Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study
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Background/Aims: The adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested. This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy. Methods: We performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR. Results: A total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001). Conclusions: The colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.
Abstract
Background/Aims: The adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested. This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy. Methods: We performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR. Results: A total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001). Conclusions: The colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.
참고문헌 (23)
- Rex DK, "Quality indicators for colonoscopy", Gastrointest Endosc, 63(4 Suppl), pp.S16~S28 (2006)
- Rex DK, "Quality indicators for colonoscopy", Gastrointest Endosc, 81, pp.31~53 (2015)
- Kaminski MF, "Quality indicators for colonoscopy and the risk of interval cancer", N Engl J Med, 362, pp.1795~1803 (2010)
- Wang HS, "Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance", Gastrointest Endosc, 77, pp.71~78 (2013)
- Corley DA, "Adenoma detection rate and risk of colorectal cancer and death", N Engl J Med, 370, pp.1298~1306 (2014)
- Heresbach D, "Miss rate for colorectal neoplastic polyps : a prospective multicenter study of back-to-back video colonoscopies", Endoscopy, 40, pp.284~290 (2008)
- Munroe CA, "A tandem colonoscopy study of adenoma miss rates during endoscopic training : a venture into uncharted territory", Gastrointest Endosc, 75, pp.561~567 (2012)
- Aniwan S, "The secondary quality indicator to improve prediction of adenoma miss rate apart from adenoma detection rate", Am J Gastroenterol, 111, pp.723~729 (2016)
- Francis DL, "Application of a conversion factor to estimate the adenoma detection rate from the polyp detection rate", Gastrointest Endosc, 73, pp.493~497 (2011)
- Williams JE, "Polypectomy rate is a valid quality measure for colonoscopy : results from a national endoscopy database", Gastrointest Endosc, 75, pp.576~582 (2012)
- Zhao S, "Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy : a systematic review and meta-analysis", Gastroenterology, 156, pp.1661~1674 (2019)
- Jeeyeon Kim, "Clinical comparison of low-volume agents (oral sulfate solution and sodium picosulfate with magnesium citrate) for bowel preparation: the EASE study", Intestinal research, 17(3), pp.413~418 (2019), 대한장연구학회[DOI]
- Schlemper RJ, "The macroscopic classification of early neoplasia of the digestive tract", Endoscopy, 34, pp.163~168 (2002)
- Winawer SJ, "The advanced adenoma as the primary target of screening", Gastrointest Endosc Clin N Am, 12, pp.1~9 (2002)
- Shaukat A, "Longer withdrawal time is associated with a reduced incidence of interval cancer after screening colonoscopy", Gastroenterology, 149, pp.952~957 (2015)
- Ng S, "Polyp detection rate correlates strongly with adenoma detection rate in trainee endoscopists", Dig Dis Sci, 65, pp.2229~2233 (2020)
- Zorron Cheng Tao Pu L, "Polyp detection rate as a surrogate for adenoma and sessile serrated adenoma", polyp detection rates, 2020, pp.7, 74~82
- Lee TJ, "Colonoscopy quality measures : experience from the NHS Bowel Cancer Screening Programme", Gut, 61, pp.1050~1057 (2012)
- Kahi CJ, "Improving measurement of the adenoma detection rate and adenoma per colonoscopy quality metric : the Indiana University experience", Gastrointest Endosc, 79, pp.448~454 (2014)
- Park SK, "Comparison of adenoma detection rate and adenoma per colonoscopy as a quality indicator of colonoscopy", Scand J Gastroenterol, 51, pp.886~890 (2016)
- Sang Bong Ahn, "The Miss Rate for Colorectal Adenoma Determined by Quality-Adjusted, Back-to-Back Colonoscopies", Gut and Liver, 6(1), pp.64~70 (2012), 거트앤리버 소화기연관학회협의회
- 김남희, "Miss rate of colorectal neoplastic polyps and risk factors for missed polyps in consecutive colonoscopies", Intestinal research, 15(3), pp.411~418 (2017), 대한장연구학회
- Rex DK, "Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies", Gastroenterology, 112, pp.24~28 (1997)