Format

Send to

Choose Destination
See comment in PubMed Commons below
World J Gastroenterol. 2014 Aug 21;20(31):10927-37. doi: 10.3748/wjg.v20.i31.10927.

Risk factors associated with missed colorectal flat adenoma: a multicenter retrospective tandem colonoscopy study.

Author information

1
Li Xiang, Qiang Zhan, Xin-Hua Zhao, Ya-Dong Wang, Yang-Zhi Xu, Ai-Min Li, Wei Gong, Yang Bai, Fa-Chao Zhi, Si-De Liu, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China.

Abstract

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.

KEYWORDS:

Colonoscopy; Colorectal cancer; Flat adenoma; Miss rate; Risk factor

PMID:
25152596
PMCID:
PMC4138473
DOI:
10.3748/wjg.v20.i31.10927
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Baishideng Publishing Group Inc. Icon for PubMed Central
    Loading ...
    Support Center