Flat lesion detection as a surrogate for colonoscopy quality

We read with interest the article by Reinhart et al. [1] on the prevalence of colonic flat lesions, their malignant potential, and the correlation between flat polyps and adenoma detection rate (ADR). Much attention has focused on the reduction of colonic lesion miss rates. It is true, as the authors highlighted, that the ADR has gained a pivotal role as a colonoscopy quality index [2]. However, other quality measures, such as polyp detection rate, have been proposed [3]. The main advantage of the polyp detection rate is that its calculation is easier for the endoscopist because it does not require the histopathology of the lesion to be known.

In a similar fashion, flat polyp detection rate (FPDR) seems to be a practical colonoscopic quality index. However, the authors showed that the FPDR correlated weakly with the ADR. This fact is noteworthy because a better correlation could be expected. As flat polyps can be frequently overlooked, their detection would imply a thorough examination of the colonic mucosa; thus, the more flat lesions an endoscopist finds, the better the examination of the colonic mucosa. Moreover, FPDR calculation does not require the histology of the lesion to be known, making it easier to calculate in everyday practice. More evidence may be necessary in order to confirm the findings of the authors on the performance of FPDR as a colonoscopy quality index.

• References

• 1 Reinhart K, Bannert C, Dunkler D et al. Prevalence of flat lesions in a large screening population and their role in colonoscopy quality improvement. Endoscopy 2013; 45: 350-356
• 2 Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-803
• 3 Williams JE, Holub JL, Faigel DO. Polypectomy rate is a valid quality measure for colonoscopy: results from a national endoscopy database. Gastrointest Endosc 2012; 75: 576-582