Serrated lesion detection-based quality markers in colonoscopy: ready for prime time?

Abstract

Background: Adenoma detection rate (ADR) is well established as a quality marker in colonoscopy. Studies have demonstrated the importance of detection of serrated lesions with respect to development of proximal colorectal neoplasia in particular; however, there is significant heterogeneity in the definition of quality assurance markers based on serrated lesions. Patel VD, Thompson WK et al (DDW, 2015) suggest novel indicators including the sessile serrated polyp detection rate (SSPDR), defined as any sessile serrated polyp (SSP) in the colorectum, and the clinically significant serrated polyp detection rate (CSSPDR), defined as all SSP in the colorectum + hyperplastic polyps (HP) proximal to the sigmoid flexure.1 Aims: To examine the rate of serrated lesion detection using the above definitions, as well as ADR in a retrospective cohort of patients at a tertiary referral center. Methods: A retrospective audit of 842 consecutive colonoscopy procedures performed over a 6-month period at the Canberra Hospital was performed. Patients under 50 years old and those with inflammatory bowel disease were excluded, leaving 521 procedures. Approval was obtained from the human research ethics committee at the Canberra Hospital. Results: • 139 colonoscopies detected at least one adenoma, giving an ADR of 26.7% • 89 colonoscopies detected at least one adenoma proximal to the splenic flexure, giving a proximal ADR of 17.1%, and 83 colonoscopies detected at least one adenoma distal to the splenic flexure, giving a distal ADR of 15.9% • 29 colonoscopies detected at least one sessile serrated polyp (SSPDR, 5.6%) • 34 colonoscopies detected at least one CSSP, giving a CSSPDR of 6.5% • 16 colonoscopies detected at least one distal CSSP, giving a distal CSSPDR of 3.1%, and 20 colonoscopies detected at least one proximal CSSP, giving a proximal CSSPDR of 3.8% • 152 colonoscopies detected at least one adenoma or a CSSP (29.2%) • Cecal intubation rate was 90.6%. Quality of bowel preparation was deemed ‘good’ in 285 procedures (54.7%), ‘satisfactory’ in 169 procedures (32.4%), and ‘poor’ in 63 (12.1%). Conclusions: The ADR was 26.7%, the SSPDR was 5.6%, and the CSSPDR was 6.5%. 29.2% of colonoscopies detected either an adenoma or a CSSP; the authors propose a novel quality marker based on this with the acronym ‘PASSCARD’ (clinically significant serrated polyp and adenoma detection rate). The Gastroenterological Society of Australia suggests an ADR > 25% for voluntary colonoscopy recertification. The authors suggest a target CSSPDR of 5% or a ‘PASSCARD’ of 30% may be alternative or complementary targets in the future; however, prospective validation studies are required to further define the role of these serrated polyp-based quality markers in terms of reducing interval cancers. Show more