Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study

Abstract

Background/Aims: The adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested. This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy. Methods:We performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR.Results: A total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001). Conclusions:The colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.

What Is the Optimal Surrogate Indicator for a Miss Rate of Adenoma in Colonoscopy?

“…8 Given these results, APP has drawn attention as a surrogate indicator for AMR. However, the study by Han et al 7 showed inconsistent results with previous studies. The authors of this study stated the cause of this discrepancy as heterogeneity among the participants.…”

“…None of the colonoscopy indicators were significantly associated with the AMR. 7 The logistic regression analysis revealed that the probability of missed polyp increased significantly as the number of adenomas increased during the first colonoscopy. 7 Therefore, we should be aware the AMR in patients with multiple adenomas may be high.…”

“…Han et al 7 conducted a prospective multicenter study, which performed back-to-back colonoscopy to investigate the correlation between the AMR and other colonoscopy parameters including ADR, polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy, and total number of adenomas per positive participant (APP). A total of eight endoscopists participated in this study.…”

“…The authors of this study stated the cause of this discrepancy as heterogeneity among the participants. 7 Considering the intrinsic limitation of clinical studies related to colorectal polyps, in addition to the participant's heterogeneity pointed out by the author, various factors, including the endoscopist's own characteristics and equipment in each institution, which are related to adenoma detection, might have caused this discrepancy. Eventually, the optimal surrogate indicator of AMR should be addressed through subsequent studies.…”