Mohammad Alomari, MD1, Laith Al Momani, MD2, Bara El Kurdi, MD2, Shrouq Khazaaleh, MD3, Muhammad Talal Sarmini, MD1, Vaibhav Wadhwa, MD4, Prashanthi N. Thota, MD5, Madhusudhan R. Sanaka, MD, FACG5
1Cleveland Clinic Foundation, Cleveland, OH; 2East Tennessee State University, Johnson City, TN; 3King Abdullah University Hospital, Ar Ramtha, Irbid, Jordan; 4Cleveland Clinic, Weston, FL; 5Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
Introduction: Adenoma detection rate (ADR) is an established colonoscopy quality metric primarily used to prevent interval colorectal cancer (CRC). Likewise, higher sessile serrated polyp detection rates (SSPDR) were linked to reduced interval CRC. Recently, some studies suggested the use SSPDR as a quality indicator with proposed benchmarks mimicking that seen in ADR where 25% of all procedures should yield adenomas (20% for females and 30% for males). We aimed in our study to examine the utility of SSPDR as a quality metric for screening colonoscopies with proposed new target benchmarks.
Methods: A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our tertiary center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good, or adequate bowel preparation were included. Overall and segment specific ADR and SSPDR were calculated and compared using t-tests. Data is presented as mean ± standard deviation or frequency (%). The adjusted R-Squared statistic (R2) was used to test the correlation variability. The p-value corresponds to the correlation between ADR and SSPDR. All analyses were done using SAS (version 9. 4, The SAS Institute, Cary, NC) and a p-value < 0. 05 was considered statistically significant.
Results: A total of 4151 patients were included in the analysis. Average patient age was 60.0±7.7 years and 53.2% were females. Colonoscopies were performed by 54 (64.3%) gastroenterologists and 30 (35.7%) non-gastroenterologists (General Surgeons=9; Colorectal Surgeons=21). (Table 1)Overall ADR was 26.4±11.0, overall SSPDR was 19.3±11.4. Overall SSPDR that corresponds to a predicted ADR of 25% was 16% (adjusted R2=0.16, p-value < 0.001). SSPDR in females that corresponds to an ADR of 20% was 10% (adjusted R2=0.11, p-value= 0.001). (Figure 1) These findings reflect a significant but poor correlation between ADR and SSPDR.
Discussion: Based on a large screening colonoscopy registry-based analysis, our results support the use of SSPDR as an ancillary rather than independent colonoscopy quality metric. The current study suggests a cut-off values of 16% for overall SSPDR and 10% for the female papulation. SSPDR above these values may be congruous with adequate serrated polyp detection rates. Further multicenter studies are needed to validate our findings.
Citation: Mohammad Alomari, MD; Laith Al Momani, MD; Bara El Kurdi, MD; Shrouq Khazaaleh, MD; Muhammad Talal Sarmini, MD; Vaibhav Wadhwa, MD; Prashanthi N. Thota, MD; Madhusudhan R. Sanaka, MD, FACG. P0233 - SESSILE SERRATED POLYP DETECTION RATE AS A SCREENING COLONOSCOPY QUALITY METRIC. Program No. P0233. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.