Original Article

Digestive Diseases and Sciences

, Volume 57, Issue 3, pp 764-770

Proficiency in the Diagnosis of Nonpolypoid Colorectal Neoplasm Yields High Adenoma Detection Rates

  • Tonya KaltenbachAffiliated withGastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Division of Gastroenterology, Stanford University School of Medicine Email author 
  • , Sarah K. McGillAffiliated withGastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Division of Gastroenterology, Stanford University School of Medicine
  • , Venkat KalidindiAffiliated withGastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Division of Gastroenterology, Stanford University School of Medicine
  • , Shai FriedlandAffiliated withGastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Division of Gastroenterology, Stanford University School of Medicine
  • , Roy SoetiknoAffiliated withGastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Division of Gastroenterology, Stanford University School of Medicine

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Abstract

Background and Aims

Current efforts to prevent colorectal cancer focus on the detection and removal of neoplasms. Nonpolypoid colorectal neoplasms (NP-CRN) have a subtle appearance that can be difficult to recognize during colonoscopy. Endoscopists must first be familiar with the patterns of NP-CRN in order to detect and diagnose them. We studied the adenoma detection rates of endoscopists who had trained to detect NP-CRN, versus endoscopists who had not.

Materials and Methods

Design: Retrospective Nested Case Control Study. Setting: Outpatient Screening Colonoscopy. Participants: Adult Veterans. Intervention: Proficiency in the features and diagnosis of NP-CRN. Main Outcomes Measurements: Adenoma detection.

Results

In total, 462 patients had screening colonoscopies—267 by colonoscopists who had trained in the features and diagnosis of NP-CRN. Patient characteristics were similar between groups—the majority were men with a mean age of 62 ± 6 years. Neoplasia was more prevalent (45.7 vs. 34.9%; p = 0.02) in patients evaluated by the trained compared to the conventionally trained group. Trained colonoscopists had a higher adenoma detection rate (0.76 vs. 0.54 adenomas per patient, p < 0.001); removed a higher proportion of neoplasia (77 vs. 35%, p < 0.001); and more frequently diagnosed NP-CRN lesions (OR 2.98, 95% CI: 1.46–6.08) compared to colonoscopists without supplemental training.

Conclusions

Endoscopists who are proficient in the detection of NP-CRN had significantly higher adenoma detection rates—of both polypoid and flat adenomas—compared to endoscopists without training, and were more specific in resection of adenomatous over hyperplastic lesions.

Keywords

Colonoscopy Endoscopy lower GI tract Adenoma detection Nonpolypoid Polyp Neoplasm Cancer