Elsevier

Gastrointestinal Endoscopy

Volume 82, Issue 2, August 2015, Pages 370-375.e1
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Nonneoplastic polypectomy during screening colonoscopy: the impact on polyp detection rate, adenoma detection rate, and overall cost

https://doi.org/10.1016/j.gie.2015.01.016Get rights and content

Background

The frequency of nonneoplastic polypectomy (NNP) and its impact on the polyp detection rate (PDR) is unknown. The correlation between NNP and adenoma detection rate (ADR) and its impact on the cost of colonoscopy has not been investigated.

Objective

To determine the rate of NNP in screening colonoscopy, the impact of NNP on the PDR, and the correlation of NNP with ADR. The increased cost of NNP during screening colonoscopy also was calculated.

Design

We reviewed all screening colonoscopies. PDR and ADR were calculated. We then calculated a nonneoplastic polyp detection rate (patients with ≥1 nonneoplastic polyp).

Setting

Tertiary-care referral center.

Patients

Patients who underwent screening colonoscopies from 2010 to 2011.

Interventions

Colonoscopy.

Main Outcome Measurements

ADR, PDR, NNP rate.

Results

A total of 1797 colonoscopies were reviewed. Mean (± standard deviation) PDR was 47.7% ± 12.0%, and mean ADR was 27.3% ± 6.9%. The overall NNP rate was 10.4% ± 7.1%, with a range of 2.4% to 28.4%. Among all polypectomies (n = 2061), 276 were for nonneoplastic polyps (13.4%). Endoscopists with a higher rate of nonneoplastic polyp detection were more likely to detect an adenoma (odds ratio 1.58; 95% confidence interval, 1.1-1.2). With one outlier excluded, there was a strong correlation between ADR and NNP (r = 0.825; P < .001). The increased cost of removal of nonneoplastic polyps was $32,963.

Limitations

Retrospective study.

Conclusion

There is a strong correlation between adenoma detection and nonneoplastic polyp detection. The etiology is unclear, but nonneoplastic polyp detection rate may inflate the PDR for some endoscopists. NNP also adds an increased cost. Increasing the awareness of endoscopic appearances through advanced imaging techniques of normal versus neoplastic tissue may be an area to improve cost containment in screening colonoscopy.

Section snippets

Materials and methods

Endoscopy and pathology reports were reviewed at a single, tertiary-care referral center for all patients undergoing screening colonoscopy from October 1, 2010 to September 30, 2011. Our institutional review board granted permission for this minimal risk study to retrospectively review our endoscopic database, analyze de-identified patient data, and report our findings. The procedure was classified as screening if patients were asymptomatic and without a history of polyps. Either a board

Results

A total of 1797 screening colonoscopies performed by 20 gastroenterologists were analyzed. The mean (± SD) patient age was 59.1 ± 9.1 years, and 52% were male. Completion to the cecum overall was 98% (37 incomplete examinations). The distribution of bowel preparation quality among all procedures is as follows: 1.3% (21) poor, 2.8% (46) fair-inadequate, 35.7% (595) fair-adequate, 53.4% (889) good, and 6.9% (115) excellent. Table 1 lists the number of procedures and calculated PDR, ADR, and NNP

Discussion

In this series of over 1500 screening colonoscopies among 20 providers, we described the variation in PDR, ADR, and NNP individually and as a group. Our PDR and ADR from this study are comparable to prior data.7, 10, 22 During screening colonoscopy, 13% of polyps removed are nonneoplastic, consisting of only normal mucosa or lymphoid aggregates without hyperplastic or adenomatous features. Nonneoplastic polyps tend to be <5 mm (Fig. 4). There is a strong correlation between adenoma detection

References (32)

  • A.G. Zauber et al.

    Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths

    N Engl J Med

    (2012)
  • R. Nishihara et al.

    Long-term colorectal-cancer incidence and mortality after lower endoscopy

    N Engl J Med

    (2013)
  • R. Siegel et al.

    Cancer statistics, 2012

    CA Cancer J Clin

    (2012)
  • A. Sonnenberg et al.

    Cost-effectiveness of colonoscopy in screening for colorectal cancer

    Ann Intern Med

    (2000)
  • S.C. Chen et al.

    Variable detection of nonadenomatous polyps by individual endoscopists at colonoscopy and correlation with adenoma detection

    J Clin Gastroenterol

    (2008)
  • R.L. Barclay et al.

    Colonoscopic withdrawal times and adenoma detection during screening colonoscopy

    N Engl J Med

    (2006)
  • Cited by (0)

    DISCLOSURE: All authors disclosed no financial relationships relevant to this article.

    If you would like to chat with an author of this article, you may contact Dr Ramirez at [email protected].

    View full text