Download PDF
Endoscopy 2023; 55(05): 434-441
DOI: 10.1055/a-1974-9979
Original article

Comparison of adenoma detection rate and proximal serrated polyp detection rate and their effect on post-colonoscopy colorectal cancer mortality in screening patients

Jasmin Zessner-Spitzenberg
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Elisabeth Waldmann
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Lena Jiricka
3   Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Clinical Biometrics, Medical University of Vienna, Vienna, Austria
,
Lisa-Maria Rockenbauer
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Anna Hinterberger
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Jeremy Cook
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Arno Asaturi
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Aleksandra Szymanska
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Barbara Majcher
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
Michael Trauner
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
Monika Ferlitsch
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
› Author AffiliationsAustrian Main Association of Statutory Insurance Institutions Austrian Cancer Aid Österreichische Gesellschaft für Gastroenterologie und Hepatologie http://dx.doi.org/10.13039 /501100020617
› Further Information
Also available at
    Permissions and Reprints


Referred to by:

Author commentary on Jasmin Zessner-Spitzenberg et al.Endoscopy 2023; 55(05): v12-v12
DOI: 10.1055/a-1965-8446

Referred to by:

Proximal serrated polyp detection rate and post-colonoscopy colorectal cancer: the missing linkEndoscopy 2023; 55(05): 442-443
DOI: 10.1055/a-2003-1068

Abstract

Background Patients with serrated polyps are at increased risk for post-colonoscopy colorectal cancer (PCCRC); however, evidence for a dedicated serrated polyp detection rate is lacking. The aim of this study was to investigate the association of the proximal serrated polyp detection rate (PSDR) and adenoma detection rate (ADR) with PCCRC death.

Methods This was a retrospective analysis within the Austrian quality assurance program for screening colonoscopy. Spearman’s rank coefficient was calculated for the assessment of association between ADR and PSDR. Whether ADR or PSDR were associated with colorectal cancer mortality was assessed by Cox proportional hazards model.

Results 229/729 screening colonoscopies performed by 308 endoscopists were analyzed. The ADR (hazard ratio [HR] per 1 percentage point increase 0.98, 95 %CI 0.96–0.99) as well as the PSDR (HR per 1 percentage point increase 0.97, 95 %CI 0.94–0.99) were significantly associated with PCCRC death. The correlation coefficient of the ADR and PSDR calculated at every colonoscopy was 0.70 (95 %CI 0.70–0.71), and the corresponding PSDR value for an ADR performance standard of 25 % was 11.1 %. At the end of the study period, 86 endoscopists (27.9 %) reached an ADR of > 25 % and a PSDR of > 11.1 %.

Conclusions The ADR as well as the PSDR were associated with PCCRC death. Striving for a high PSDR in addition to a high ADR might reduce the risk for PCCRC mortality in patients undergoing screening colonoscopy.

Supplementary material



Publication History

Received: 22 February 2022

Accepted after revision: 12 October 2022

Article published online:
08 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rees CJ, Thomas Gibson S, Rutter MD. et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65: 1923-1929
    CrossrefPubMedGoogle Scholar
  • 2 Crockett SD, Nagtegaal ID. Terminology, molecular features, epidemiology, and management of serrated colorectal neoplasia. Gastroenterology 2019; 157: 949-966
    CrossrefPubMedGoogle Scholar
  • 3 Rex DK, Ahnen DJ, Baron JA. et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 2012; 107: 1315-1330
    CrossrefPubMedGoogle Scholar
  • 4 Yamane L, Scapulatempo-Neto C, Reis RM. et al. Serrated pathway in colorectal carcinogenesis. World J Gastroenterol 2014; 20: 2634-2640
    CrossrefPubMedGoogle Scholar
  • 5 Nagtegaal ID, Odze RD, Klimstra D. et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188
    CrossrefPubMedGoogle Scholar
  • 6 Weisenberger DJ, Siegmund KD, Campan M. et al. CpG island methylator phenotype underlies sporadic microsatellite instability and is tightly associated with BRAF mutation in colorectal cancer. Nat Genet 2006; 38: 787-793
    CrossrefPubMedGoogle Scholar
  • 7 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
    CrossrefPubMedGoogle Scholar
  • 8 Wu K, Nishihara R, Qian ZR. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
    CrossrefPubMedGoogle Scholar
  • 9 Rosenberg DW, Yang S, Pleau DC. et al. Mutations in BRAF and KRAS differentially distinguish serrated versus non-serrated hyperplastic aberrant crypt foci in humans. Cancer Res 2007; 67: 3551-3554
    CrossrefPubMedGoogle Scholar
  • 10 Spring KJ, Zhao ZZ, Karamatic R. et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology 2006; 131: 1400-1407
    CrossrefPubMedGoogle Scholar
  • 11 Kahi CJ, Hewett DG, Norton DL. et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
    CrossrefPubMedGoogle Scholar
  • 12 Anderson JC, Butterly LF, Weiss JE. et al. Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2017; 85: 1188-1194
    CrossrefPubMedGoogle Scholar
  • 13 Payne SR, Church TR, Wandell M. et al. Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center. Clin Gastroenterol Hepatol 2014; 12: 1119-1126
    CrossrefPubMedGoogle Scholar
  • 14 Liang J, Kalady MF, Appau K. et al. Serrated polyp detection rate during screening colonoscopy. Colorectal Disease 2012; 14: 1323-1327
    CrossrefPubMedGoogle Scholar
  • 15 East JE, Atkin WS, Bateman AC. et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017; 66: 1181-1196
    CrossrefPubMedGoogle Scholar
  • 16 Ferlitsch M, Reinhart K, Pramhas S. et al. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA 2011; 306: 1352-1358
    CrossrefPubMedGoogle Scholar
  • 17 Waldmann E, Gessl I, Sallinger D. et al. Trends in quality of screening colonoscopy in Austria. Endoscopy 2016; 48: 1102-1109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Waldmann E, Penz D, Šinkovec H. et al. Interval cancer after colonoscopy in the Austrian National Screening Programme: influence of physician and patient factors. Gut 2021; 70: 1309-1317
    CrossrefPubMedGoogle Scholar
  • 19 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 He X, Hang D, Wu K. et al. Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology 2020; 158: 852-861
    CrossrefPubMedGoogle Scholar
  • 21 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    CrossrefPubMedGoogle Scholar
  • 22 Hassan C, Antonelli G, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020. Endoscopy 2020; 52: 687-700
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Bronzwaer MES, Vleugels JLA, van Doorn SC. et al. Are adenoma and serrated polyp detection rates correlated with endoscopists’ sensitivity of optical diagnosis?. Endoscopy 2020; 52: 763-772
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Crockett SD, Gourevitch RA, Morris M. et al. Endoscopist factors that influence serrated polyp detection: a multicenter study. Endoscopy 2018; 50: 984-992
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Ijspeert JEG, van Doorn SC, van der Brug YM. et al. The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps. Gastrointest Endosc 2015; 82: 870-877
    CrossrefPubMedGoogle Scholar
  • 26 Parikh MP, Muthukuru S, Jobanputra Y. et al. Proximal sessile serrated adenomas are more prevalent in caucasians, and gastroenterologists are better than nongastroenterologists at their detection. Gastroenterol Res Pract 2017; 2017: 6710931
    CrossrefPubMedGoogle Scholar
  • 27 Sarvepalli S, Garber A, Rothberg MB. et al. Association of adenoma and proximal sessile serrated polyp detection rates with endoscopist characteristics. JAMA Surg 2019; 154: 627-635
    CrossrefPubMedGoogle Scholar
  • 28 Schachschal G, Sehner S, Choschzick M. et al. Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists. Int J Colorectal Dis 2016; 31: 675-683
    CrossrefPubMedGoogle Scholar
  • 29 Kim JH, Kang GH. Evolving pathologic concepts of serrated lesions of the colorectum. J Pathol Transl Med 2020; 54: 276-289
    CrossrefPubMedGoogle Scholar
  • 30 Stoffel EM, Erichsen R, Frøslev T. et al. Clinical and molecular characteristics of post-colonoscopy colorectal cancer: a population-based study. Gastroenterology 2016; 151: 870-878
    CrossrefPubMedGoogle Scholar
  • 31 Soong TR, Nayor J, Stachler MD. et al. Clinicopathologic and genetic characteristics of interval colorectal carcinomas favor origin from missed or incompletely excised precursors. Mod Pathol 2019; 32: 666-674
    CrossrefPubMedGoogle Scholar
  • 32 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy – results of the Complete Adenoma Resection (CARE) Study. Gastroenterology 2013; 144: 74-80
    CrossrefPubMedGoogle Scholar
  • 33 Hetzel JT, Huang CS, Coukos JA. et al. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol 2010; 105: 2656-2664
    CrossrefPubMedGoogle Scholar
  • 34 Bosman F, Carneiro F, Hruban R. Theise ND. WHO classification of tumors of the digestive system. Lyon: International Agency for Research on Cancer; 2010. 4th edn.
    Google Scholar
  • 35 Amitay EL, Carr PR, Jansen L. et al. Smoking, alcohol consumption and colorectal cancer risk by molecular pathological subtypes and pathways. Br J Cancer 2020; 122: 1604-1610
    CrossrefPubMedGoogle Scholar
  • 36 Symonds E, Anwar S, Young G. et al. Sessile serrated polyps with synchronous conventional adenomas increase risk of future advanced neoplasia. Dig Dis Sci 2019; 64: 1680-1685
    CrossrefPubMedGoogle Scholar