PMID- 28843582
OWN - NLM
STAT- MEDLINE
DCOM- 20181005
LR  - 20181005
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 87
IP  - 3
DP  - 2018 Mar
TI  - Diagnosis and predictors of sessile serrated adenoma after educational training
      in a large, community-based, integrated healthcare setting.
PG  - 755-765.e1
LID - S0016-5107(17)32194-6 [pii]
LID - 10.1016/j.gie.2017.08.012 [doi]
AB  - BACKGROUND AND AIMS: Sessile serrated adenomas (SSAs) are precursors of 15% to
      30% of colorectal cancers but are frequently underdiagnosed. We sought to measure
      the SSA detection rate (SDR) and predictors of SSA detection after educational
      training for community gastroenterologists and pathologists. METHODS: Colonoscopy
      and pathology data (2010-2014) from 3 medical centers at Kaiser Permanente
      Northern California were accessed electronically. Gastroenterologists and
      pathologists attended a training session on SSA diagnosis in 2012. Mean SDRs and 
      patient-level predictors of SSA detection post-training (2013-2014) were
      investigated. RESULTS: Mean SDRs increased from .6% in 2010-2012 to 3.7% in
      2013-2014. The increase in the detection of proximal SSAs was accompanied by a
      decrease in the detection of proximal hyperplastic polyps (HPs). Among 34,161
      colonoscopies performed in 2013 to 2014, SDRs for screening, fecal immunochemical
      test positivity, surveillance, and diagnostic indication were 4.2%, 4.5%, 4.9%,
      and 3.0%, respectively. SSA detection was lower among Asians (adjusted odds ratio
      [aOR], .46; 95% confidence interval [CI], .31-.69) and Hispanics (aOR, .59; 95%
      CI, .36-.95) compared with non-Hispanic whites and higher among patients with
      synchronous conventional adenoma (aOR, 1.46; 95% CI, 1.15-1.86), HP (aOR, 1.74;
      95% CI, 1.30-2.34), and current smokers (aOR, 1.78; 95% CI, 1.17-2.72). SDRs
      varied widely among experienced gastroenterologists, even after training
      (1.1%-8.1%). There was a moderately strong correlation between adenoma detection 
      rate (ADR) and SDR for any SSA (r = .64, P = .0003) and for right-sided SSAs (r =
      .71, P < .0001). CONCLUSIONS: Educational training significantly increased the
      detection of SSA, but a wide variation in SDR remained across
      gastroenterologists. SSA detection was inversely associated with Asian and
      Hispanic race/ethnicity and positively associated with the presence of
      conventional adenoma, HP, and current smoking. There was a moderately strong
      correlation between ADR and SDR.
CI  - Copyright (c) 2018 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Li, Dan
AU  - Li D
AD  - Department of Gastroenterology, Kaiser Permanente Northern California, Santa
      Clara, California, USA.
FAU - Woolfrey, John
AU  - Woolfrey J
AD  - Department of Medicine, Kaiser Permanente Northern California, Santa Clara,
      California, USA.
FAU - Jiang, Sheng-Fang
AU  - Jiang SF
AD  - Division of Research, Kaiser Permanente Northern California, Oakland, California,
      USA.
FAU - Jensen, Christopher D
AU  - Jensen CD
AD  - Division of Research, Kaiser Permanente Northern California, Oakland, California,
      USA.
FAU - Zhao, Wei K
AU  - Zhao WK
AD  - Division of Research, Kaiser Permanente Northern California, Oakland, California,
      USA.
FAU - Kakar, Sanjay
AU  - Kakar S
AD  - Department of Pathology, University of California, San Francisco, California,
      USA.
FAU - Santamaria, Monica
AU  - Santamaria M
AD  - Department of Pathology, Kaiser Permanente Northern California, Santa Clara,
      California, USA.
FAU - Rumore, Greg
AU  - Rumore G
AD  - Department of Pathology, Kaiser Permanente Northern California, Walnut Creek,
      California, USA.
FAU - Armstrong, Mary Anne
AU  - Armstrong MA
AD  - Division of Research, Kaiser Permanente Northern California, Oakland, California,
      USA.
FAU - Postlethwaite, Debbie
AU  - Postlethwaite D
AD  - Division of Research, Kaiser Permanente Northern California, Oakland, California,
      USA.
FAU - Corley, Douglas A
AU  - Corley DA
AD  - Division of Research, Kaiser Permanente Northern California, Oakland, California,
      USA.
FAU - Levin, Theodore R
AU  - Levin TR
AD  - Department of Gastroenterology, Kaiser Permanente Northern California, Walnut
      Creek, California, USA.
LA  - eng
PT  - Journal Article
DEP - 20170824
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Adenoma/*diagnosis/epidemiology/pathology
MH  - Aged
MH  - Aged, 80 and over
MH  - California
MH  - Cohort Studies
MH  - Colonic Neoplasms/*diagnosis/epidemiology/pathology
MH  - Colonoscopy/methods
MH  - Community Health Centers
MH  - Education, Medical, Continuing/*methods
MH  - Female
MH  - Gastroenterologists/*education
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pathologists/*education
MH  - Retrospective Studies
EDAT- 2017/08/28 06:00
MHDA- 2018/10/06 06:00
CRDT- 2017/08/28 06:00
PHST- 2017/06/11 00:00 [received]
PHST- 2017/08/06 00:00 [accepted]
PHST- 2017/08/28 06:00 [pubmed]
PHST- 2018/10/06 06:00 [medline]
PHST- 2017/08/28 06:00 [entrez]
AID - S0016-5107(17)32194-6 [pii]
AID - 10.1016/j.gie.2017.08.012 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2018 Mar;87(3):755-765.e1. doi: 10.1016/j.gie.2017.08.012.
      Epub 2017 Aug 24.