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Risk factors associated with missed colorectal flat adenoma: A multicenter retrospective tandem colonoscopy study.
MedLine Citation:
PMID:  25152596     Owner:  NLM     Status:  In-Data-Review    
AIM: To determine the miss rate for colorectal flat adenomas during colonoscopy and the risk factors.
METHODS: Flat adenomas are frequently missed during colonoscopy. However, the risk factors that influence their miss rates are unclear. This was a multicenter, retrospective study in which patients diagnosed with colorectal adenomas at a diagnostic colonoscopy and followed within 3 mo by a second therapeutic colonoscopy were pooled out from the established database. The "per-patient" and "per-adenoma" adenoma miss rates (AMR) for overall adenomas and flat adenomas, and patient-, adenoma-, and procedure-related risk factors potentially associated with the "per-adenoma" AMR for flat adenomas were determined.
RESULTS: Chromoscopy and high-definition colonoscopy were not taken under consideration in the study. Among 2093 patients with colorectal adenomas, 691 (33.0%) were diagnosed with flat adenomas, 514 with concomitant protruding adenomas and 177 without. The "per-patient" AMR for flat adenomas was 43.3% (299/691); the rates were 54.3% and 11.3%, respectively, for those with protruding adenomas and those without (OR = 9.320, 95%CI: 5.672-15.314, χ (2) = 99.084, P < 0.001). The "per-adenoma" AMR for flat adenomas was 44.3% (406/916). In multivariate analysis, older age, presence of concomitant protruding adenomas, poor bowel preparation, smaller adenoma size, location at the right colon, insufficient experience of the colonoscopist, and withdrawal time < 6 min were associated with an increased "per-adenoma" AMR for flat adenomas. The AMR for flat adenomas was moderately correlated with that for overall adenomas (r = 0.516, P < 0.0001). The AMR for flat adenomas during colonoscopy was high.
CONCLUSION: Patient's age, concomitant protruding adenomas, bowel preparation, size and location of adenomas, proficiency of the colonoscopist, and withdrawal time are factors affecting the "per-adenoma" AMR for flat adenomas.
Li Xiang; Qiang Zhan; Xin-Hua Zhao; Ya-Dong Wang; Sheng-Li An; Yang-Zhi Xu; Ai-Min Li; Wei Gong; Yang Bai; Fa-Chao Zhi; Si-De Liu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  20     ISSN:  2219-2840     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-08-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10927-37     Citation Subset:  IM    
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