Adenoma detection rates in an opportunistic screening colonoscopy program in Iran, a country with rising colorectal cancer incidence

BMC Gastroenterology

Reza Malekzadeh³  Masoud Sotoudeh³  Mehdi Saberifiroozi³  Bijan Shahbazkhani³  Homayoon Vahedi³  Reza Ansari³  Shahin Merat³  Siavosh Nasseri-Moghaddam³  Farnaz Delavari⁴  Pejman Khosravi³  Hamideh Salimzadeh¹  Faraz Bishehsari²  Alireza Delavari³ 

[1] Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran;Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA;Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Clinic, Tehran, Iran;Non-Communicable Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran

关键词: Colon cancers;    Colonic polyps;    Screening colonoscopy;   

Others  :  1121761
DOI  :  10.1186/s12876-014-0196-8

 received in 2014-08-19, accepted in 2014-10-29,  发布年份 2014

【 摘 要 】

Background

Data on the quality of colonoscopies in populations with rising colorectal cancer (CRC) incidence is scarce. We aimed to calculate the adenoma detection rates (ADR), and assess the quality of colonoscopies in an opportunistic screening colonoscopy program in Iran.

Methods

All the colonoscopy and pathology reports of asymptomatic adults over age 50 who underwent screening colonoscopy between June 2007 and March 2013 were reviewed. The colonoscopy quality indicators including ADR were calculated, and patient factors associated with the adenoma detection were determined.

Results

A total of 713 asymptomatic adults aged 50 years and older who underwent their first-time screening colonoscopy were included in this study. ADR and advanced-ADR were 33.00% (95% CI: 29.52-36.54) and 13.18% (95% CI: 10.79-15.90), respectively. We observed a significantly higher rate of cecal intubation in patients with fair or better bowel preparation compared to those with poor prep, 90.00% vs. 70.45%, respectively (P < 0.001). Bowel preparation (adjusted OR: 2.49, 95% CI: 1.75-3.55), older age (≥60) (adjusted OR: 1.70, 95% CI: 1.22-2.36), and male gender (adjusted OR: 1.39, 95% CI: 1.01-1.92) were associated with the adenoma detection.

Conclusions

Our ADR in both genders meets and exceeds the recommended colonoscopy quality benchmarks. The polyp and adenoma detection rates in the current study are comparable to those reported from Western countries where the incidence of CRC is traditionally high. These data are in line with the epidemiologic transition of CRC in Iran.

【 授权许可】

   
2014 Delavari et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Jemal A, Center MM, DeSantis C, Ward EM: Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010, 19(8):1893-1907.
• [2]Bishehsari F, Mahdavinia M, Vacca M, Malekzadeh R, Mariani-Costantini R: Colon cancer in developing countries: facts, new perspectives and opportunities. World J Gastroenterol 2014, 20(20):6055-6072.
• [3]Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE, Hoffman B, Jacobson BC, Mergener K, Petersen BT: Quality indicators for colonoscopy. Gastrointest Endosc 2006, 63(4):S16-S28.
• [4]Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E: Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010, 362(19):1795-1803.
• [5]Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF: Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012, 366(8):687-696.
• [6]Brenner H, Chang–Claude J, Jansen L, Knebel P, Stock C, Hoffmeister M: Reduced risk of colorectal cancer up to 10 years after screening, surveillance, or diagnostic colonoscopy. Gastroenterology 2013, 146(3):709-717.
• [7]Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, Kirk LM, Litlin S, Lieberman DA, Waye JD: Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the US Multi-Society Task Force on colorectal cancer. Am J Gastroenterol 2002, 97(6):1296-1308.
• [8]Fletcher RH, Allen JI, Dominitz JA, Faigel DO, Johnson DA, Lane DS, Lieberman D, Pope JB, Potter MB, Robin DP: The Quality of colonoscopy services—responsibilities of referring clinicians. J Gen Intern Med 2010, 25(11):1230-1234.
• [9]Ansari R, Mahdavinia M, Sadjadi A, Nouraie M, Kamangar F, Bishehsari F, Fakheri H, Semnani S, Arshi S, Zahedi MJ, Darvish-Moghadam S, Mansour-Ghanaei F, Mosavi A, Malekzadeh R: Incidence and age distribution of colorectal cancer in Iran: results of a population-based cancer registry. Cancer Lett 2006, 240(1):143-147.
• [10]Malekzadeh R, Bishehsari F, Mahdavinia M, Ansari R: Epidemiology and molecular genetics of colorectal cancer in iran: a review. Arch Iran Med 2009, 12(2):161-169.
• [11]Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G: Validation of an instrument to assess colon cleansing [abstract]. Am J Gastroenterol 1999, 94:2667.
• [12]Morson BC, Sobin LH: Histological Typing of Intestinal Tumours. In WHO International Histological Classification of Tumors. Volume 15. World Health Organization, Geneva; 1976.
• [13]Boroff ES, Gurudu SR, Hentz JG, Leighton JA, Ramirez FC: Polyp and adenoma detection rates in the proximal and distal colon. Am J Gastroenterol 2013, 108(6):993-999.
• [14]Gohel TD, Burke CA, Lankaala P, Podugu A, Kiran RP, Thota PN, Lopez R, Sanaka MR: Polypectomy rate: a surrogate for adenoma detection rate varies by colon segment, gender, and endoscopist. Clin Gastroenterol Hepatol 2014, 12(7):1137-1142.
• [15]Denis B, Sauleau EA, Gendre I, Piette C, Bretagne JF, Perrin P: Measurement of adenoma detection and discrimination during colonoscopy in routine practice: an exploratory study. Gastrointest Endosc 2011, 74(6):1325-1336.
• [16]Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, Dash C, Giardiello FM, Glick S, Levin TR: Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi‐Society Task Force on colorectal cancer, and the American College of Radiology. CA Cancer J Clin 2008, 58(3):130-160.
• [17]Coriat R, Lecler A, Lamarque D, Deyra J, Roche H, Nizou C, Berretta O, Mesnard B, Bouygues M, Soupison A: Quality indicators for colonoscopy procedures: a prospective multicentre method for endoscopy units. PLoS ONE 2012, 7(4):e33957.
• [18]Ferlitsch M, Reinhart K, Pramhas S, Wiener C, Gal O, Bannert C, Hassler M, Kozbial K, Dunkler D, Trauner M: Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA 2011, 306(12):1352-1358.
• [19]Adler A, Wegscheider K, Lieberman D, Aminalai A, Aschenbeck J, Drossel R, Mayr M, Mroß M, Scheel M, Schröder A: Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12 134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut 2013, 62(2):236-241.
• [20]Lebwohl B, Kastrinos F, Glick M, Rosenbaum AJ, Wang T, Neugut AI: The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc 2011, 73(6):1207-1214.
• [21]Chokshi RV, Hovis CE, Hollander T, Early DS, Wang JS: Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc 2012, 75(6):1197-1203.
• [22]Ness RM, Manam R, Hoen H, Chalasani N: Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 2001, 96(6):1797-1802.
• [23]Shieh TY, Chen MJ, Chang CW, Hung CY, Hu KC, Kuo YC, Shih SC, Wang HY: Effect of physician-delivered patient education on the quality of bowel preparation for screening colonoscopy.Gastroenterol Res Pract 2013, doi: 10.1155/2013/570180.
• [24]Rosenfeld G, Krygier D, Enns RA, Singham J, Wiesinger H, Bressler B: The impact of patient education on the quality of inpatient bowel preparation for colonoscopy. Can J Gastroenterol 2010, 24(9):543-546.
• [25]Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, Hemmelgarn BR: Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009, 7(12):1272-1278.
• [26]Nguyen SP, Bent S, Chen Y-H, Terdiman JP: Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009, 7(6):676-681.
• [27]Coe SG, Wallace MB: Assessment of adenoma detection rate benchmarks in women versus men. Gastrointest Endosc 2013, 77(4):631-635.
• [28]Lane DS, Messina CR, Cavanagh MF, Anderson JC: Delivering colonoscopy screening for low-income populations in Suffolk County: strategies, outcomes, and benchmarks. Cancer 2013, 119(15):2842-2848.
• [29]Salimzadeh H, Delavari A, Montazeri A, Mirzazadeh A: Knowledge and practice of Iranians toward colorectal cancer, and barriers to screening. Int J Prev Med 2012, 3(1):29-35.