Intest Res.  2017 Jul;15(3):411-418. 10.5217/ir.2017.15.3.411.

Miss rate of colorectal neoplastic polyps and risk factors for missed polyps in consecutive colonoscopies

• Kim NH
• Jung YS
• Jeong WS
• Yang HJ
• Park SK
• Choi K
• Park DI

• KMID: 2382386
• DOI: http://doi.org/10.5217/ir.2017.15.3.411

Abstract

BACKGROUND/AIMS
Colonoscopic polypectomy is the best diagnostic and therapeutic tool to detect and prevent colorectal neoplasms. However, previous studies have reported that 17% to 28% of colorectal polyps are missed during colonoscopy. We investigated the miss rate of neoplastic polyps and the factors associated with missed polyps from quality-adjusted consecutive colonoscopies.
METHODS
We reviewed the medical records of patients who were found to have colorectal polyps at a medical examination center of the Kangbuk Samsung Hospital between March 2012 and February 2013. Patients who were referred to a single tertiary academic medical center and underwent colonoscopic polypectomy on the same day were enrolled in our study. The odds ratios (ORs) associated with polyp-related and patient-related factors were evaluated using logistic regression analyses.
RESULTS
A total of 463 patients and 1,294 neoplastic polyps were analyzed. The miss rates for adenomas, advanced adenomas, and carcinomas were 24.1% (312/1,294), 1.2% (15/1,294), and 0% (0/1,294), respectively. Flat/sessile-shaped adenomas (adjusted OR, 3.62; 95% confidence interval [CI], 2.40-5.46) and smaller adenomas (adjusted OR, 5.63; 95% CI, 2.84- 11.15 for ≤5 mm; adjusted OR, 3.18; 95% CI, 1.60-6.30 for 6-9 mm, respectively) were more frequently missed than pedunculated/sub-pedunculated adenomas and larger adenomas. In patients with 2 or more polyps compared with only one detected (adjusted OR, 2.37; 95% CI, 1.55-3.61 for 2-4 polyps; adjusted OR, 11.52; 95% CI, 4.61-28.79 for ≥5 polyps, respectively) during the first endoscopy, the risk of missing an additional polyp was significantly higher.
CONCLUSIONS
One-quarter of neoplastic polyps was missed during colonoscopy. We encourage endoscopists to detect smaller and flat or sessile polyps by using the optimal withdrawal technique.

Keyword

Colorectal polyp; Miss rate; Consecutive colonoscopies

MeSH Terms

Academic Medical Centers
Adenoma
Colonoscopy*
Colorectal Neoplasms
Endoscopy
Humans
Logistic Models
Medical Records
Odds Ratio
Polyps*
Risk Factors*

Figure

• 

  Fig. 1 Flow diagram illustrating the selection of study subjects.

• 

  Fig. 2 Characteristics of overall neoplastic polyps detected during the first or second colonoscopy. R, rectum; SC, sigmoid colon; DC, descending colon; TC, transverse colon; AC, ascending colon; Is, sessile type; Ip, pedunculated type; Isp, subpedunculated type.

Reference

1. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993; 329:1977–1981. PMID: 8247072.

2. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012; 366:687–696. PMID: 22356322.

3. Brenner H, Chang-Claude J, Seiler CM, Hoffmeister M. Interval cancers after negative colonoscopy: population-based case-control study. Gut. 2012; 61:1576–1582. PMID: 22200840.

4. Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology. 2007; 132:96–102. PMID: 17241863.

5. Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol. 2006; 101:2866–2877. PMID: 17227527.

6. Cha JM. Interval cancers after a negative colonoscopy finding in a Korean population: a small step for gastroenterologists but one giant leap for Koreans. Intest Res. 2014; 12:169–170. PMID: 25349587.

7. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006; 355:2533–2541. PMID: 17167136.

8. Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2014; 63:949–956. PMID: 23793224.

9. van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006; 101:343–350. PMID: 16454841.

10. Shehadeh I, Rebala S, Kumar R, Markert RJ, Barde C, Gopalswamy N. Retrospective analysis of missed advanced adenomas on surveillance colonoscopy. Am J Gastroenterol. 2002; 97:1143–1147. PMID: 12014718.

11. Kasugai K, Miyata M, Hashimoto T, et al. Assessment of miss and incidence rates of neoplastic polyps at colonoscopy. Dig Endosc. 2005; 17:44–49.

12. Ahn SB, Han DS, Bae JH, Byun TJ, Kim JP, Eun CS. The miss rate for colorectal adenoma determined by quality-adjusted, back-to-back colonoscopies. Gut Liver. 2012; 6:64–70. PMID: 22375173.

13. Heresbach D, Barrioz T, Lapalus MG, et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy. 2008; 40:284–290. PMID: 18389446.

14. Leufkens AM, van Oijen MG, Vleggaar FP, Siersema PD. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscopy. 2012; 44:470–475. PMID: 22441756.

15. Hong SN, Sung IK, Kim JH, et al. The effect of the bowel preparation status on the risk of missing polyp and adenoma during screening colonoscopy: a tandem colonoscopic study. Clin Endosc. 2012; 45:404–411. PMID: 23251889.

16. Ferrández A, Navarro M, Díez M, et al. Risk factors for advanced lesions undetected at prior colonoscopy: not always poor preparation. Endoscopy. 2010; 42:1071–1076. PMID: 20960390.

17. Kim JH, Kim YS, Cheon JH, et al. Influence of the insertion time and number of polyps on miss rate in colonoscopy. Scand J Gastroenterol. 2011; 46:634–639. PMID: 21370993.

18. Pohl H, Robertson DJ. Colorectal cancers detected after colonoscopy frequently result from missed lesions. Clin Gastroenterol Hepatol. 2010; 8:858–864. PMID: 20655393.

19. Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc. 2000; 52:346–352. PMID: 10968848.

20. Ng SC, Tsoi KK, Hirai HW, et al. The efficacy of cap-assisted colonoscopy in polyp detection and cecal intubation: a meta-analysis of randomized controlled trials. Am J Gastroenterol. 2012; 107:1165–1173. PMID: 22664471.

21. Kondo S, Yamaji Y, Watabe H, et al. A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol. 2007; 102:75–81. PMID: 17100978.

22. Tsai FC, Strum WB. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size. Dig Dis Sci. 2011; 56:2384–2388. PMID: 21318587.

23. Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997; 112:24–28. PMID: 8978338.

24. Bianco MA, Cipolletta L, Rotondano G, et al. Prevalence of nonpolypoid colorectal neoplasia: an Italian multicenter observational study. Endoscopy. 2010; 42:279–285. PMID: 20235006.

25. Martínez ME, Sampliner R, Marshall JR, Bhattacharyya AK, Reid ME, Alberts DS. Adenoma characteristics as risk factors for recurrence of advanced adenomas. Gastroenterology. 2001; 120:1077–1083. PMID: 11266371.

26. Bonithon-Kopp C, Piard F, Fenger C, et al. Colorectal adenoma characteristics as predictors of recurrence. Dis Colon Rectum. 2004; 47:323–333. PMID: 14991494.