanced neoplasms. These findings suggest that the quality of colonoscopies performed for a positive FIT is insufficiently assessed by the conventional ADR and requires additional quality metrics.

Keywords

Screening Colonoscopy Colon neoplasm 

Notes

Author’s contribution

EK contributed to acquisition of data; analysis and interpretation of data; and drafting of the manuscript, WL and GE analyzed and interpreted the data and critically revised the manuscript for important intellectual content, and CK contributed in study concept and design; analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53.CrossRefPubMedGoogle Scholar
  2. 2.
    Corley DA, Levin TR, Doubeni CA. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:2541.CrossRefPubMedGoogle Scholar
  3. 3.
    Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803.CrossRefPubMedGoogle Scholar
  4. 4.
    Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on colorectal cancer. Gastroenterology. 2017;153:307–323.CrossRefPubMedGoogle Scholar
  5. 5.
    Robertson DJ, Lee JK, Boland CR, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on colorectal cancer. Gastrointest Endosc. 2017;85:e3.Google Scholar
  6. 6.
    Jensen CD, Corley DA, Quinn VP, et al. Fecal immunochemical test program performance over 4 rounds of annual screening: a retrospective cohort study. Ann Intern Med. 2016;164:456–463.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.CrossRefPubMedGoogle Scholar
  8. 8.
    D’Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–2281.CrossRefPubMedGoogle Scholar
  9. 9.
    Hilsden RJ, Bridges R, Dube C, et al. Defining benchmarks for adenoma detection rate and adenomas per colonoscopy in patients undergoing colonoscopy due to a positive fecal immunochemical test. Am J Gastroenterol. 2016;111:1743–1749.CrossRefPubMedGoogle Scholar
  10. 10.
    Wang HS, Pisegna J, Modi R, et al. Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance. Gastrointest Endosc. 2013;77:71–78.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee TJ, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61:1050–1057.CrossRefPubMedGoogle Scholar
  12. 12.
    Denis B, Sauleau EA, Gendre I, et al. The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy: a population-based cohort study. Dig Liver Dis. 2014;46:176–181.CrossRefPubMedGoogle Scholar
  13. 13.
    Kahi CJ, Vemulapalli KC, Johnson CS, Rex DK. Improving measurement of the adenoma detection rate and adenoma per colonoscopy quality metric: the Indiana University experience. Gastrointest Endosc. 2014;79:448–454.CrossRefPubMedGoogle Scholar
  14. 14.
    Greenspan M, Rajan KB, Baig A, Beck T, Mobarhan S, Melson J. Advanced adenoma detection rate is independent of nonadvanced adenoma detection rate. Am J Gastroenterol. 2013;108:1286–1292.CrossRefPubMedGoogle Scholar
  15. 15.
    Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med. 2014;160:171.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Eugene Kligman
    • 1
  • Wenfang Li
    • 2
    • 3
  • George J. Eckert
    • 2
    • 3
  • Charles Kahi
    • 1
    • 4
  1. 1.Department of MedicineIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of BiostatisticsIndiana University School of MedicineIndianapolisUSA
  3. 3.Richard M. Fairbanks School of Public HealthIndianapolisUSA
  4. 4.Richard L. Roudebush VA Medical CenterIndianapolisUSA

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