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 19 October 2017

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News

Endoscopic quality improvement program for adenoma detection on polyp detection

June's issue of the Digestive Diseases & Sciences investigates the impact of an endoscopic quality improvement program focused on adenoma detection on sessile serrated adenoma/polyp detection.

News image

Sessile serrated adenomas/polyps are an under-recognized disease with a unique malignant pathway.

Improved endoscopic recognition and pathological interpretation is needed.

Dr Ronald Racho and colleagues from Florida, USA determined whether an educational intervention that improved adenoma detection rate could improve sessile serrated adenomas/polyps detection rate after reclassification of previously termed “hyperplastic" polyps.

The researchers reanalyzed data from a prospective randomized trial of an educational intervention aimed at increasing adenoma detection rate.

All hyperplastic polyps 6 mm or more reported in a previously published study were rereviewed and reclassified using standardized criteria for serrated lesions.

Detection rates of sessile serrated adenomas/polyps and other clinically relevant serrated polyps were calculated in the baseline and post-training phases of the original study.

Detection of serrated polyp during colonoscopy increased by only 3% with the educational intervention
Digestive Diseases & Sciences

Of 263 available for rereview, 13% were reclassified as sessile serrated adenomas/polyps or traditional serrated adenoma.

The team found that reclassification was more common in the right colon.

Baseline sessile serrated adenomas/polyps detection rate was less than 1% in the untrained group, and 1% in the trained group.

Post-training, the researchers noted that the sessile serrated adenomas/polyps detection rate increased to 2% and 1.5%, respectively.

The team observed that clinically relevant serrated polyp detection rate at baseline was 14% in the untrained group and 11% in the trained group.

After the educational intervention, the clinically relevant serrated polyp detection rates increased to 17% and 15% in the untrained and trained groups, respectively.

The estimated odds of an endoscopist detecting either a sessile serrated adenomas/polyps or other clinically relevant serrated polyp during colonoscopy increased by only 3% with the educational intervention.

Dr Racho's team concludes, "Pathological re-interpretation of larger serrated polyps resulted in the reclassification of 13% of lesions."

"Quality improvement methods focused on adenoma detection did not impact sessile serrated adenomas/polyps detection, and thus specific methods for serrated polyp detection are needed."

Dig Dis Sci 2017: 62(6): 1464–1471
01 June 2017

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