Background & Aims Colorectal cancer (CRC) screening with diagnostic imaging can detect polyps. The management of patients whose largest polyp is less than 10mm is uncertain. The primary aim of this study was to determine rates of advanced histology in patients undergoing CRC screening whose largest polyp is 9mm or less. Methods Subjects include all asymptomatic adults receiving colonoscopy for screening during 2005 from 17 practice sites, which provide both colonoscopy and pathology reports to the Clinical Outcomes Research Initiative repository. Patients were classified by size of largest polyp. Advanced histology was defined as an adenoma with villous or serrated histology, high-grade dysplasia or an invasive cancer. Risk factors for advanced histology were determined using Pearson chi-square and Fisher’s Exact tests. Results 13,992 asymptomatic patients had screening with colonoscopy; 6360 patients (45%) had polyps, with complete histology available in 5977 (94%). The proportion with advanced histology was 1.7% in the 1–5mm group; 6.6% in the 6–9mm group; 30.6% in the greater than 10mm group; 72.1% in the tumor group. Distal location was associated with advanced histology in the 6–9mm group (p =0.04) and the greater than 10mm group (p = 0.002). Conclusions One in 15 asymptomatic patients whose largest polyp is 6 to 9mm will have advanced histology and would undergo surveillance at 3 years based on current guidelines. Since histology is necessary for this decision, most of these patients should be offered colonoscopy. Further study should determine if patients whose largest polyp is 1–5mm, can be safely followed without polypectomy.

Background & Aims-The risk of serious complications after colonoscopy has important implications for the overall benefits of colorectal cancer screening programs. We evaluated the incidence of serious complications within 30 days after screening or surveillance colonoscopies in diverse clinical settings and to identify potential risk factors for complications.

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Background & Aims Colorectal cancer risk differs based on patient demographics. We aimed to measure the prevalence of significant colorectal polyps in average-risk individuals and to determine differences based on age, sex, race, or ethnicity. Methods In a prospective study, colonoscopy data were collected, using an endoscopic report generator, from 327,785 average-risk adults who underwent colorectal cancer screening at 84 gastrointestinal practice sites from 2000 to 2011. Demographic characteristics included age, sex, race, and ethnicity. The primary outcome was the presence of suspected malignancy or large polyp(s) >9 mm. The benchmark risk for age to initiate screening was based on white men, 50–54 years old. Results Risk of large polyps and tumors increased progressively in men and women with age. Women had lower risks than men in every age group, regardless of race. Blacks had higher risk than whites from ages 50 through 65 years and Hispanics had lower risk than whites from ages 50 through 80 years. The prevalence of large polyps was 6.2% in white men 50–54 years old. The risk was similar among the groups of white women 65–69 years old, Black women 55–59 years old, Black men 50–54 years old, Hispanic women 70–74 years old, and Hispanic men 55–59 years old. The risk of proximal large polyps increased with age, female sex, and Black race. Conclusions There are differences in the prevalence and location of large polyp and tumors in average-risk individuals based on age, sex, race, and ethnicity. These findings could be used to select ages at which specific groups should begin colorectal cancer screening.

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Background The adenoma detection rate (ADR) is one of the main quality measures for colonoscopy, but it is burdensome to calculate and is not amenable to claims-based reporting. Objective To validate the correlation between polypectomy rates (PRs) and ADRs by using a large group of endoscopists. Design Retrospective study. Setting Community and academic endoscopy units in the United States. Subjects Sixty endoscopists and their patients. Main outcome measurements Proportion of patients with any adenoma and any polyp removed; correlation between ADRs and PRs. Results In total, 14,341 screening colonoscopies were included, and there was high correlation between endoscopists’ PRs and ADRs in men (Rs .91, P < .0001) and women (Rs .91, P < .0001). Endoscopists with PRs in the highest quartile had a significantly higher ADR than did those in the lowest quartile in men (44.6% vs 19.4%, P < .0001) and women (33.6% vs 11.6%, P < .0001). Endoscopists in the top polypectomy quartile also found more advanced adenomas than did endoscopists in the bottom quartile (men: 9.6% vs 4.6%, P = .0006; women: 6.3% vs 3.0%, P = .01). Benchmark PRs of 40% and 30% correlated with ADRs greater than 25% and 15% for men and women, respectively. Limitation Retrospective analysis of a subset of a national endoscopic database. Conclusions Endoscopists’ PRs correlate well with their ADRs. Given its clinical relevance, its simplicity, and the ease with which it can be incorporated into claims-based reporting programs, the PR may become an important quality measure.