Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8549
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
Processing time: 104 Days and 13.6 Hours
To assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.
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.
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.
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.