Proficiency in the Diagnosis of Nonpolypoid Colorectal Neoplasm Yields High Adenoma Detection Rates
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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.
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.
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.
KeywordsColonoscopy Endoscopy lower GI tract Adenoma detection Nonpolypoid Polyp Neoplasm Cancer
Nonpolypoid colorectal neoplasm
- 10.Soetikno R, Friedland S, Kaltenbach T, Chayama K, Tanaka S. Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology 2006;130:566–576; quiz 588–589.Google Scholar
- 12.Kudo S. Early colorectal cancer. Igaku-Shoin; 1996.Google Scholar
- 13.Fujii T, Shimoda T. National cancer center hospital atlas of magnifying colonoscopic diagnosis. Tokyo: Igaku-Shoin Ltd.; 2004.Google Scholar
- 14.Ellis G. Veterans Affairs Palo Alto Hospital. High-Definition Endoscopy and Sharing the Knowledge in HD: Apple Inc., 2007.Google Scholar
- 15.Soetikno RM, Fujii T, Friedland S, Barro J, Matsui S, Rouse RV. Diagnosis of flat and depressed colorectal neoplasms—an educational DVD. Chicago, IL: American Society Gastrointestinal Endoscopy; 2004.Google Scholar
- 16.Hamilton S, Altonen L. Tumours of the digestive system. World Health Organization Classification of Tumours. International Agency for Research on Cancer, 2000.Google Scholar
- 17.Yasutomi M, Baba S, Hojo K, et al. Japanese classification of colorectal carcinoma. Tokyo: Kanehara & Co., LTD.; 1997.Google Scholar
- 20.Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol. 2010;8:865–869, 869 e1-3.Google Scholar