Adenoma and sessile serrated polyp detection rates: variation by patient sex and colonic segment but not specialty of the endoscopist

Abstract

Background: Adenoma detection rate is an important quality indicator. High adenoma detection rate is related to fewer interval cancers. Interval cancers arise from sessile serrated polyps, often in the proximal colon. The detection of adenomas and sessile serrated polyps by location may enhance colonoscopy efficacy.

Objective: The aim of this study was to determine entire colon and segmental adenoma and sessile serrated polyp detection rates and to assess the impact of endoscopist specialty on polyp detection.

Design: Colonoscopies performed by 65 multispecialty endoscopists were studied.

Setting: This study was conducted at an academic medical center.

Patients: Average-risk outpatients undergoing screening colonoscopy were selected.

Main outcome measures: Polyp detection rates were determined by sex, colon segment, and each endoscopist.

Results: Included were 2167 patients. Adenoma and sessile serrated polyp detection rates were 25% and 2% and not significantly different by specialty of the endoscopist. The adenoma detection rate was higher in men (31%) than in women (20%), including each segment in the colon. It was higher proximally (20%) than distally (16%) (p = 0.027) in men, but no different in proximal (11%) and distal colon (11%) (p = 0.66) in women. Sessile serrated polyp detection was the same in men and women at 2% (p = 0.84) and 3-fold higher in the proximal than in the distal colon (1.4% vs 0.5%), but only significantly so in women (p = 0.041). We found a poor correlation between adenoma and sessile serrated polyp detection rates (r = 0.35).

Limitations: This study was limited by its retrospective nature.

Conclusions: Prevalent adenomas are detected more often in men than in women, including overall and by colon segment. The proximal adenoma detection rate is significantly higher than the distal adenoma detection rate in men, but segmental rates are similar in women. Sessile serrated polyp detection rates are low, albeit 3-fold higher in the proximal colon, and are found as frequently in men and women. High-quality colonoscopy, as evidenced by adenoma detection rate, varies by endoscopist but is independent of colonoscopist subspecialty.