Adenomas per positive colonoscopy better than ADR, study says — 5 insights

Chinese researchers discovered adenomas and advanced adenomas were missed more frequently by colonoscopies than previously reported, Medpage Today reports.

Researchers reviewed 43 publications involving 15,152 tandem colonoscopies and 10,852 adenomas, based on studies from Asia, the U.S., Australia and multiple other countries. The results were published in Gastroenterology.

What you should know:

1. They calculated adenoma miss rates of 26 percent for adenomas, 9 percent for advanced adenomas and 27 percent for serrated polyps. They also found high miss rates for proximal advanced adenomas, flat adenomas and in patients at high risk for colorectal cancer.

2. The analysis detected a slightly higher miss rate for both polyps and adenomas compared to a previous systematic review of 441 tandem colonoscopies.

3. Adenoma detection rate, adenomas per index colonoscopy and adenomas per positive index colonoscopy were independent predictors of adenoma miss rates.

4. Adenomas per positive index colonoscopy was the only independent predictor of miss rate for advanced adenomas and should be considered when designing future colonoscopy guidelines, researchers concluded.

5. Researchers noted ADR may be insufficient for monitoring colonoscopy quality because the colonoscopist might not inspect the colon carefully after detecting one adenoma.

"Although ADR has been a widely accepted measure for about a decade, there are problems with it," Cleveland Clinic physician James M. Church, MD, told MedPage Today. "The take-home message here is that colonoscopists should not rely on the ADR for quality assessment but should start using the AMR as well and avoiding checking the box after finding one."

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