Comparison of adenoma detection rate and proximal serrated polyp detection rate and their effect on post-colonoscopy colorectal cancer mortality in screening patients

Background Patients with serrated polyps are at increased risk for post-colonoscopy colorectal cancer (PCCRC); how-ever, evidence for a dedicated serrated polyp detection rate is lacking. The aim of this study was to investigate the association of the proximal serrated polyp detection rate(PSDR) and adenoma detection rate (ADR) with PCCRC death. Methods This was a retrospective analysis within the Austrian quality assurance program for screening colonoscopy. Spearman's rank coefficient was calculated for the assessment of association between ADR and PSDR. Whether ADR or PSDR were associated with colorectal cancer mortality was assessed by Cox proportional hazards model. Results: 229/729 screening colonoscopies performed by308 endoscopists were analyzed. The ADR (hazard ratio[HR] per 1 percentage point increase 0.98, 95%CI 0.96-0.99) as well as the PSDR (HR per 1 percentage point in-crease 0.97, 95%CI 0.94-0.99) were significantly associated with PCCRC death. The correlation coefficient of the ADR and PSDR calculated at every colonoscopy was 0.70(95%CI 0.70-0.71), and the corresponding PSDR value foran ADR performance standard of 25% was 11.1%. At the end of the study period, 86 endoscopists (27.9%) reached an ADR of > 25% and a PSDR of > 11.1%. Conclusions:The ADR as well as the PSDR were associated with PCCRC death. Striving for a high PSDR in addition to a high ADR might reduce the risk for PCCRC mortality in patients undergoing screening colonoscopy

Automated summary

This study investigated the association of proximal serrated polyp detection rate (PSDR) and adenoma detection rate (ADR) with post-colonoscopy colorectal cancer (PCCRC) death. The results showed that both ADR and PSDR were significantly associated with PCCRC death. Therefore, striving for a high PSDR in addition to a high ADR may reduce the risk of PCCRC mortality in patients undergoing screening colonoscopy.