Adenoma miss rate of polypectomy-referring hospitals is high in Korea

Risk Factors of Missed Adenoma Detected by Colonoscopic Polypectomy and Its Impact of the Endoscopic System

BACKGROUND

The adenoma detection rate is a key colonoscopy quality indicator, but the adenoma miss rate (AMR) is more strongly linked to post-colonoscopy colorectal cancer risk. While studies examined high-definition colonoscopy and AMR, no studies have assessed its impact on consecutive polypectomy.

AIM

This study aimed to identify adenomas missed in screening or surveillance colonoscopy and determine if the endoscopic system affects the miss rate.

METHODS

This retrospective study analyzed patients referred to Dong-A University Hospital for polypectomy after polyps were detected during screening or surveillance colonoscopy at 24 healthcare institutions. Endoscopic systems used in these colonoscopies were classified as FHD (FHD) or non-FHD. Consecutive polypectomies were performed by a single expert between March 2020 and February 2022 using the FHD system. The AMR was compared and analyzed for screening or surveillance colonoscopies performed using FHD endoscopic systems and those using non-FHD endoscopic systems.

RESULTS

Of 542 polyps, 186 were missed (miss rate: 25.22%). Miss rates for adenoma and advanced neoplasia were 27.34% and 14.69%. Univariate analysis identified age, adenoma count, and endoscopic system as significant factors. However, only the endoscopic system remained significant in the multivariate analysis. In screening or surveillance colonoscopy, the use of FHD endoscopic systems demonstrated a lower AMR compared to non-FHD systems (21.86% vs. 31.41%, P = 0.014).

CONCLUSION

The use of FHD endoscopic systems reduced AMR compared to non-FHD systems.

Comparison of missed adenomas in deep-sedated and unsedated colonoscopy: A multicenter retrospective study

BACKGROUND

Deep-sedated colonoscopy with propofol is widely used in China. However, its impact on quality metrics remains controversial. We aimed to investigate the effects of deep-sedated colonoscopy on missed adenomas, specifically in each colorectal segment.

METHODS

Data of 3710 individuals from seven hospitals in China who underwent an initial colonoscopy with or without propofol sedation and a second colonoscopy without sedation within six months for surveillance or polypectomy by endoscopist of the same level between October 2020 and September 2021 were retrospectively analyzed.

RESULTS

A total of 1113 missed adenomas in 3710 patients were evaluated. The adenoma miss rate (AMR) was significantly higher in deep-sedated colonoscopy than in unsedated colonoscop [19.14% (578/3020) vs. 16.15% (535/3313), P < 0.05]. The risk of missing adenomas in deep-sedated colonoscopy was 1.229 times higher than in unsedated colonoscopy (OR, 1.229; 95% CI: 1.080-1.399). AMRs of the splenic flexure (26.02% [96/369] vs. 16.04% [47/293], P < 0.05) and descending colon (20.86% [102/489] vs. 13.37% [54/404], P < 0.05) were significantly higher in deep-sedated colonoscopy than in unsedated colonoscopy when performed by middle-level endoscopists rather than high-level endoscopists (P < 0.05).

CONCLUSIONS

AMR was higher in deep-sedated colonoscopy than in unsedated colonoscopy. Furthermore, adenomas in the splenic flexure and descending colon were more frequently missed in deep-sedated colonoscopy than in unsedated colonoscopy, particularly when performed by less experienced endoscopists.

Factors Affecting Adenoma Risk Level in Patients with Intestinal Polyp and Association Analysis

Objective. To explore the factors affecting the adenoma risk level in patients with intestinal polyp and association. Methods. The clinical data of 3,911 patients with intestinal polyp treated in our hospital from January 2018 to January 2021 were retrospectively analyzed, all patients accepted the histopathological examination, their risk of suffering from adenoma was evaluated according to the results of pathological diagnosis, and relevant hazard factors affecting adenoma risk level in them were analyzed by multifactor logistic regression analysis. Results. The results of multifactor logistic analysis showed that male gender, age ≥60 years, number of polyps >3, diameter ≥2 cm, onset at colon, and physiologically tubulovillous adenoma were the hazard factors causing high-grade adenoma risk in patients with intestinal polyp. Conclusion. There are many risk factors causing high-grade adenoma in patients with intestinal polyp, and therefore, the screening for high-risk population shall be enhanced to reduce the potential of carcinomatous change in such patients.

Clinicopathological and molecular features of colorectal cancer with synchronous adenoma

OBJECTIVE

To investigate the clinicopathological and molecular features of colorectal cancer (CRC) with synchronous adenoma and to describe features of synchronous adenomas in CRC patients.

METHODS

Single-centre retrospective cohort of 180 patients were included. The clinicopathological and endoscopic data were collected. The expression mismatch repair (MMR) proteins were detected by immunohistochemistry. The determination of microsatellite instability (MSI) was performed by multiple fluorescence PCR, and the mutations of genes were detected by real-time PCR.

RESULTS

Among all cases, 49 were diagnosed as CRC with synchronous adenoma, and 131 were diagnosed as solitary CRC. Some of the differences between the groups are: higher incidence was found in male (71.4 vs. 52.6%, p = .023) and in patients with habit drinking (34.7 vs. 14.5%, p = .030) and with other neoplastic diseases (42.7 vs. 26%, p = .028). Less tumors in the synchronous group were diagnosed as stage III and IV than in the solitary group (28.6 vs. 45%, p = .045). One and four mutant subtypes of KRAS gene mutations were detected insynchronous group and solitary group respectively.The prevalence of BRAF mutations in solitary group was higher than that in the synchronous group (7.4 vs. 0%, p = .045). A total of 123 adenomas were found in synchronous group and they tend to be smaller than 10 mm (74%).

CONCLUSION

Gender, a habit of drinking and other neoplastic diseases are risk factors for the development of a synchronous adenoma. With a low rate of BRAF mutations, the responses to monoclonal antibody and prognosis of patients with synchronous adenomas may be better than that of solitary CRC.