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Adenoma miss rate of polypectomy-referring hospitals is high in Korea

Korean Journal of Internal Medicine 2020년 35권 4호 p.881 ~ 888
서주현 ( Seo Ju-Hyun ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine

이보인 ( Lee Bo-In ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
이경진 ( Lee Kyung-Jin ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
박재명 ( Park Jae-Myung ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
김진수 ( Kim Jin-Soo ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
조영석 ( Cho Young-Seok ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
이강문 ( Lee Kang-Moon ) - Catholic University College of Medicine St. Vincent’s Hospital Department of Internal Medicine
김상우 ( Kim Sang-Woo ) - Catholic University College of Medicine Uijeongbu St. Mary’s Hospital Department of Internal Medicine
 ( Choi Hwang ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine
최명규 ( Choi Myung-Gyu ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine

Abstract


Background/Aims: We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas.

Methods: We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016.

Results: A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively).

Conclusions: Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.

키워드

Adenoma; Colonoscopy; Miss rate; Polyp
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