Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry

Details

• Alternative Title:
  Gastrointest Endosc
• Personal Author:
  Anderson, Joseph C. ; Hisey, William ; Mackenzie, Todd A. ; Robinson, Christina M. ; Srivastava, Amitabh ; Meester, Reinier G. S. ; Butterly, Lynn F.
• Corporate Authors:
  Hanover, New Hampshire; White River Junction, Vermont; New York, New York, USA; Rotterdam, Netherlands
• Description:
  Background and Aims:
  
  Higher adenoma detection rates reduce the risk of postcolonoscopy colorectal cancer (PCCRC). Clinically significant serrated polyps (CSSPs; defined as any sessile serrated polyp, traditional serrated adenoma, large [≥1 cm] or proximal hyperplastic polyp >5 mm) also lead to PCCRC, but there are no data on associated CSSP detection rates (CSSDRs). We used data from the New Hampshire Colonoscopy Registry (NHCR) to investigate the association between PCCRC risk and endoscopist CSSDR.
  
  Methods:
  
  We included NHCR patients with 1 or more follow-up events: either a colonoscopy or a colorectal cancer (CRC) diagnosis identified through linkage with the New Hampshire State Cancer Registry. We defined our outcome, PCCRC, in 3 time periods: CRC diagnosed 6 to 36 months, 6 to 60 months, or all examinations (6 months or longer) after an index examination. We excluded patients with CRC diagnosed at or within 6 months of the index examination, with incomplete examinations, or with inflammatory bowel disease. The exposure variable was endoscopist CSSDR at the index colonoscopy. Cox regression was used to model the hazard of PCCRC on CSSDR controlling for age, sex, index findings, year of examination, personal history of colorectal neoplasia, and having more than 1 surveillance examination.
  
  Results:
  
  One hundred twenty-eight patients with CRC diagnosed at least 6 months after their index examination were included. Our cohort included 142 endoscopists (92 gastroenterologists). We observed that the risk for PCCRC 6 months or longer after the index examination was significantly lower for examinations performed by endoscopists with CSSDRs of 3% to <9% (hazard ratio [HR], .57; 95% confidence interval [CI], .39−.83) or 9% or higher (HR, .39; 95% CI, .20−.78) relative to those with CSSDRs under 3%.
  
  Conclusions:
  
  Our study is the first to demonstrate a lower PCCRC risk after examinations performed by endoscopists with higher CSSDRs. Both CSSDRs of 9% and 3% to <9% had statistically lower risk of PCCRC than CSSDRs of <3%. These data validate CSSDR as a clinically relevant quality measure for endoscopists.
  
  
• Subjects:
  Adenoma Article Colonic Polyps Colonoscopy Colorectal Neoplasms Humans New Hampshire Polyps Registries
• Source:
  Gastrointest Endosc. 96(2):310-317
• Pubmed ID:
  35276209
• Pubmed Central ID:
  PMC9296608
• Document Type:
  Journal Article
• Funding:
  R01 CA243449/CA/NCI NIH HHSUnited States/ ; U58 DP003930/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  96
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:33e9e1b0ee3e514f029a10da2fab5db126e0ed521cdc571468bd842d036890b9
• Download URL:
  https://stacks.cdc.gov/view/cdc/119558/cdc_119558_DS1.pdf
• File Type:
  [PDF - 333.40 KB ]