Interventions to improve adenoma detection rates for colonoscopy

Shaukat, Aasma; Tuskey, Anne; Rao, Vijaya L.; Dominitz, Jason A.; Murad, M. Hassan; Keswani, Rajesh N.; Bazerbachi, Fateh; Day, Lukejohn W.

doi:10.1016/j.gie.2022.03.026

Cited by 14 publications

(8 citation statements)

References 130 publications

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“…32 The evidence was based on meta-analyses 33,34 reporting WE outperformed cap, and Endocuff in ADR, advanced ADR, and SSA/PDR, and editorial board reviews recognizing the importance of WE as an important advance in gastrointestinal endoscopy. [35][36][37][38][39] Recent evidence-based reports and guidelines, for example, discussions on colonoscopy quality, 40 American Gastroenterology Association Clinical Practice Update, 41 and American Society for Gastrointestinal Endoscopy Standard of Practice statement, 42 endorsed the inclusion of WE in clinical practice as a method that could increase ADR. Moreover, WE significantly increased ARD in propofol-sedated patients providing a justification for the inclusion of WE in propofolsedated patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Right Colon Flat Polyp Detection Rate by Water Exchange Versus Water Immersion-pooled Results of Data File of 3 Published Reports

Leung

Koo

Jia

et al. 2023

Journal of Clinical Gastroenterology

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Goals:We tested the hypothesis that water exchange (WE) achieved a significantly higher right colon flat polyp detection rate (rFPDR) than water immersion (WI).Background: Current endoscopy methods provide real-time morphology but not histopathology. Flat serrated polyps are difficult to find during colonoscopy. In 2022 2 studies reported that the serrated polyp detection rate (SPDR) significantly inversely predicted the development of interval cancers. In 2021 1 systemic review with meta-analysis showed that WE, but not WI increased SPDR. The relative contributions of WE and WI on rFPDR are unknown.Study: Individual patient data from 3 reports comparing air insufflation, WI, and WE were pooled. Multiple logistic regression analysis was used to assess the factors associated with a higher rFPDR. Results:The pooled data showed that the rFPDR of air insufflation, WI, and WE were 15.4%, 14.1%, and 19.4% (P = 0.009), respectively. After adjusting for age and withdrawal time, multiple logistic regression analysis revealed that WE, when compared with WI, was significantly associated with a higher rFPDR (adjusted odds ratio [aOR] = 1.53, P = 0.002). Analysis of data on pathology and size were omitted to avoid duplicating our earlier publications.Conclusions: Significantly higher rFPDR was achieved by WE. Water exchange rather than WI merits consideration for use to maximize rFPDR. Removal of flat polyps, and by inference serrated polyps, ensures their optimal management to minimize the occurrence of interval cancers. The potential benefit of WE in maximizing SPDR and minimizing interval cancers deserves evaluation in longterm randomized controlled studies focused on flat polyps detection.

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Section: Discussionmentioning

confidence: 99%

Comparison of Right Colon Flat Polyp Detection Rate by Water Exchange Versus Water Immersion-pooled Results of Data File of 3 Published Reports

Leung

Koo

Jia

et al. 2023

Journal of Clinical Gastroenterology

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“…Moreover, although 9-minute m-WT may not improve ADR of colonoscopists who reach high ADRs in the 6-minute m-WT, yet it decreased their AMR (P 5 0.003) and AAMR (P 5 0.01), showing the complementary value of WT to ADR in monitoring colonoscopy quality and weakening the "one and done" effect (2). Therefore, 9-minute m-NWT is gradually recommended as an aspirational WT target by the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy for the best clinical practice (35,36). The American Journal of GASTROENTEROLOGY…”

Section: Discussionmentioning

confidence: 99%

Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

et al. 2022

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INTRODUCTION: Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR. METHODS:A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n 5 366) or vice versa (6-minute-first group, 6MF, n 5 367). The primary outcome was the lesion-level AMR. RESULTS:The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P < 0.001) and participant-level AMR (10.9% vs 25.9%, P < 0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P 5 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P 5 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P 5 0.01) of 6MF without compromising detection efficiency (P 5 0.79). In addition, a lower false-negative rate for adenomas (P 5 0.002) and high-risk adenomas (P < 0.05), and a lower rate of shortening surveillance schedule (P < 0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P 5 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR.

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“…SSP detection and resection is important to reduce CRC and establishing a benchmark for SSPDR on colonoscopy after a positive stool-based test would be of importance. SSPs are more difficult to detect endoscopically than adenomas due to their flat morphology and indistinct borders [4] and detection can be improved with longer withdrawal times, training, and visual and technological aids [42,43]. It has been recently suggested that the SSPDR goal should be ≥ 7% for screening colonoscopy [44].…”

Section: Reviewmentioning

confidence: 99%

Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: Systematic review and meta-analysis

Garg,

Burke,

Aggarwal

et al. 2024

Endosc Int Open

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Background: Published studies report a higher adenoma detection rate (ADR) for FIT-DNA as compared to FIT. Data is less replete on the performance of stool-based tests on sessile serrated polyp (SSP) detection. We performed meta-analysis to evaluate the performance of FIT and FIT-DNA test on SSP detection rate (SSPDR) for patients undergoing colonoscopy for follow up of positive noninvasive tests. Methods A comprehensive literature search of multiple databases (until September 2022) was performed to identify studies reporting SSPDR in patients with positive FIT or FIT-DNA. The outcome was overall colonoscopy detection of any SSP and an advanced serrated polyps (ASP: SSP ≥ 10 mm and/or dysplasia) Results 482,405 (52.4% females) patients with a mean age of 62.3 ± 4.4 years were included from 23 studies. The pooled SSPDR for all positive stool-based tests was 5.3% and higher for FIT-DNA (15.0%, 95% CI: 8.3 – 25.7) versus FIT (4.1%, 95% CI: 3.0 – 5.6; p=0.0002). The overall pooled ASP detection rate was 1.4% (95% CI: 0.81 – 2.3) and higher in FIT-DNA (3.8 %, 95% CI: 1.7 – 8.6) compared to FIT (0.71%, 95% CI: 0.36 – 1.4; p< 0.01). SSPDR with FIT-DNA was also significantly higher than FIT where FIT cutoff was >10 ug/g and in FIT positive patients in studies conducted in North America (p<0.05). Conclusion FIT-DNA outperformed FIT in both SSP and ASP detection including FIT with a lower threshold cutoff >10 ug/g. Further comparative studies are needed to assess impact of our findings on colorectal cancer reduction.

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Interventions to improve adenoma detection rates for colonoscopy

Cited by 14 publications

References 130 publications

Comparison of Right Colon Flat Polyp Detection Rate by Water Exchange Versus Water Immersion-pooled Results of Data File of 3 Published Reports

Comparison of Right Colon Flat Polyp Detection Rate by Water Exchange Versus Water Immersion-pooled Results of Data File of 3 Published Reports

Reduced Adenoma Miss Rate With 9-Minute vs 6-Minute Withdrawal Times for Screening Colonoscopy: A Multicenter Randomized Tandem Trial

Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: Systematic review and meta-analysis

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