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

Abstract

Background/Aims: We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. Methods: We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary's Hospital obtained from May 2014 to February 2016. Results: A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). Conclusions: Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.

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

“…Investigations have revealed [5,6] that intestinal polyps are the most predominant precancerous lesions of colorectal cancer; thus, it is particularly important for early detection, treatment, and follow-up of intestinal polyps. According to research findings, intestinal carcinomatous change is related to the size, pathology, age, and other factors of adenomas, and its carcinogenesis time is about 10-15 years, which provides the temporal feasibility for early intervention in the malignant transformation of adenomatous polyps, and therefore, it is important to summarize the risk factors for the development of a high-grade risk of adenoma in patients with various types of intestinal polyps [7][8][9]. e current rule of colon polyp-adenoma-carcinomatous change has been generally accepted, so attention shall be paid to patients who have adenomatous polyps, and early detection and resection can reduce the risk of colorectal cancer to some extent.…”