Search

Introduction: Adenoma detection rate (ADR) is highly variable across practices, and national or population-based estimates are not available. Our aim was to study the ADR, variability of rates over time, and factors associated with detection rates of ADR in a national sample of patients undergoing colonoscopy., Methods: We used colonoscopies submitted to the GI Quality Improvement Consortium, Ltd. registry from 2014 to 2018 on adults aged 50-89 years. We used hierarchical logistic models to study factors associated with ADR., Results: A total of 2,646,833 colonoscopies were performed by 1,169 endoscopists during the study period. The average ADR for screening colonoscopies per endoscopist was 36.80% (SD 10.21), 44.08 (SD 10.98) in men and 31.20 (SD 9.65) in women. Adjusted to the US population, the ADR was 39.08%. There was a significant increase in ADR from screening colonoscopies over the study period from 33.93% in 2014 to 38.12% in 2018., Discussion: The average ADR from a large national US sample standardized to the US population is 39.05% and has increased over time., (Copyright © 2021 by The American College of Gastroenterology.)

Introduction: Sessile serrated lesions (SSLs) are important precursor lesions for the CpG island-methylated pathway to colorectal cancer. The reported detection rates of SSL are highly variable, and national or population-based estimates are not available. Patient-, provider-, and procedure-level factors associated with the detection rates of SSL have not been well described. The aim of our study was to study the detection rates of SSL, variability of rates over time, and factors associated with detection rates of SSL in a national sample of patients undergoing colonoscopy using the GIQuIC registry., Methods: We used colonoscopies submitted to the GIQuIC registry from 2014 to 2017 on adults, aged 18-89 years. Only the first colonoscopy record per patient was included. Indications for colonoscopy were categorized as screening, diagnostic, and surveillance. We used the hierarchical logistic models to study the factors associated with the detection rates of SSL. The Cochrane-Armitage test was used to study the significance of trend over time., Results: There were a total of 5,173,211 colonoscopies performed by 3,934 endoscopists during the study period. Among the 2,101,082 screening colonoscopies over the study period in adults older than or equal to 50 years that were complete to the cecum, the average detection rate per endoscopist for SSL was 6.43% (SD 5.18) and 6.25% standardized for the 2010 US population. There was a significant increase in the detection rates of SSLs from screening colonoscopies over the study period from 4.99% in 2014 to 7.09% in 2017 (P trend <0.001). Clinically significant factors associated with higher detection rates of SSL were longer withdrawal times (>11 minutes vs ≤6 minutes) (odds ratio [OR] 9.61; 9.03-10.24), adequate preparation (OR 1.25; 1.22-1.28), female sex (OR 1.17; 1.16-1.18), and use of a specialized gastrointestinal pathology group (OR 1.12; 95% confidence interval 1.04, 1.19)., Discussion: Population-based estimates of the detection rates of SSL are 6% and have increased over time., (Copyright © 2020 by The American College of Gastroenterology.)

Background: Compared with whites, Hispanics have lower incidence of and mortality from colorectal cancer. The purpose of this study was to determine whether asymptomatic Hispanics undergoing colonoscopy screening also have lower age-adjusted incidence of polyps ≥ 10 mm. Such data could be used to formulate future screening guidelines., Aims: The objectives of this study were to measure and analyze the prevalence and location of polyps sized ≥ 10 mm in asymptomatic white and Hispanic patients who received colonoscopy screening., Methods: Colonoscopy data were prospectively collected from the Clinical Outcomes Research Initiative database, which includes data from a consortium of 66 adult gastrointestinal practice sites in the United States. Asymptomatic white (n = 146,798) and Hispanic (n = 7,654) patients who received colonoscopy screening from 2004 to 2007 were identified. The prevalence of any polyps ≥ 10 mm and of proximal polyps ≥ 10 mm was adjusted for age, sex, practice site type, and family history of colorectal cancer in a multivariate analysis., Results: There was no significant difference between prevalence of polyps ≥ 10 mm in Hispanic and white patients (5.8% vs. 6.2%; P = 0.11; adjusted OR 0.94; 95% CI 0.85-1.03). There was also no significant difference between prevalence of proximal polyps ≥ 10 mm in Hispanics and whites (adjusted OR 1.05; 95% CI 0.87-1.27)., Conclusion: Despite lower incidence of colorectal cancer, the risk of polyps ≥ 10 mm for Hispanic patients undergoing colonoscopy screening is similar to that for whites. These data emphasize the importance of encouraging timely colorectal cancer screening in Hispanics. Our findings support the application of similar recommendations for colorectal cancer screening of Hispanics and whites.

Background and Study Aims: There are no definite guidelines regarding colonoscopic evaluation for the indication of constipation, a common gastrointestinal complaint. The aim of our study was to determine the risk of finding significant lesions in patients undergoing colonoscopy for the indication of constipation alone compared with constipation with another indication or average-risk screening., Patients and Methods: A retrospective review of the Clinical Outcomes Research Initiative database was carried out for colonoscopies undertaken between 1 January 2000 and 30 June 2003. A total of 41,775 index colonoscopies performed for the indications of average-risk screening, constipation only or constipation with another indication were identified. Logistic regression analyses were performed for constipation alone versus constipation with another indication, and for constipation alone versus average-risk screening., Results: Constipation alone did not show any increased risk of significant findings on colonoscopy. Constipation and the presence of another indication, however, had a statistically significant increased risk of a significant finding on colonoscopy. The indication of constipation alone had a lower risk of significant findings on colonoscopy compared with average-risk screening. Variations in the definition of constipation used was a limitation of the study., Conclusions: Colonoscopy for constipation alone has a lower yield for significant findings compared with average-risk screening and constipation with another indication; hence, colonoscopy should not be done for constipation alone., (Georg Thieme Verlag KG Stuttgart. New York.)

Background & Aims: Colonoscopy is often performed with the goal of identification of patients with serious colon neoplasia. We determined the prevalence of colon masses or polyps greater than 9 mm on the basis of age, gender, race, and procedure indication in diverse clinical practice settings and compared occurrence in patients receiving colonoscopy for screening, surveillance, or evaluation of symptoms., Methods: We obtained patient demographics, procedure indication, and endoscopic findings from colonoscopy reports in the Clinical Outcomes Research Initiative data repository, which receives endoscopy reports from 73 diverse practice sites in the United States. A multivariate model was developed to measure risk variables for a mass or polyps >9 mm. Absolute risk was calculated in the model on the basis of the number needed to endoscope (NNE) to identify 1 patient with a mass or polyp >9 mm., Results: From 2000-2002, colonoscopies in 141,413 unique patients were analyzed. Sixty-nine percent of the reports came from private practice (nonacademic) settings. Increasing age, male gender, and black race were associated with increased risk of mass or polyps >9 mm. In the 50- to 59-year-old average-risk group, 28 women and 18 men would need to have screening colonoscopy to identify 1 patient with a mass/polyp >9 mm. Patients with positive fecal occult blood test results, hematochezia, and anemia had lower NNE, whereas men older than 60 years receiving adenoma surveillance and patients with irritable bowel symptoms had similar NNE compared with average-risk subjects., Conclusions: The prevalence of a colon lesion >9 mm varies on the basis of age, gender, race, and procedure indication. Understanding utilization and outcomes can lead to more optimal use of colonoscopy.