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Multicenter Study
. 2022 Nov;10(9):1008-1019.
doi: 10.1002/ueg2.12325. Epub 2022 Oct 27.

Factors associated with lesion detection in colonoscopy among different indications

Carolina Mangas-Sanjuan  1 , Agustin Seoane  2 , Marco Antonio Alvarez-Gonzalez  2 , Alberto Luè  3 , Adolfo Suárez  4 , Verónica Álvarez-García  4 , Luis Bujanda  5 , Isabel Portillo  6 , Natalia González  7 , Lucía Cid-Gomez  8 , Joaquín Cubiella  9 , Elena Rodríguez-Camacho  10 , Marta Ponce  11 , Pilar Díez-Redondo  12 , Maite Herráiz  13 , María Pellisé  14 , Akiko Ono  15 , S Baile-Maxía  1 , L Medina-Prado  1 , Murcia O  1 , Pedro Zapater  16 , Rodrigo Jover  1 ; QUALISCOPIA Study Investigators
Affiliations
Multicenter Study

Factors associated with lesion detection in colonoscopy among different indications

Carolina Mangas-Sanjuan et al. United European Gastroenterol J. 2022 Nov.

Abstract

Background and objective: Different factors may influence colonoscopy performance measures. We aimed to analyze procedure- and endoscopist-related factors associated with detection of colorectal lesions and whether these factors have a similar influence in the context of different colonoscopy indications: positive fecal immunochemical test (+FIT) and post-polypectomy surveillance colonoscopies.

Methods: This multicenter cross-sectional study included adults aged 40-80 years. Endoscopists (N = 96) who had performed ≥50 examinations were assessed for physician-related factors. Adenoma detection rate (ADR), adenomas per colonoscopy rate (APCR), advanced ADR, serrated polyp detection (SDR), and serrated polyps per colonoscopy rate (SPPCR) were calculated.

Results: We included 12,932 procedures, with 4810 carried out after a positive FIT and 1967 for surveillance. Of the 96 endoscopists evaluated, 43.8% were women, and the mean age was 41.9 years. The ADR, advanced ADR, and SDR were 39.7%, 17.7%, and 12.8%, respectively. Adenoma detection rate was higher in colonoscopies after a +FIT (50.3%) with a more than doubled advanced ADR compared to non-FIT procedures (27.6% vs. 13.0%) and similar results in serrated lesions (14.7% vs. 13.5%). Among all the detection indicators analyzed, withdrawal time was the only factor independently related to improvement (p < 0.001). Regarding FIT-positive and surveillance procedures, for both indications, withdrawal time was also the only factor associated with a higher detection of adenomas and serrated polyps (p < 0.001). Endoscopist-related factors (i.e., weekly hours dedicated to endoscopy, annual colonoscopy volume and lifetime number of colonoscopies performed) had also impact on lesion detection (APCR, advanced ADR and SPPCR).

Conclusions: Withdrawal time was the factor most commonly associated with improved detection of colonic lesions globally and in endoscopies for + FIT and post-polypectomy surveillance. Physician-related factors may help to address strategies to support training and service provision. Our results can be used for establishing future benchmarking and quality improvement in different colonoscopy indications.

Keywords: adenoma detection; colonoscopy; colorectal cancer; endoscopist; serrated polyp.

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Conflict of interest statement

The author declares that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Detection rate of lesions according to indication
FIGURE 2
FIGURE 2
Adenoma, advanced adenoma and serrated polyp detection according to different withdrawal time intervals (<6 min, 6–7 min, 8–9 min and ≥10 min) in all procedures, in colonoscopies after + fecal immunochemical test (FIT) and in procedures because of post‐polypectomy surveillance
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