Original ResearchClinical—Alimentary TractIncomplete Polyp Resection During Colonoscopy—Results of the Complete Adenoma Resection (CARE) Study
Section snippets
Participants
Adults (aged 40 through 85 years) who presented for an outpatient colonoscopy at 2 academic medical centers (ie, Dartmouth-Hitchcock Medical Center, Lebanon, NH and VA Medical Center, White River Junction, VT) without a history of inflammatory bowel disease or a coagulopathy (international normalized ratio ≥1.8) were asked to participate. Those who agreed provided informed consent and were subsequently included into the study cohort if at least one polyp of eligible size (≥5 mm to ≤20 mm) was
Patient Characteristics
An eligible polyp was found in 269 patients of the 1427 individuals who were consented for the study (Figure 1). The mean age in the study cohort was 63.4 years (±9.1 standard deviation) and 84.0% were men. Most colonoscopies were performed either for screening (36.8%) or surveillance (33.1%) (Table 1).
Polyp Characteristics
A total of 418 study polyps were resected by 11 endoscopists; 346 polyps (82.8%) were neoplastic (Table 2), of which 286 (68.4%) were classified as tubular, tubulovillous, or villous adenomas.
Discussion
Our 2-center multi-endoscopist study showed that approximately 10% of all neoplastic polyps between 5 and 20 mm are incompletely resected, ie, neoplastic tissue was left behind, as proven by biopsies from resection margins. Incomplete resection was more frequent for large polyps (≥ 10 mm) and for SSA/P. We observed a broad variation in the resection rate between individual endoscopists.
The occurrence of post-colonoscopy CRC4, 5, 6, 7 is well described and 3 main reasons have been implicated in
Conclusions
We found that 10% of neoplastic polyps between 5 and 20 mm were incompletely removed. Incomplete resection increased with polyp size, was significantly higher for SSA/P (both factors are associated with increased risk of malignant degeneration of adenomas), and varied broadly between endoscopists. To date, quality measures have predominantly focused on polyp detection (eg, adenoma detection rates). Our results suggest a need for quality metrics evaluating polyp resection. The performance of
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Conflicts of interest The authors disclose no conflicts.
Funding This material is the result of work supported with resources and the use of facilities at the VA Medical Center, White River Junction, Vermont. The contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government.