PROXIMAL SERRATED POLYP DETECTION RATE AND INTERVAL POST-COLONOSCOPY COLORECTAL CANCER RISK

Aims The adenoma detection rate (ADR) is a well-established colonoscopy quality indicator and inversely associated with interval post-colonoscopy colorectal cancer (PCCRC) incidence. However, interval PCCRCs frequently develop from serrated polyps. The proximal serrated polyp detection rate (PSPDR) was advocated as quality indicator, but its association with interval PCCRCs has not yet been studied.

Methods Using colonoscopy data from the Dutch fecal immunochemical test (FIT) based CRC screening program between 2014 and 2020, we evaluated the association between endoscopists’ individual PSPDR and their patients’ risk of interval PCCRC with a multilevel Cox proportional-hazard regression analysis. We additionally evaluated the risk of interval PCCRC for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median.

Results In total, 277,555 colonoscopies performed by 441 endoscopists were included. Median PSPDR was 11.9% (range, 1-29%). Median ADR was 66.3% (range, 43.0-83.2%). During a median follow up of 33 months, 305 interval PCCRCs were detected. Each percent higher PSPDR of endoscopists was associated with a 7% lower risk of interval PCCRC (HR 0.93, CI95% 0.90-0.95). Compared to endoscopists with a PSPDR>11.9% and ADR>66.3% , the hazard ratio of interval PCCRC for endoscopists with a low-PSPDR/high ADR was 1.79 (CI95%, 1.22-2.63), for high-PSPDR/low-ADR 1.97 (1.19-3.24) and for low-PSPDR/low-ADR 2.55 (1.89-3.45).

Fig. 1

Conclusions The PSPDR of an endoscopist is inversely associated with the incidence of interval PCCRC. Implementation of PSPDR monitoring, in addition to ADR monitoring, can contribute to optimize cancer prevention in FIT-based screening programs.

Publication History

Article published online:
14 April 2022