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DOI: 10.1055/a-1784-0959
Most large colorectal polyps missed by gastroenterology fellows at colonoscopy are sessile serrated lesions
Abstract
Background and study aims Data on adenoma and sessile serrated lesion (SSL) miss rates for gastroenterology fellows during colonoscopy are limited. We aimed to describe the miss rate of fellows based on a second examination by a colonoscopist with a high rate of detection.
Patients and methods Second- and third-year gastroenterology fellows at a single, tertiary center performed initial examinations. A single experienced attending doctor then performed a complete examination of the colon. We recorded the size and pathology of all lesions found at both examinations and calculated the adenoma and SSL miss rates for fellows.
Results Ten trainees performed 100 examinations. Miss rates for conventional adenomas and SSLs were 30.5 % and 85.7 %, respectively. Among pre-cancerous polyps ≥ 10 mm, 10 of 14 lesions missed were SSLs.
Conclusions While conventional adenoma detection skills of gastroenterology fellows are acceptable, SSL detection is poor.
Publication History
Received: 27 September 2021
Accepted after revision: 03 December 2021
Article published online:
13 May 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
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References
- 1 El-Halabi MM, Barrett PR, Martinez Mateo M. et al. Should we measure adenoma detection rate for gastroenterology fellows in training?. Gastroenterology Res 2018; 11: 290-294
- 2 Kahi CJ, Hewett DG, Norton DL. et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
- 3 Lee J, Park SW, Kim YS. et al. Risk factors of missed colorectal lesions after colonoscopy. Medicine (Baltimore) 2017; 96: e7468
- 4 Sawhney MS, Farrar WD, Gudiseva S. et al. Microsatellite instability in interval colon cancers. Gastroenterology 2006; 131: 1700-1705
- 5 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
- 6 Nishihara R, Wu K, Lochhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
- 7 Lee YM, Huh KC. Clinical and biological features of interval colorectal cancer. Clin Endosc 2017; 50: 254-260
- 8 Hamada T, Nishihara R, Ogino S. Post-colonoscopy colorectal cancer: the key role of molecular pathological epidemiology. Transl Gastroenterol Hepatol 2017; 2: 9
- 9 Cisyk AL, Nugent Z, Wightman RH. et al. Characterizing microsatellite instability and chromosome instability in interval colorectal cancers. Neoplasia 2018; 20: 943-950
- 10 van Rijn JC, Reitsma JB, Stoker J. et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101: 343-350
- 11 Zhao S, Wang S, Pan P. et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019; 156: 1661-1674
- 12 Rex DK, Sullivan AW, Perkins AJ. et al. Colorectal polyp prevalence and aspirational detection targets determined using high definition colonoscopy and a high level detector in 2017. Dig Liver Dis 2020; 52: 72-78
- 13 Rex DK, Cutler CS, Lemmel GT. et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997; 112: 24-28
- 14 Anderson JC, Kahi CJ, Sullivan A. et al. Comparing adenoma and polyp miss rates for total underwater colonoscopy versus standard CO2: a randomized controlled trial using a tandem colonoscopy approach. Gastrointest Endosc 2019; 89: 591-598
- 15 Hewett DG, Rex DK. Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates. Gastrointest Endosc 2010; 72: 775-81
- 16 Rahmi G, Lecomte T, Malka D. et al. Impact of chromoscopy on adenoma detection in patients with lynch syndrome: a prospective, multicenter, blinded, tandem colonoscopy study. Am J Gastroenterol 2015; 110: 288-298
- 17 Bleijenberg AGC, van Leerdam ME, Bargeman M. et al. Substantial and sustained improvement of serrated polyp detection after a simple educational intervention: results from a prospective controlled trial. Gut 2020; 69: 2150-2158
- 18 Li T, Glissen Brown JR, Tsourides K. et al. Training a computer-aided polyp detection system to detect sessile serrated adenomas using public domain colonoscopy videos. Endosc Int Open 2020; 8: E1448-E1454