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News

Polypectomy rate as a surrogate for adenoma detection rate

Polypectomy rate as a surrogate for adenoma detection rate varies by colon segment, gender, and endoscopist, reports the latest issue of the Clinical Gastroenterology & Hepatology.

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The adenoma detection rate is an important measure of the quality of colonoscopy.

It is associated with interval colorectal cancer and varies among sexes and locations.

Recommended indicators of competence for colonoscopy include minimal adenoma detection rate >25% for average-risk men and >15% for women.

These adenoma detection rates are rigorous, so polypectomy detection rate has been suggested as a surrogate.

Colonoscopy is less effective in the proximal colon, where interval cancers are more likely to occur.

Dr Madhusudhan Sanaka and colleagues compared adenoma detection rates and polypectomy detection rates in different segments of colon and between sexes.

The mean overall polypectomy detection rate was 42%
Clinical Gastroenterology & Hepatology

The research team performed a cross-sectional review of findings from 2167 screening colonoscopies performed by 65 endoscopists on average-risk outpatients at the Cleveland Clinic, 2008–2009.

The team reviewed colonoscopy and pathology reports of randomly selected procedures.

The researchers calculated polypectomy detection rates, adenoma detection rates, and correlation between polypectomy and adenoma detection rate for each colon segment and sex.

The team found that the mean overall polypectomy detection rate was 42%, and adenoma detection rate was 25%.

The team noted that the correlation between overall adenoma detection rate and polypectomy detection rate was stron.

Polypectomy detection rate of 40% in men and 30% in women correlated with the established minimum benchmark adenoma detection rates of 25% and 15% for men and women, respectively.

Polypectomy detection rate was more strongly correlated with adenoma detection rate in the proximal colon than the distal colon.

The researcher's correlation was stronger in men than in women, as well as in the entire colon, the proximal colon, and the distal colon.

The advanced adenoma detection rate was 4% and did not correlate with polypectomy detection rate.

Dr Sanaka's team concludes, "On the basis of a review of findings from screening colonoscopies, overall polypectomy detection rate correlates with adenoma detection rate for the entire colon, but polypectomy detection rate and adenoma detection rate correlate most strongly for the proximal colon, where many adenomas can be missed and interval cancers develop."

"The correlation between polypectomy detection rate and adenoma detection rate is weaker for women than men and for distal colon."

"If polypectomy detection rate is used as a surrogate for adenoma detection rate, colon location and patient sex should be considered."

Clin Gastroenterol Hepatol 2014: 12(7): 1137–1142
30 June 2014

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