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Seo JH, Lee BI, Lee K, Park JM, Kim JS, Cho YS, Lee KM, Kim SW, Choi H, Choi MG. Adenoma miss rate of polypectomy-referring hospitals is high in Korea. Korean J Intern Med 2020; 35:881-888. [PMID: 31610632 PMCID: PMC7373960 DOI: 10.3904/kjim.2018.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/21/2018] [Indexed: 02/07/2023] Open
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). CONCLUSION 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.
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Affiliation(s)
- Ju Hyun Seo
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Correspondence to Bo-In Lee, M.D Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-2044 Fax: +82-2-2258-2083 E-mail:
| | - Kyungjin Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jin Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kang-Moon Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Hwang Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Maida M, Morreale G, Sinagra E, Ianiro G, Margherita V, Cirrone Cipolla A, Camilleri S. Quality measures improving endoscopic screening of colorectal cancer: a review of the literature. Expert Rev Anticancer Ther 2019; 19:223-235. [PMID: 30614284 DOI: 10.1080/14737140.2019.1565999] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a major health-care problem all over the world and CRC screening is effective in reducing mortality and increasing the 5-year survival. Colonoscopy has a central role in CRC screening. It can be performed as a primary test, as a recall policy after a positive result of another screening test, and for surveillance. Since effectiveness of endoscopic screening depends on adequate detection and removal of colonic polyps, consistent quality measures, which are useful in enhancing the diagnostic yield of examination, are essential. Areas covered: The aim of this review is to analyze current evidence from literature supporting quality measures able to refine endoscopic screening of colorectal cancer. Expert commentary: Quality measures namely a) time slot allotted to colonoscopy, b) assessment of indication, c) bowel preparation, d) Cecal intubation, e) withdrawal time, f) adenoma detection rate, g) proper management of lesions (polypectomy technique, polyps retrieval rate and tattooing of resection sites), and h) adequate follow-up intervals play a key role in identifying malignant and at-risk lesions and improving the outcome of screening. Adherence to these quality measures is critical to maximize the effectiveness of CRC screening, as well as, a proper technique of colonoscopy and a quality report of the procedure. Among all recommended measures, adenoma detection rate is the most important and must be kept above the recommended quality threshold by all physicians practicing in the setting of screening.
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Affiliation(s)
- Marcello Maida
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Gaetano Morreale
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Emanuele Sinagra
- b Gastroenterology and Endoscopy Unit , Fondazione Istituto San Raffaele Giglio , Cefalù , Italy
| | - Gianluca Ianiro
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Vito Margherita
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Alfonso Cirrone Cipolla
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Salvatore Camilleri
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
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Predictive factors for missed adenoma on repeat colonoscopy in patients with suboptimal bowel preparation on initial colonoscopy: A KASID multicenter study. PLoS One 2018. [PMID: 29698398 DOI: 10.1371/journal.pone.0195709.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Suboptimal bowel preparation can result in missed colorectal adenoma that can evolve into interval colorectal cancer. This study aims to identify the predictive factors associated with missed adenoma on repeat colonoscopy in patients with suboptimal bowel preparation at initial colonoscopy. A total of 441 patients with suboptimal bowel preparation on initial colonoscopy and who had repeat colonoscopy within two years were included from 2007 to 2014 in six tertiary hospitals. Suboptimal bowel preparation was defined as 'poor' according to the Aronchick scale or a score ≤ 1 in at least one segment or total score < 6 according to the Boston bowel preparation scale. Of 441 patients, mean age at initial colonoscopy was 59.1 years, and 69.2% patients were male. The mean interval from initial to repeat colonoscopy was 14.1 months. The per-patient adenoma miss rate (AMR) was 42.4% for any adenoma and 5.4% for advanced adenoma. When the association between baseline clinical characteristics and missed lesions on repeat colonoscopy was analyzed, dyslipidemia (odds ratio [OR], 5.19; 95% confidence interval [CI], 1.14-23.66; P = 0.034), and high-risk adenoma (OR, 4.45; 95% CI, 1.12-17.68; P = 0.034) on initial colonoscopy were independent risk factors for missed advanced adenoma. In patients with suboptimal bowel preparation, dyslipidemia and high-risk adenoma on initial colonoscopy were independently predictive of missed advanced adenoma on repeat colonoscopy.
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Chang JY, Moon CM, Lee HJ, Yang HJ, Jung Y, Kim SW, Jung SA, Byeon JS. Predictive factors for missed adenoma on repeat colonoscopy in patients with suboptimal bowel preparation on initial colonoscopy: A KASID multicenter study. PLoS One 2018; 13:e0195709. [PMID: 29698398 PMCID: PMC5919514 DOI: 10.1371/journal.pone.0195709] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/28/2018] [Indexed: 12/17/2022] Open
Abstract
Suboptimal bowel preparation can result in missed colorectal adenoma that can evolve into interval colorectal cancer. This study aims to identify the predictive factors associated with missed adenoma on repeat colonoscopy in patients with suboptimal bowel preparation at initial colonoscopy. A total of 441 patients with suboptimal bowel preparation on initial colonoscopy and who had repeat colonoscopy within two years were included from 2007 to 2014 in six tertiary hospitals. Suboptimal bowel preparation was defined as ‘poor’ according to the Aronchick scale or a score ≤ 1 in at least one segment or total score < 6 according to the Boston bowel preparation scale. Of 441 patients, mean age at initial colonoscopy was 59.1 years, and 69.2% patients were male. The mean interval from initial to repeat colonoscopy was 14.1 months. The per-patient adenoma miss rate (AMR) was 42.4% for any adenoma and 5.4% for advanced adenoma. When the association between baseline clinical characteristics and missed lesions on repeat colonoscopy was analyzed, dyslipidemia (odds ratio [OR], 5.19; 95% confidence interval [CI], 1.14–23.66; P = 0.034), and high-risk adenoma (OR, 4.45; 95% CI, 1.12–17.68; P = 0.034) on initial colonoscopy were independent risk factors for missed advanced adenoma. In patients with suboptimal bowel preparation, dyslipidemia and high-risk adenoma on initial colonoscopy were independently predictive of missed advanced adenoma on repeat colonoscopy.
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Affiliation(s)
- Ji Young Chang
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chang Mo Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Republic of Korea
- * E-mail: (CM); (JB)
| | - Hyun Jung Lee
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yunho Jung
- Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Chonbuk National University College of Medicine, Jeonju, Republic of Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (CM); (JB)
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Gálvez M, Zarate AM, Espino H, Higuera-de la Tijera F, Awad RA, Camacho S. A short telephone-call reminder improves bowel preparation, quality indicators and patient satisfaction with first colonoscopy. Endosc Int Open 2017; 5:E1172-E1178. [PMID: 29202000 PMCID: PMC5698010 DOI: 10.1055/s-0043-117954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/03/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Addition of a reminder program to conventional indications improves colonoscopy. The aim of this study was to evaluate the effectiveness of a short telephone call reminder (STCR) on a patient's first colonoscopy. PATIENTS AND METHODS One day before colonoscopy, we made a STCR of < 10 minutes to 141 randomly selected patients of 258 recruited. The STCRs informed patients about the procedure date, indications for taking laxatives, and dietetic requirements. Questions were clarified only when patients asked directly. We evaluated bowel preparation, quality indicators, and patient satisfaction. Data were expressed as mean ± SD and percentages. Statistical differences were evaluated by Student's t and Chi squared tests; alpha = 0.05. All authors had access to the study data and reviewed and approved the final manuscript. RESULTS The STCR group had better bowel preparation which was demonstrated by higher completion frequency (97.16 % vs. 82.05 %), in less time (4.52 ± 3.06 vs. 5.38 ± 3.03 hours) intake of laxative, and higher Boston's scale (7.66 ± 2.42 vs. 5.2 ± 1.65). Quality indicators of colonoscopy were better in patients that received a STCR [cecal intubation rate: 100.00 % vs. 87.18 %; polyp detection: 42.55 % vs. 9.4 %; and cecal arrival time (min): 12.09 ± 3.62 vs. 15.09 ± 5.02]. STCR patients were more satisfied (97.87 % vs. 55.56 %) and would repeat colonoscopy (21.99 % vs. 11.11 %). CONCLUSIONS A simple additional step such as a STCR improves quality of bowel preparation, quality indicators, and satisfaction of patients undergoing their first colonoscopy. Clinical trial registry in Mexico City General Hospital: DI/16/107/3/108.
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Affiliation(s)
- Marisol Gálvez
- Endoscopy Unit of Gastroenterology Service, Mexico City General Hospital “Dr Eduardo Liceaga”, Mexico City, Mexico
| | - Angel Mario Zarate
- Endoscopy Unit of Gastroenterology Service, Mexico City General Hospital “Dr Eduardo Liceaga”, Mexico City, Mexico
| | - Hector Espino
- Endoscopy Unit of Gastroenterology Service, Mexico City General Hospital “Dr Eduardo Liceaga”, Mexico City, Mexico
| | - Fátima Higuera-de la Tijera
- Endoscopy Unit of Gastroenterology Service, Mexico City General Hospital “Dr Eduardo Liceaga”, Mexico City, Mexico
| | - Richard Alexander Awad
- Endoscopy Unit of Gastroenterology Service, Mexico City General Hospital “Dr Eduardo Liceaga”, Mexico City, Mexico
| | - Santiago Camacho
- Endoscopy Unit of Gastroenterology Service, Mexico City General Hospital “Dr Eduardo Liceaga”, Mexico City, Mexico
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current state of endoscopic quality measurement and use of measures in enhancing the value of endoscopic services. RECENT FINDINGS Initially, quality measurement of endoscopic procedures was claims based or included small unit or practice-specific efforts. Now we have a mature national registry and large electronic medical or procedural records that are designed to yield valuable data relevant to quality measurement. SUMMARY With the advent of better measures, we are beginning to understand that initial process and surrogate outcome measures (adenoma detection rate) can be improved to provide a better reflection of endoscopic quality. Importantly, however, even measures currently in use relate to important patient outcomes such as missed colon cancers. At a federal level, older cumbersome pay-for-performance initiatives have been combined into a new overarching program named the quality payment program within the centers for medicare and medicaid services. This program is an additional step toward furthering the progress from volume-to-value-based reimbursement. The legislation mandating the movement toward outcomes-linked (value) reimbursement is the medicare access and children's health insurance program reauthorization act, which was passed with overwhelming bipartisan support and will not be walked back by alterations of the affordable care act. Increasing portions of medicare reimbursement (and likely commercial to follow) will be linked to quality metrics, so familiarity with the underlying process and rationale will be important for all proceduralists.
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Inaba CS, Pigazzi A. Current Trends in the Use of Bowel Preparation for Colorectal Surgery. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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