Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies

Rex, Douglas K.; Cutler, Christopher S.; Lemmel, Gregory T.; Rahmani, Emad; Clark, David W.; Helper, Debra J.; Lehman, Glen A.; Mark, David

doi:10.1016/s0016-5085(97)70214-2

Cited by 1,467 publications

(889 citation statements)

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“…Sensitivity of the initial and surveillance colonoscopic examinations is based on tandem studies of colonoscopy and increases from 80% for adenomas Յ 5 mm to 95% for preclinical cancer. [23][24][25] The simulated population of 5 independent simulations of 30,000 each (5 ϫ 30,000 ϭ 150,000) was designed to be approximately 100 times as large as the observed National Polyp Study cohort of 1,418 patients to minimize chance variation in the simulation results. The National Polyp Study surveillance schema and the observed compliance rates per arm and round are applied to the simulated trial population.…”

Section: Sensitivity Of Fictitious Screening Testmentioning

confidence: 99%

National Polyp Study data: Evidence for regression of adenomas

Loeve

Boer

Zauber

et al. 2004

Intl Journal of Cancer

134

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The data of the National Polyp Study, a large longitudinal study on surveillance of adenoma patients, is used for testing assumptions on the adenoma-carcinoma sequence. The observed adenoma and colorectal cancer incidence in the National Polyp Study were compared with the simulated outcomes of the MISCAN-COLON model of epidemiology and control of colorectal cancer for the U.S. population based on expert opinion. Variants of this model were explored in order to identify assumptions on the adenoma-carcinoma sequence that are consistent with the study observations. The high observed adenoma detection rates at surveillance and low observed colorectal cancer incidence in the National Polyp Study could only be explained by assuming a high incidence rate of adenomas accompanied by regression of adenomas. The National Polyp Study data suggest that adenoma prevalence results from a dynamic process of both formation as well as regression of adenomas. This lowers the expectations for the effects of colorectal cancer screening strategies that focus on adenoma detection.

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Section: Sensitivity Of Fictitious Screening Testmentioning

confidence: 99%

National Polyp Study data: Evidence for regression of adenomas

Loeve

Boer

Zauber

et al. 2004

Intl Journal of Cancer

134

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“…Es ist jedoch von einer Untererfassung der Komplikationen auszugehen, da Spät-komplikationen nur inkomplett erfasst werden. Tandemuntersuchungen haben gezeigt, dass größere Adenome nur selten (0 -6 %) übersehen werden [117]. Es wird davon ausgegangen, dass eine unauffällige Koloskopie nach 10 Jahren wiederholt werden sollte.…”

Section: Gcp Konsensunclassified

“…Auch bei multiplen Adenomen ist das Risiko, ein metachrones Karzinom zu entwickeln, deutlich (4-bis 6-fach) gesteigert [191,208,210,211,213,214]. Hierbei dürfte das erhöhte Risiko einerseits auf einer stärkeren individuellen Disposition, andererseits auf einer höheren Prävalenz übersehener Polypen bei der initialen Koloskopie beruhen: beim koloskopischen Nachweis von ≥ 3 Polypen besteht eine signifikant größere Wahrscheinlichkeit, dass weitere Polypen übersehen wurden [117,216]. (polyp detection rate) [409] sowie übersehene Polypen bei weniger als 10 % der Untersuchten (polyp miss rate) [410,411].…”

Section: Hintergrundunclassified

S3-Leitlinie Kolorektales Karzinom Version 1.0 - Juni 2013 AWMF-Registernummer: 021/007OL

et al. 2013

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“…It seems that CAC predominantly improves the detection of small (6-9 mm) and diminutive (5 mm) adenomas. A study of colonoscopic miss rates determined by back-toback colonoscopies revealed the miss rate was 13 % for small adenomas and 27 % for diminutive adenomas [4]. Because up to 15.5 % of small adenomas and up to 3.4 % of diminutive adenomas contain high-grade dysplasia, it is possible that those that are missed contribute to the occurrence of interval cancers [14,15].…”

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confidence: 99%

“…A large populationbased study showed that failure to intubate the cecum is not uncommon, especially for less experienced endoscopists; it was estimated to occur in 13.1 % of attempted colonoscopies [3]. Furthermore, occurrence of missed adenoma ranging from 13 to 26 % has been reported [4]. Adenoma detection has been shown to be an independent predictor of the risk of interval colorectal cancer after screening colonoscopy [5].…”

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confidence: 99%

Can Cap-Assisted Colonoscopy Be a Savior for Right Side Interval Cancer?

Kim

2012

Dig Dis Sci

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There is no doubt that effective colorectal cancer screening relies on early identification and removal of polyps with neoplastic potential [1,2]. Although colonoscopy is regarded as the best method for detecting colonic neoplasm, it does have limitations. Right-sided lesions, flat polyps, and variable detection of endoscopist adenoma are all reasons why polyps are missed and interval cancers develop after a negative screening colonoscopy. Successful colorectal cancer protection by colonoscopy depends on complete intubation of the colon combined with careful and complete visualization of the colonic mucosal surface on withdrawal. A large populationbased study showed that failure to intubate the cecum is not uncommon, especially for less experienced endoscopists; it was estimated to occur in 13.1 % of attempted colonoscopies [3]. Furthermore, occurrence of missed adenoma ranging from 13 to 26 % has been reported [4]. Adenoma detection has been shown to be an independent predictor of the risk of interval colorectal cancer after screening colonoscopy [5]. Several types of new technology have therefore been developed to improve adenoma detection, including high-definition white-light colonoscopy, pan-chromoendoscopy, wide-angle colonoscopy, virtual chromoendoscopy, third-eye retroscopy (TER), and cap-assisted colonoscopy (CAC) [6].CAC is a simple method in which a transparent or nontransparent rubber cap is attached to the tip of a colonoscope with an appropriate protrusion length. The cap can be readily equipped and the field of vision is not substantially affected by the cap. Although conflicting results have been reported after recent studies that compared CAC with standard colonoscopy (SC), CAC has been reported to be associated with improved polyp detection, reduced cecal intubation time, and enhanced cecal intubation [7][8][9][10].Theoretically, CAC can detect polyps better than SC, especially those behind semilunar folds. CAC can help depress semilunar folds, thereby reducing the blind mucosal surface area, and may improve the efficiency of adenoma detection [6]. A study of lesions missed at colonoscopy but detected by computed tomography colonography revealed that 67 % lie on the proximal side of semilunar folds [11]. The cap also keeps the tip of the endoscope a distance from the colonic mucosa, particularly around colonic bends, and provides a continuous visual field of the lumen direction. CAC seeks to reduce the percentage of the colonic mucosal surface that is left unexamined in a ''complete'' colonoscopy [12]. Largescale meta-analyses have revealed that CAC improves the detection of colonic neoplasm compared with standard colonoscopy (SC) both in terms of the number of patients identified with at least one polyp and in terms of the polyp miss rate determined by tandem colonoscopy [6,13]. It seems that CAC predominantly improves the detection of small (6-9 mm) and diminutive (5 mm) adenomas. A study of colonoscopic miss rates determined by back-toback colonoscopies revealed the miss rate was 13 % for sm...

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Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies

Cited by 1,467 publications

References 1 publication

National Polyp Study data: Evidence for regression of adenomas

National Polyp Study data: Evidence for regression of adenomas

S3-Leitlinie Kolorektales Karzinom Version 1.0 - Juni 2013 AWMF-Registernummer: 021/007OL

Can Cap-Assisted Colonoscopy Be a Savior for Right Side Interval Cancer?

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