Bretagne JF, Hamonic S, Piette C, Viel JF, Bouguen G. Interendoscopist variability in proximal colon polyp detection is twice higher for serrated polyps than adenomas. World J Gastroenterol 2016; 22(38): 8549-8557 [PMID: 27784967 DOI: 10.3748/wjg.v22.i38.8549]
Corresponding Author of This Article
Dr. Jean-François Bretagne, Professor of Medicine, Service des maladies de l’appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France. jean-francois.bretagne@chu-rennes.fr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jean-François Bretagne, Guillaume Bouguen, Service des maladies de l’appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France
Stéphanie Hamonic, Jean-François Viel, Service d’épidémiologie et de santé publique, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France
Christine Piette, Association pour le dépistage des cancers en Ille et Vilaine, 35033 Rennes, France
Author contributions: Bretagne JF designed the study and wrote the paper; Hamonic S and Viel JF performed the statistical analyses; Piette C collected the database information; Bouguen G contributed to the writing and the data interpretation; all of the authors contributed to the data analysis and approved the final submitted draft.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: Participants to the screening program were informed that personal data and colonoscopy findings could be used anonymously for scientific studies.
Conflict-of-interest statement: The authors have no potential conflict of interest.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at jean-francois.bretagne@chu-rennes.fr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jean-François Bretagne, Professor of Medicine, Service des maladies de l’appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France. jean-francois.bretagne@chu-rennes.fr
Telephone: +33-299-284347 Fax: +33-299-284189
Received: June 30, 2016 Peer-review started: June 30, 2016 First decision: July 29, 2016 Revised: August 19, 2016 Accepted: September 12, 2016 Article in press: September 12, 2016 Published online: October 14, 2016
Abstract
AIM
To assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.
METHODS
This study was a retrospective analysis of prospectively collected data from a regional colorectal cancer (CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma (A), one proximal adenoma (PA), one distal adenoma (DA), and one proximal serrated polyp (PSP) was assessed by using multilevel logistic regression models.
RESULTS
The observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6% (mean = 35.7%) for A, from 19.1% to 39.0% (mean = 29.4%) for DA, from 6.0% to 22.9% (mean = 12.4%) for PA, and from 1.3% to 19.3% (mean = 6.9%) for PSP. After adjusting for patient-level variables (sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for DA (P = 0.03, P = 0.02, P = 0.02 and P = 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA (6.6%) compared with A (2.1%), and twofold higher for PSP (12.3%) compared with PA.
CONCLUSION
These results demonstrate significant interendoscopist variability for proximal polyp particularly for serrated polyps, but not for distal adenoma detection. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.
Core tip: The present study demonstrates high interendoscopist variability in adenoma, proximal adenoma, and proximal serrated polyp detection rates but not in distal adenoma detection rates. The magnitude of interendoscopist variation was wider for proximal serrated polyps as compared to proximal adenoma detection. Altogether, these findings might explain why complete colonoscopies are less effective at preventing proximal than distal colorectal cancers.
