Adenoma miss rate of polypectomy-referring hospitals is high in Korea
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Background/Aims: We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. Methods: We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016. Results: A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). Conclusions: Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.
Abstract
Background/Aims: We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. Methods: We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016. Results: A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). Conclusions: Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.
참고문헌 (27)
- Winawer SJ, "Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup", N Engl J Med, 329, pp.1977~1981 (1993)
- Citarda F, "Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence", Gut, 48, pp.812~815 (2001)
- Zauber AG, "Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths", N Engl J Med, 366, pp.687~696 (2012)
- Rex DK, "Colorectal cancer prevention 2000 : screening recommendations of the American College of Gastroenterology. American College of Gastroenterology", Am J Gastroenterol, 95, pp.868~877 (2000)
- Cisyk AL, "Establishing a biological profile for interval colorectal cancers", Dig Dis Sci, 59, pp.2390~2402 (2014)
- le Clercq CM, "Postcolonoscopy colorectal cancers are preventable: a population-based study", Gut, 63, pp.957~963 (2014)
- Hancock KS, "What can we do to optimize colonoscopy and how effective can we be", Curr Gastroenterol Rep, 18, pp.27~ (2016)
- Rex DK, "Quality indicators for colonoscopy", Am J Gastroenterol, 110, pp.72~90 (2015)
- 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)
- "Healthcare Bigdata Hub" (2017)[URL]
- 전성우, "일차 및 이차 의료기관에서 내시경 절제술은 가능한가?", Clinical Endoscopy, 41(6), pp.338~343 (2010), 대한소화기내시경학회
- Aronchick CA, "A novel tableted purgative for colonoscopic preparation : efficacy and safety comparisons with Colyte and Fleet Phospho-Soda", Gastrointest Endosc, 52, pp.346~352 (2000)
- Participants in the Paris Workshop, "The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002", Gastrointest Endosc, 58, pp.S3~S43 (2003)
- Kaminski MF, "Quality indicators for colonoscopy and the risk of interval cancer", N Engl J Med, 362, pp.1795~1803 (2010)
- Corley DA, "Adenoma detection rate and risk of colorectal cancer and death", N Engl J Med, 370, pp.2541~ (2014)
- Dominitz JA, "Editorial : on the quality of quality metrics : rethinking what defines a good colonoscopy", Am J Gastroenterol, 111, pp.730~732 (2016)
- Hye-Won Park, "Colorectal Neoplasm in Asymptomatic Average-risk Koreans: The KASID Prospective Multicenter Colonoscopy Survey", Gut and Liver, 3(1), pp.35~40 (2009), 거트앤리버 소화기연관학회협의회
- 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
- Rex DK, "Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies", Gastroenterology, 112, pp.24~28 (1997)
- Heresbach D, "Miss rate for colorectal neoplastic polyps : a prospective multicenter study of back-to-back video colonoscopies", Endoscopy, 40, pp.284~290 (2008)
- van Rijn JC, "Polyp miss rate determined by tandem colonoscopy : a systematic review", Am J Gastroenterol, 101, pp.343~350 (2006)
- 최한나, "Tandem 대장내시경에서 대장 용종 간과율에 영향을 주는 인자", 대한소화기학회지, 64(1), pp.24~30 (2014), 대한소화기학회
- Leufkens AM, "Factors influencing the miss rate of polyps in a back-toback colonoscopy study", Endoscopy, 44, pp.470~475 (2012)
- 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)
- Kim JH, "Influence of the insertion time and number of polyps on miss rate in colonoscopy", Scand J Gastroenterol, 46, pp.634~639 (2011)
- Ju Sung Sim, "Predictors of Inadequate Bowel Preparation and Salvage Options on Colonoscopy", Clinical Endoscopy, 49(4), pp.346~349 (2016), 대한소화기내시경학회
- Lai EJ, "The Boston bowel preparation scale : a valid and reliable instrument for colonoscopy-oriented research", Gastrointest Endosc, 69, pp.620~625 (2009)