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Yang SY, Quan SY, Friedland S, Pan JY. Predictive factors for adenoma detection rates: a video study of endoscopist practices. Endosc Int Open 2021; 9:E216-E223. [PMID: 33553584 PMCID: PMC7857972 DOI: 10.1055/a-1321-0990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background and study aims In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) Task Force on Quality in Endoscopy deemed adenoma detection rate (ADR) the most important quality measure for colonoscopy. There has been much interest in factors that can increase ADR. To date, however, few studies have looked at what intra-procedural endoscopist practices are associated with improving ADR. We conducted a retrospective review of colonoscopy videos to evaluate intra-procedural practices that could be associated with ADR. Methods Videos were recorded of colonoscopies performed between September and December 2017 at the Palo Alto Veterans Affairs Health Care System. Colonoscopies for screening and surveillance were included for video review. Factors assessed included withdrawal time, intra-procedural cleaning, inspection technique, and other variables (colon distention, removal of equivocal/hyperplastic polyps). A series of multiple regression analyses was conducted on variables of interest before running a final model of significant predictors. Results A total of 130 videos were reviewed from nine endoscopists whose ADRs ranged between 37.5 % and 73.7 %. The final regression model was significant (F = 15.35, df = 2, P = 0.0044), R 2 = 0.8365) with close inspection of behind folds and quality of cecal inspection being the factors highly correlated with predicting ADR. Withdrawal and inspection times, colonic wall distention, removal of equivocal/hyperplastic polyps, quality of rectal inspection, suctioning, and washing were factors moderately correlated with predicting ADR. Conclusions We found that behind-fold inspection and a meticulous cecal inspection technique were predictive of a high ADR.
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Affiliation(s)
- Sun Young Yang
- Division of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Susan Y. Quan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shai Friedland
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jennifer Y. Pan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
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Ahadi M, Kazemi Nejad B, Kishani Farahani Z, Mollasharifi T, Jamali E, Mohaghegh Shalmani H, Dehgan A, Saberi Afsharian M, Sadeghi A, Movafagh A, Boran R, Rakhshan A, Moradi A, Heidari MH, Moradi A. Clinicopathologic Features of Colorectal Polyps in Shahid Beheshti University of Medical Sciences (SBMU). Asian Pac J Cancer Prev 2019; 20:1773-1780. [PMID: 31244299 PMCID: PMC7021591 DOI: 10.31557/apjcp.2019.20.6.1773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 12/24/2022] Open
Abstract
Aim: This study was designed to report epidemiologic findings of polyps in Iranian patients, and predict histology of polyp regarding to demographic and colonoscopic findings. Background: Classification of colorectal polyps had been revised in the past two decades and there is a need for polyp categorization in the Iranian Health System. Patients and methods: In this retrospective study, the medical records of patients with colonoscopic diagnosis of polyp in pathology departments of SBMU affiliated teaching hospitals were reviewed. Patient’s slides evaluated and demographics findings were assessed. The anatomical location, macroscopic appearance including size and histological assessment of all polyps were recorded. Results: From total number of 1106 polyps (detected in 862 patients), adenomatous polyps (638 [57.7%]) were the most prevalent findings, followed by colon mucosal tag (184[16.6%]), hyperplastic and serrated polyps (122[11%]), inflammatory polyps (110[9.9%]), hamartomatous (21[1.9%]), and malignant lesions (13[1.2%]). Multivariate logistic regression showed age (each one year increasing age; odds ratio [OR] = 1.026, 95%confidence interval [CI] = 1.016–1.036, p < 0.0001), location of polyp (right colon; OR = 1.905, 95%CI = 1.366–2.656, p < 0.0001), and polyp size of 5-10 mm (OR = 1.662, 95%CI = 1.214–2.276, p = 0.002), and polyp size of >10 mm (OR = 2.778, 95%CI = 1.750–4.411, p< 0.0001) were independently associated with neoplastic polyps. Also, polyp size of >10 mm (OR= 2.613, 95%CI= 1.083-6.307, p=0.033), tubulovillous pattern of polyp (OR= 3.508, 95%CI= 1.666-7.387, p=0.001) and villous pattern of polyp (OR= 10.444, 95%CI= 4.211-25.905, p<0.0001) were associated with high grade dysplasia in neoplastic polyps. Conclusion: Increased age, location of polyp (right colon), increased size of polyp and villous component of polyp could classify patients in high risk groups.
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Affiliation(s)
- Mahsa Ahadi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behrang Kazemi Nejad
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Tahmineh Mollasharifi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elena Jamali
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Mohaghegh Shalmani
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Dehgan
- Department of Pathology, Hamedan University of Medical Sciences, Hamedan, Iran
| | | | - Amir Sadeghi
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, Schoolof Medicine, Shahid Behesti University of Medical Sciences, Tehran, Iran
| | - Roxana Boran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azadeh Rakhshan
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arsham Moradi
- University of Toronto, Department of Biology, Toronto, Canada
| | - Mohammad Hassan Heidari
- Department of Anatomy, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moradi
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sakata S, Naidu S, Stevenson ARL, Hewett DG. Optical diagnosis of diminutive colorectal polyps. ANZ J Surg 2017; 87:326-327. [PMID: 28470708 DOI: 10.1111/ans.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/08/2016] [Accepted: 02/17/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Shinichiro Sakata
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Surgery, The Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Sanjeev Naidu
- Department of Surgery, The Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Andrew R L Stevenson
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Division of Gastroenterology, The Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
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Sakata S, Kheir AO, Hewett DG. Optical diagnosis of colorectal neoplasia: A Western perspective. Dig Endosc 2016; 28:281-8. [PMID: 26841371 DOI: 10.1111/den.12625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 02/08/2023]
Abstract
Optical diagnosis is an emerging paradigm in Western endoscopic practice for the colonoscopic management of diminutive polyps, and includes two complementary clinical strategies: 'resect and discard', in which diminutive high-confidence adenomas are identified, and then removed and discarded without pathological assessment; and 'diagnose and leave', where diminutive high-confidence hyperplastic polyps are identified in the rectosigmoid and then left without resection or biopsy. Like other aspects of colonoscopy performance, adoption of optical diagnosis in Western practice is limited by operator dependency and variation in clinical effectiveness. There is substantial potential for optical diagnosis of colorectal neoplasia during colonoscopy to alleviate the rising costs of health care in the West. However, operator dependence in diagnostic performance together with critical system factors such as informed consent, credentialing, medical legal support and reimbursement incentives must be overcome before optical diagnosis of diminutive lesions is considered for widespread adoption in Western clinical practice.
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Affiliation(s)
- Shinichiro Sakata
- School of Medicine, The University of Queensland, Brisbane, Australia.,Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Ammar O Kheir
- Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Australia.,Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
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Saligram S, Rastogi A. Methods to become a high performer in characterization of colorectal polyp histology. Best Pract Res Clin Gastroenterol 2015; 29:651-62. [PMID: 26381309 DOI: 10.1016/j.bpg.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/11/2015] [Accepted: 06/08/2015] [Indexed: 01/31/2023]
Abstract
The recent advent of advanced imaging technologies has brought real time characterization of polyp histology to the forefront. This concept of optical diagnosis of diminutive polyp histology can bring about a huge paradigm shift in the management of these lesions. Instead of resecting and sending all the diminutive polyps to pathology, there is the potential to practice "resect and discard" for those predicted to be adenomas and "do not resect" strategy for the recto-sigmoid polyps predicted to be hyperplastic. However, one of the major steps before the clinical implementation of real-time histology can be a reality, will be training endoscopists with varying levels of experience in novel imaging technologies. The two major methods for training include didactic teaching and the computer based method. After the initial training, it is imperative that the endoscopists practice this skill during performance of routine colonoscopy to auto validate and assess their own competency. Both practice and reinforcement can help endoscopists become high performers in the characterization of polyp histology.
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Affiliation(s)
- Shreyas Saligram
- University of Kansas, Kansas City, KS-66160, USA; Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
| | - Amit Rastogi
- University of Kansas, Kansas City, KS-66160, USA; Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
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