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The adenoma detection rate is commonly used as a measure of the quality of colonoscopy. This study assessed both the association between the adenoma detection rate and the quality of bowel preparation and the risk factors associated with the adenoma detection rate in screening colonoscopy.
This retrospective analysis involved 1,079 individuals who underwent screening colonoscopy at the National Cancer Center between December 2012 and April 2014. Bowel preparation was classified by using the Aronchick scale. Individuals with inadequate bowel preparations (n = 47, 4.4%) were excluded because additional bowel preparation was needed. The results of 1,032 colonoscopies were included in the analysis.
The subjects' mean age was 53.1 years, and 657 subjects (63.7%) were men. The mean cecal intubation time was 6.7 minutes, and the mean withdrawal time was 8.7 minutes. The adenoma and polyp detection rates were 28.1% and 41.8%, respectively. The polyp, adenoma, and advanced adenoma detection rates did not correlate with the quality of bowel preparation. The multivariate analysis showed age ≥ 60 years (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.02–1.97; P = 0.040), body mass index ≥ 25 kg/m2 (HR, 1.56; 95% CI, 1.17–2.08; P = 0.002) and current smoking (HR, 1.44; 95% CI, 1.01–2.06; P = 0.014) to be independent risk factors for adenoma detection.
The adenoma detection rate was unrelated to the quality of bowel preparation for screening colonoscopy. Older age, obesity, and smoking were independent risk factors for adenoma detection.
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A colonic mucosa-associated lymphoid-tissue (MALT) lymphoma is relatively rare compared to lymphomas of the stomach or small intestine. We present a case of a MALT lymphoma in the cecum and rectum found during screening colonoscopy. A 54-year-old female, who had undergone right-breast-conserving surgery with axillary dissection due to an invasive ductal carcinoma and a left-breast excisional biopsy due to microcalcification following adjuvant chemoradiation therapy 3 years earlier, was found to have 3-mm-sized smooth elevated lesions in both the cecum and rectum. No pathologic lesion or lymphadenopathy was found at any other site, but chronic gastritis negative for
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Minimizing the polyp miss rate during colonoscopy is important for patients at high risk for colorectal polyps. We investigated the polyp miss rate and the factors associated with it in high-risk patients.
The medical records of 163 patients who underwent follow-up colonoscopy between January 2001 and April 2010, which was within 9 months after a polypectomy, because the index colonoscopy had shown multiple (more than 3) adenomas or advanced adenoma were retrospectively reviewed. Miss rates were calculated for all polyps, for neoplastic polyps and for advanced adenomas. Factors associated with the miss rates in these patients, such as the location, shape and size of the polyp, were analyzed.
The miss rates for polyps, adenomas, adenomas <5 mm, adenomas ≥5 mm and advanced adenomas were 32.6%, 20.9%, 17.7%, 3.2%, and 0.9%, respectively. No carcinoma, except for one small carcinoid tumor, was missed. Flat shape and small size (<5 mm) were significantly associated with adenoma miss rate. The miss rate was significantly higher for flat-type advanced adenomas than for protruded-type advanced adenomas (27.7% vs 4.1%).
The polyp miss rate in patients at high risk for colorectal polyps was higher than expected. Efforts are needed to reduce miss rates and improve the quality of colonoscopy. Also, early follow-up colonoscopy is mandatory, especially in patients at high risk.
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