Polyp detection rates as quality indicator in clinical versus screening colonoscopy

Adenoma Detection Rate and Polyp Detection Rate among Gastroenterology Fellows and Consultants in a Tertiary Hospital in the Philippines: A Cross-sectional Study

Background and Objective

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide. Likewise in the Philippines, the prevalence of CRC has shown to be increasing. Colonoscopy, a screening procedure for CRC, has parameters to gauge quality of detection. One of which is the Adenoma Detection Rate (ADR). Higher ADR has been linked to improved cancer detection. This study aimed to determine the ADR and Polyp Detection Rate (PDR) among Gastroenterology practitioners in a tertiary government university hospital in the Philippines, estimate ADR from PDR, and identify factors associated with ADR.

Methods

An analytical, cross-sectional study among patients who underwent colonoscopy for the years 2021 and the first half of 2022 at the Central Endoscopy Unit (CENDU) of the Philippine General Hospital. Demographic data of fellows and consultants were collected through an online form, while those from patients were obtained from electronic records. Colonoscopy details and histopathology results were accessed through the hospital's Open Medical Record System (MRS). ADR, PDR, and estimated ADR were computed using established formulas. To evaluate the strength of the relationship between the estimated and actual ADR, Pearson's correlation coefficient was used. Chi-square analysis, Mann-Whitney U test, and Kruskal-Wallis H test were performed to identify the factors that might influence the ADR. A cut-off of p <0.05 was considered statistically significant.

Results

The total computed ADR of consultants and fellows combined is 22%. The difference between the ADRs of Gastroenterology consultants and Fellows-in-Training is statistically significant at 31.6% and 18.7%, respectively (p= 0.017). The total Polyp Detection Rate is 57.6% while the weighted group average Adenoma to Polyp Detection Rate Quotient (APDRQ) is 0.4085 or 40.85%. The estimated ADR has a moderate degree of correlation with the actual ADR when an outlier was excluded (r=0.521 (95% CI, 0.072-0.795, p=0.0266). Significant factors related to ADR include endoscopists' years of practice (p=0.020), number of colonoscopies done (p=0.031), and patient tobacco use (p=0.014).

Conclusion

The overall ADR among consultants and fellows is at par with the standard guidelines. A moderate degree of correlation exists between actual and estimated ADR when an outlier is excluded; however, more studies are needed to determine the APDRQ in the wider local setting. Longer years in practice, total number of colonoscopies performed, and patient tobacco use are associated with increased ADR.

Overall Polyp Detection Rate as a Surrogate Measure for Screening Efficacy Independent of Histopathology: Evidence from National Endoscopy Database

Adenoma detection rate (ADR) is challenging to measure, given its dependency on pathology reporting. Polyp detection rate (PDR) (percentage of screening colonoscopies detecting a polyp) is a proposed alternative to overcome this issue. Overall PDR from all colonoscopies is a relatively novel concept, with no large-scale studies comparing overall PDR with screening-only PDR. The aim of the study was to compare PDR from screening, surveillance, and diagnostic indications with overall PDR and evaluate any correlation between individual endoscopist PDR by indication to determine if overall PDR can be a valuable surrogate for screening PDR. Our study analyzed a prospectively collected national endoscopy database maintained by the National Institute of Health from 2009 to 2014. Out of 354,505 colonoscopies performed between 2009-2014, 298,920 (n = 110,794 average-risk screening, n = 83,556 average-risk surveillance, n = 104,770 diagnostic) met inclusion criteria. The median screening PDR was 25.45 (IQR 13.15-39.60), comparable with the median overall PDR of 24.01 (IQR 11.46-35.86, p = 0.21). Median surveillance PDR was higher at 33.73 (IQR 16.92-47.01), and median diagnostic PDR was lower at 19.35 (IQR 9.66-29.17), compared with median overall PDR 24.01 (IQR 11.46-35.86; p < 0.01). The overall PDR showed excellent concordance with screening, surveillance, and diagnostic PDR (r > 0.85, p < 0.01, 2-tailed). The overall PDR is a reliable and pragmatic surrogate for screening PDR and can be measured in real time, irrespective of colonoscopy indication.

Is There a Difference in Adenoma Detection Rates According to Indication? An Experience in a Panamanian Colorectal Cancer Screening Program

Background

The benefit of colorectal cancer screening in reducing cancer risk and related death is unclear. There are quality measure indicators and multiple factors that affect the performance of a successful colonoscopy. The main objective of our study was to identify if there is a difference in polyp detection rate (PDR) and adenoma detection rate (ADR) according to colonoscopy indication and which factors might be associated.

Methods

We conducted a retrospective review of all colonoscopies performed between January 2018 and January 2019, in a tertiary endoscopic center. All patients ≥ 50 years old scheduled for a nonurgent colonoscopy and screening colonoscopy were included. We stratified the total number of colonoscopies into two categories according to the indication: screening vs. non-screening, and then calculated PDR, ADR and serrated polyp detection rate (SDR). We also performed logistic regression model to identify factors associated with detecting polyps and adenomatous polyps.

Results

A total of 1,129 and 365 colonoscopies were performed in the non-screening and screening group, respectively. In comparison with the screening group, PDR and ADR were lower for the non-screening group (33% vs. 25%; P = 0.005 and 17% vs. 13%; P = 0.005). SDR was non-significantly lower in the non-screening group when compared with the screening group (11% vs. 9%; P = 0.53 and 22% vs. 13%; P = 0.007).

Conclusion

In conclusion, this observational study reported differences in PDR and ADR depending on screening and non-screening indication. These differences could be related to factors related to the endoscopist, time slot allotted for colonoscopy, population background, and external factors.

Bowel cleansing efficacy of 1 L NER1006versus macrogol and 3 L polyethylene glycol using split-dose administration

Background and Aim

Colonoscopies are an important diagnostic technique in the detection of colorectal cancer and colonic disease. Adequate examination is dependent on the degree of mucosal visibility, with poor cleansing impeding the detection of neoplasms. These patients require shorter colonoscopy surveillance intervals, longer hospital stays, and increased healthcare costs-rendering a screening colonoscopy cost-ineffective. In Australia and the Gold Coast Hospital and Health Service (GCHHS), macrogol and 3 L of polyethylene glycol are the preferred regimen given its safety profile and efficacy. Yet, little is known locally about the use of the new low-volume bowel preparation NER1006 (Plenvu) given its recent registration with the Therapeutic Goods of Australia (TGA). The primary outcome assessed the bowel cleansing efficacy of NER1006 compared with 7 days of macrogol and 3 L of polyethylene glycol using the Boston Bowel Preparation Scale (BBPS), while also assessing the influence of notable patient characteristics such as age, gender, body mass index (BMI), and the patients Charlson comorbidity index (CCI). Secondary outcomes assessed the polyp detection rate and procedural factors including cecal intubation, scope withdrawal time, and rebooking rates.

Methods

Data from all patients who underwent an outpatient colonoscopy procedure at GCHHS between 1 July 2020 and 30 September 2020 were analyzed. Patients were aged 50-74 years of age and were referred for a screening colonoscopy due to a positive fecal occult blood test (FOBT) result from the National Bowel Cancer Screening Program.

Results

Of the 238 patients who met the inclusion criteria, 108 patients received NER1006 and 130 patients received macrogol and 3 L polyethylene glycol. NER1006 achieved superior overall (P < 0.001) and right-sided colon cleansing (P = 0.016). There was an even distribution of males and females (P = 0.118), the mean age of both cohorts was <65 years of age. The macrogol and 3 L polyethylene glycol group had a statistically higher BMI (P < 0.001) and CCI (P < 0.001). Cecal intubation success was achieved in both cohorts (≥95%) and scope withdrawal time was ≥6 min, polyp detection was non-superior (P = 0.824), but superior in NER1006 when BBPS ≥6 (P = 0.002). Rebooking rates were significantly lower in the NER1006 group (P = 0.013).

Conclusion

This study demonstrated that NER1006 was superior in terms of overall and right-sided bowel cleansing as a primary endpoint. Patient factors demonstrated to be independent predictors of inadequate bowel preparation. Future studies should aim to explore the safety and tolerability of NER1006 while also assessing the bowel cleansing effectiveness in patients with a high BMI and comorbidity index.

Simple feedback of colonoscopy performance improved the number of adenomas per colonoscopy and serrated polyp detection rate

Background and study aims  High-quality endoscopy requires improvement of not only the adenoma detection rate (ADR) but also the serrated polyp (SP) detection rate and the mean number of adenomas per positive procedure (MAP +). We evaluated whether a simple feedback of colonoscopy performance improves those quality indicators using propensity-score matching. Patients and methods  Eleven endoscopists were evaluated regarding colonoscopy performance including ADRs, SP detection rates, mean numbers of adenomas per procedure (MAPs), and MAPs + with their ranking in the clinic. Endoscopic performance was compared before and after the feedback. Results  Colonoscopies were performed for 874 patients before the feedback and 1,272 patients after the feedback. Using propensity-score matching, 803 patients before the feedback and 803 patients after the feedback were matched. ADR after the feedback was significantly higher than that before the feedback (50.8 % and 40.8 %, respectively). MAP after feedback was significantly larger than that before the feedback (0.92 and 0.69, respectively), as well as MAP + (1.96 and 1.69, respectively). Clinically significant SP detection rate was also improved from 10.0 % to 14.9 %. Conclusions  Feedback including ADR, MAP, MAP +, and clinically significant SR detection rate could improve on those quality indicators. Further studies are needed to effectively prevent colorectal cancer in colonoscopy practice.

Correlation between ADR of screening and all colonoscopies

BACKGROUND AND AIMS

Colonoscopy with polypectomy are associated with a reduction in the incidence of colorectal cancer (CRC), as well as mortality, secondary to CRC. Because of the variation in physicians' performance and the risk of interval CRC after a colonoscopy, several quality indicators have been established. ADR (adenoma detection rate) is a generally accepted quality indicator. But it is also a target of possible gaming and achieving an adequate number of colonoscopies only from screening may be a problem for some practices. The aim of this study was to compare ADR for colonoscopies done for various indications and to look for correlations between the ADR of screening and all examinations.

METHODS

We retrospectively assessed the quality indicators of all colonoscopies performed in a nonuniversity hospital, Frydek-Mistek, from January 2013 to December 2017. We calculated the ADR for all colonoscopies in patients over 50 years of age (subdivided into screening, surveillance, diagnostic) and separately only for screening colonoscopies. Correlations were made using the Pearson's correlation coeficient.

RESULTS

The sample was composed of 6925 patients over 50 years of age (3620 men, 3305 women, mean age 66.2 years). The ADRs for screening and surveillance were higher than for diagnostic colonoscopies for all of the endoscopists, and the ADRs for all colonoscopies were lower than for screening, but sufficiently over 25%. There was a positive correlation between the ADR of screening and all colonoscopies (r=0.906, P<0.005).

CONCLUSIONS

The calculation of ADR for all colonoscopies was possible in our endoscopic department, and there was a positive correlation with ADR for screening colonoscopies. ADR for all colonoscopies is a good tool for calculating real ADR from large sample sizes without gaming.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03730441).