Risk factors for advanced lesions undetected at prior colonoscopy: not always poor preparation

 

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Background and study aim: Colonoscopy is regarded as the gold standard for diagnosis of colonic lesions. However, adenoma miss rates in tandem colonoscopy studies vary from 2 % to 26 %. We aimed to investigate the rates of advanced neoplasia in patients with a prior normal colonoscopy in an outpatient endoscopy unit.

Methods: Review of reports for colonoscopies performed in our Endoscopy Unit from 2000 to 2005. Undetected lesions were defined as advanced adenoma or colorectal cancer (CRC) not reported in a colonoscopy performed in the previous 2 or 3 years, respectively. Patients with hereditary nonpolyposis CRC (HNPCC) and familial adenomatous polyposis (FAP) were excluded.

Results: Between 2002 and 2005, 795 patients were diagnosed with at least one advanced adenoma and 386 with CRC. Among these, 107/795 patients (13.5 %) had advanced adenoma that had been undetected in a previous colonoscopy (39 % [53/135 lesions] in the right colon); 92/107 (86 %) had an undetected advanced adenoma ≥ 10 mm. Previously undetected CRCs were found in 27/386 patients (6.7 %), located in the left colon in 21/27 (78 %); in 7 the area had not been reached in the previous colonoscopy. Risk factors for undetected advanced adenoma were advanced age, male gender, the presence of another advanced adenoma at first colonoscopy, and history of advanced neoplasia.

Conclusions: Failure to detect advanced neoplasia is common in a community-based endoscopy facility. Previously undetected advanced lesions are more frequently found in the left colon and rectum. Risk factors for non-detection of advanced adenoma are similar to those for advanced neoplasia recurrence. Lowering non-detection rates is crucial for correct follow-up recommendations. Patients should be aware of rates of detection of advanced neoplasia after previous normal colonoscopic findings.

References

• 1 van Rijn J C, Reitsma J B, Stoker J. et al . Polyp miss rate determined by tandem colonoscopy: a systematic review.  Am J Gastroenterol. 2006;  101 343-350
  CrossrefPubMedGoogle Scholar
• 2 Winawer S J, Zauber A G, Fletcher R H. et al . Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society.  Gastroenterology. 2006;  130 1872
  CrossrefPubMedGoogle Scholar
• 3 Rex D K. Colonoscopic withdrawal technique is associated with adenoma miss rates.  Gastrointest Endosc. 2000;  51 33-36
  CrossrefPubMedGoogle Scholar
• 4 Inoue T, Murano M, Murano N. et al . Comparative study of conventional colonoscopy and pan-colonic narrow-band imaging system in the detection of neoplastic colonic polyps: a randomized, controlled trial.  J Gastroenterol Hepatol. 2008;  43 45-50
  PubMedGoogle Scholar
• 5 Kaltenbach T, Friedland S, Soetikno R. A randomised tandem colonoscopy trial of narrow band imaging versus white light examination to compare neoplasia miss rates.  Gut. 2008;  57 1406-1412
  CrossrefPubMedGoogle Scholar
• 6 Bressler B, Paszat L F, Chen Z. et al . Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis.  Gastroenterology. 2007;  132 96
  CrossrefPubMedGoogle Scholar
• 7 Leung K, Pinsky P, Laiyemo A O. et al . Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study.  Gastrointest Endosc. 2010;  71 111-117. Epub 2009 Jul 31
  CrossrefPubMedGoogle Scholar
• 8 Chen T H, Yen M F, Lai M S. et al . Evaluation of a selective screening for colorectal carcinoma: the Taiwan Multicenter Cancer Screening (TAMCAS) project.  Cancer. 1999;  86 1116-1128
  CrossrefPubMedGoogle Scholar
• 9 Jouve J L, Remontet L, Dancourt V. et al . Estimation of screening test (hemoccult) sensitivity in colorectal cancer mass screening.  Br J Cancer. 2001;  84 1477-1481
  CrossrefPubMedGoogle Scholar
• 10 Martínez M E, Baron J A, Lieberman D A. et al . A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.  Gastroenterology. 2009;  136 832-841
  CrossrefPubMedGoogle Scholar
• 11 Lakoff J, Paszat L F, Saskin R, Rabeneck L. Risk of developing proximal versus distal colorectal cancer after a negative colonoscopy: a population-based study.  Clin Gastroenterol Hepatol. 2008;  6 1117-1121
  CrossrefPubMedGoogle Scholar
• 12 Pickhardt P J, Nugent P A, Mysliwiec P A. et al . Location of adenomas missed by optical colonoscopy.  Ann Intern Med. 2004;  141 352-359
  CrossrefPubMedGoogle Scholar
• 13 Wallace M B. Improving colorectal adenoma detection: technology or technique?.  Gastroenterology. 2007;  132 1221-1223
  CrossrefPubMedGoogle Scholar
• 14 Vasen H FA, Moslein G, Alonso A. et al . Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer).  J Med Genet. 2007;  44 353-362
  CrossrefPubMedGoogle Scholar
• 15 Rex D K, Bond J H, Feld A D. Medical-legal risks of incident cancers after clearing colonoscopy.  Am J Gastroenterol. 2001;  96 952-957
  CrossrefPubMedGoogle Scholar
• 16 Barclay R L, Vicari J J, Doughty A S. et al . Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.  N Engl J Med. 2006;  355 2533-2541
  CrossrefPubMedGoogle Scholar
• 17 Moon W, Park S Y, Park S J. et al . The colonoscopic missing rates of colorectal polyps determined by subsequent polypectomy.  Gastroenterology. 2008;  134 (Suppl. 1) A-163
  PubMedGoogle Scholar

A. FerrándezMD 

Hospital Clinico Lozano Blesa – Digestive Diseases

Avenida San Juan Bosco 15
Zaragoza 50009
Spain

Fax: +34-976-556400

Email: angel.ferrandez@telefonica.net