Endoscopy 2021; 53(04): 383-391
DOI: 10.1055/a-1243-0379
Original article

Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study

Ina B. Pedersen
1  Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
,
Michael Bretthauer
2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3  Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Mette Kalager
2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3  Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Magnus Løberg
2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3  Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Geir Hoff
4  Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
5  Department of Medicine, Telemark Hospital Skien, Skien, Norway
,
Senaria Matapour
6  Department of Medicine, Vestre Viken Hospital Trust, Gjettum, Norway
,
Silje Hugin
6  Department of Medicine, Vestre Viken Hospital Trust, Gjettum, Norway
,
Svein O. Frigstad
6  Department of Medicine, Vestre Viken Hospital Trust, Gjettum, Norway
,
Birgitte Seip
4  Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
7  Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
,
Britta A. Kleist
8  Department of Pathology, Sorlandet Hospital Kristiansand, Norway
,
Leif Løvdal
8  Department of Pathology, Sorlandet Hospital Kristiansand, Norway
,
Edoardo Botteri
4  Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
,
Øyvind Holme
1  Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3  Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
4  Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
› Author Affiliations


Abstract

Background Endoscopic screening with polypectomy has been shown to reduce colorectal cancer incidence in randomized trials. Incomplete polyp removal and subsequent development of post-colonoscopy cancers may attenuate the effect of screening. This study aimed to quantify the extent of incomplete polyp removal.

Methods We included patients aged 50–75 years with nonpedunculated polyps ≥ 5 mm removed during colonoscopy at four hospitals in Norway. To evaluate completeness of polyp removal, biopsies from the resection margins were obtained after polypectomy. Logistic regression models were fitted to identify factors explaining incomplete resection.

Results 246 patients with 339 polyps underwent polypectomy between January 2015 and June 2017. A total of 12 polyps were excluded due to biopsy electrocautery damage, and 327 polyps in 246 patients (mean age 67 years [range 42–83]; 52 % male) were included in the analysis. Overall, 54 polyps (15.9 %) in 54 patients were incompletely resected. Histological diagnosis of the polyp (sessile serrated lesions vs. adenoma, odds ratio [OR] 10.9, 95 % confidence interval [CI] 3.9–30.1) and polyp location (proximal vs. distal colon, OR 2.8, 95 %CI 1.0–7.7) were independent risk factors for incomplete removal of polyps 5–19 mm. Board-certified endoscopists were not associated with lower rates of incomplete resection compared with trainees (14.0 % vs. 14.2 %), OR 1.0 (95 %CI 0.5–2.1).

Conclusion Incomplete polyp resection was frequent after polypectomy in routine clinical practice. Serrated histology and proximal location were independent risk factors for incomplete resection. The performance of board-certified gastroenterologists was not superior to that of trainees.

Supplementary material



Publication History

Received: 09 December 2019

Accepted: 15 July 2020

Publication Date:
22 September 2020 (online)

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