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KMID : 0988920170150030411
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Intestinal Research
2017 Volume.15 No. 3 p.411 ~ p.418
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Miss rate of colorectal neoplastic polyps and risk factors for missed polyps in consecutive colonoscopies
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Kim Nam-Hee
Jung Yoon-Suk
Jeong Woo-Shin
Yang Hyo-Joon
Park Soo-Kyung
Choi Kyu-Yong
Park Dong-Il
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Abstract
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Background/Aims: Colonoscopic polypectomy is the best diagnostic and therapeutic tool to detect and prevent colorectal neoplasms. However, previous studies have reported that 17% to 28% of colorectal polyps are missed during colonoscopy. We investigated the miss rate of neoplastic polyps and the factors associated with missed polyps from quality-adjusted consecutive colonoscopies.
Methods: We reviewed the medical records of patients who were found to have colorectal polyps at a medical examination center of the Kangbuk Samsung Hospital between March 2012 and February 2013. Patients who were referred to a single tertiary academic medical center and underwent colonoscopic polypectomy on the same day were enrolled in our study. The odds ratios (ORs) associated with polyp-related and patient-related factors were evaluated using logistic regression analyses.
Results: A total of 463 patients and 1,294 neoplastic polyps were analyzed. The miss rates for adenomas, advanced adenomas, and carcinomas were 24.1% (312/1,294), 1.2% (15/1,294), and 0% (0/1,294), respectively. Flat/sessile-shaped adenomas (adjusted OR, 3.62; 95% confidence interval [CI], 2.40?5.46) and smaller adenomas (adjusted OR, 5.63; 95% CI, 2.84? 11.15 for ≤5 mm; adjusted OR, 3.18; 95% CI, 1.60?6.30 for 6?9 mm, respectively) were more frequently missed than pedunculated/sub-pedunculated adenomas and larger adenomas. In patients with 2 or more polyps compared with only one detected (adjusted OR, 2.37; 95% CI, 1.55?3.61 for 2?4 polyps; adjusted OR, 11.52; 95% CI, 4.61?28.79 for ≥5 polyps, respectively) during the first endoscopy, the risk of missing an additional polyp was significantly higher.
Conclusions: One-quarter of neoplastic polyps was missed during colonoscopy. We encourage endoscopists to detect smaller and flat or sessile polyps by using the optimal withdrawal technique.
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KEYWORD
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Colorectal polyp, Miss rate, Consecutive colonoscopies
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