Margaret Zhou, MD, Anna Krigel, MD, Benjamin Lebwohl, MD, MS
Columbia University Medical Center, New York, NY
Introduction: Sessile serrated polyps (SSPs) have been increasingly recognized as precursors to colorectal cancer (CRC). Unlike adenoma detection rate (ADR), there is currently no agreed-upon benchmark for SSP detection rate (SSPDR), and data on factors that impact SSP detection are limited. We aimed to identify patient, endoscopist, and procedural factors associated with SSP and adenoma detection.
Methods: We used a single-center electronic endoscopy database to identify all patients ages ≥ 50 years who underwent outpatient screening colonoscopy from January 1, 2012 to June 30, 2018. We excluded patients with a personal history of inflammatory bowel disease or colorectal neoplasia, or who underwent colonoscopy performed by a provider with fewer than 50 colonoscopies over the study period. Univariate chi-square analysis was used to determine patient, endoscopist, and procedural-related factors associated with SSP or adenoma detection on colonoscopy.
Results: We identified 10,538 unique patients who underwent colonoscopy performed by 28 endoscopists. SSPs were detected in 233 cases (2.2%), and adenomas were detected in 3,066 cases (29.1%). On univariate analysis, race and any smoking history were significantly associated with SSP detection (p=0.044 and p=0.054, respectively; see Table). Higher endoscopist ADR and greater mean withdrawal time were also associated with higher likelihood of SSP detection (p=0.019 and p=0.007, respectively). There was a significant trend towards increased SSP detection in colonoscopies performed in more recent years (p < 0.001). While endoscopist gender was not associated with SSP detection on univariate analysis, female endoscopists had significantly higher ADR (35.5%) compared to male endoscopists (28.2%, p < 0.001). ADR for cases with trainees present was 33.6% compared to 28.1% in cases without trainees (p < 0.001).
Discussion: In patients undergoing screening colonoscopy, SSPDR was significantly higher in procedures performed by physicians with higher ADR or greater mean withdrawal time, and in procedures performed in more recent years. Patient tobacco use history and race were also associated with SSP detection. These findings may help in establishing SSPDR as a quality metric for screening colonoscopy.
Citation: Margaret Zhou, MD, Anna Krigel, MD, Benjamin Lebwohl, MD, MS. P0224 - PATIENT AND PROVIDER RISK FACTORS FOR SESSILE SERRATED POLYP AND ADENOMA DETECTION ON SCREENING COLONOSCOPY. Program No. P0224. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.