Patient and Physician Factors Associated with Adenoma and Sessile Serrated Lesion Detection Rates
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ORIGINAL ARTICLE
Patient and Physician Factors Associated with Adenoma and Sessile Serrated Lesion Detection Rates Margaret J. Zhou1 · Benjamin Lebwohl1,2,3,4 · Anna Krigel1,4 Received: 8 May 2020 / Accepted: 14 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and Aims Sessile serrated lesions (SSLs) have been increasingly recognized as precursors to colorectal cancer. Unlike adenoma detection rate (ADR), there is currently no agreed-upon benchmark for SSL detection rate (SSLDR), and data on factors that impact SSL detection are limited. We aimed to identify patient, endoscopist, and procedural factors associated with SSL and adenoma detection. Methods We used a single-center electronic endoscopy database to identify all patients ages ≥ 50 years who underwent outpatient screening colonoscopy from January 1, 2012, to June 30, 2018. Univariable Chi-square analysis was used to determine patient, endoscopist, and procedure-related factors associated with SSL or adenoma detection. We used logistic regression with generalized estimating equations, accounting for clustering by individual endoscopist, to determine factors independently associated with ADR and SSLDR. Results We identified 10,538 unique patients who underwent colonoscopy performed by 28 endoscopists. Overall SSLDR was 2.2%, and overall ADR was 29.1%. On multivariable analysis, patient age, sex, BMI, smoking, endoscopist withdrawal time, and year of colonoscopy were independent predictors of ADR. Smoking and year of colonoscopy were independent predictors of SSLDR. Sub-optimal bowel preparation was inversely associated with SSL detection but not ADR. Conclusions In this large study of patients undergoing average-risk screening colonoscopy, overall SSLDR was low, indicating that methods for increasing SSLDR are needed. Our findings suggest that endoscopists may take into account risk factors for SSLs, such as smoking history, and recognize that the detection of such lesions, even more so than for adenomas, is dependent on optimal bowel preparation. Keywords Colonoscopy · Sessile serrated lesion · Adenoma · Screening
* Anna Krigel [email protected] Margaret J. Zhou [email protected] Benjamin Lebwohl [email protected] 1
Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY 10032, USA
2
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
3
Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
4
Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA
Introduction In the last two decades, sessile serrated lesions (SSLs) have been increasingly recognized as precursors to colorectal cancer (CRC) [1]. SSLs arise via the serrated neoplasia pathway and are responsible fo
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