Korean J Gastroenterol.  2021 Dec;78(6):328-336. 10.4166/kjg.2021.123.

Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines

• Park SH
• Hong KI
• Park HC
• Kim YS
• Bok GH
• Kim KH
• Shin DS
• Han JY
• Kim YK
• Choi YJ
• Eun SH
• Lim BH
• Kwack KK
• The Korean Society of Digestive Endoscopy (KSDE) Polyp Study Workgroup

• KMID: 2523594
• DOI: http://doi.org/10.4166/kjg.2021.123

Abstract

Background/Aims
There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines.
Methods
The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas.
Results
Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion).
Conclusions
More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

Keyword

Colonic polyps; Detection rate; Guideline; Primary health care

Figure

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  Fig. 1 Detection rate of colon polyps in all the patients according to age group. The detection rate of polyp, adenoma, advanced adenoma, and high-risk adenoma increased with age.

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  Fig. 2 Detection rate of colon polyps in average-risk patients according to age group. The detection rate of polyp, adenoma, advanced adenoma, and high-risk adenoma increased with age.

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  Fig. 3 Detection rate of high-risk adenoma in all the patients according to age group and sex. The detection rate of high-risk adenoma in males was higher than females of the same age group except for those in their 20s and 80s.

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  Fig. 4 Detection rate of high-risk adenoma in average-risk patients according to age group and sex. The detection rate of high-risk adenoma in males was higher than females of the same age group except for those in their 80s.

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