Miss rate of colorectal neoplastic polyps and risk factors for missed polyps in consecutive colonoscopies

Abstract

Background/AimsColonoscopic polypectomy is the best diagnostic and therapeutic tool to detect and prevent colorectal neoplasms. However, previous studies have reported that 17% to 28% of colorectal polyps are missed during colonoscopy. We investigated the miss rate of neoplastic polyps and the factors associated with missed polyps from quality-adjusted consecutive colonoscopies.MethodsWe reviewed the medical records of patients who were found to have colorectal polyps at a medical examination center of the Kangbuk Samsung Hospital between March 2012 and February 2013. Patients who were referred to a single tertiary academic medical center and underwent colonoscopic polypectomy on the same day were enrolled in our study. The odds ratios (ORs) associated with polyp-related and patient-related factors were evaluated using logistic regression analyses.ResultsA total of 463 patients and 1,294 neoplastic polyps were analyzed. The miss rates for adenomas, advanced adenomas, and carcinomas were 24.1% (312/1,294), 1.2% (15/1,294), and 0% (0/1,294), respectively. Flat/sessile-shaped adenomas (adjusted OR, 3.62; 95% confidence interval [CI], 2.40–5.46) and smaller adenomas (adjusted OR, 5.63; 95% CI, 2.84– 11.15 for ≤5 mm; adjusted OR, 3.18; 95% CI, 1.60–6.30 for 6–9 mm, respectively) were more frequently missed than pedunculated/sub-pedunculated adenomas and larger adenomas. In patients with 2 or more polyps compared with only one detected (adjusted OR, 2.37; 95% CI, 1.55–3.61 for 2–4 polyps; adjusted OR, 11.52; 95% CI, 4.61–28.79 for ≥5 polyps, respectively) during the first endoscopy, the risk of missing an additional polyp was significantly higher.ConclusionsOne-quarter of neoplastic polyps was missed during colonoscopy. We encourage endoscopists to detect smaller and flat or sessile polyps by using the optimal withdrawal technique.

Dielectric properties of colon polyps, cancer, and normal mucosa: Ex vivo measurements from 0.5 to 20 GHz

“…We measured 9 pedunculated, 11 sessile, and 18 slightly elevated polyps. In general, small size and nonprotruded polyps are the ones that report higher polyp miss rates …”

“…In general, small size and nonprotruded polyps are the ones that report higher polyp miss rates. 39 For this study, we used freshly excised colon samples from 23 patients, from which we analyzed 38 polyps with different characteristics, as summarized in Table I; 11 samples of cancer and 10 samples of normal colon mucosa. The complex permittivity of polyps and cancer was measured using a Keysight 85070E dielectric probe kit with an open-ended high temperature coaxial probe 40 connected to an Agilent E8362B vector network analyzer (VNA), as can be seen in Fig.…”

Clinical Factors Associated with Missing Colorectal Polyp on Colon Capsule Endoscopy

“…CCE has high diagnostic accuracy on colorectal polyps, but there are still some polyps missed on CCE. In CS, the sensitivities of flat adenomas and smaller adenomas are lower than those of protruded adenomas and larger adenomas [12], and the cleansing level of preparation also influences the detection rate [13]. Similarly, it is considered that multiple factors influence the detection rate of colorectal polyps on CCE, but the factors are still unknown.…”

Predictors of High-Risk Adenoma Occurrence at Surveillance Colonoscopy in Patients Who Undergo Colorectal Adenoma Removal

“…In agreement with previous studies, the results of this study show that 3 or more adenomas at baseline colonoscopy independently increased the risk for overall and high-risk adenomas. One possible explanation for the relationship between more baseline adenomas and multiple recurrent adenomas is that patients with multiple polyps are more likely to have polyps missed during baseline colonoscopy [20][21][22].…”