Hamideh Salimzadeh, PhD Assistant Professor, Digestive Diseases Research Center,Tehran University of Medical Sciences, Shariati Hospital, North

Transcription

1 Hamideh Salimzadeh, PhD Assistant Professor, Digestive Diseases Research Center,Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue Tehran, Iran. Tel: Fax:

2 Definitions The polyp detection rate (PDR) The proportion of colonoscopies in which at least one polyp of any type is either sampled or removed. The adenoma detection rate (ADR) The proportion of colonoscopies in which one or more adenomas is detected. 3/5/2015 2

3 Quality measures of screening colonoscopy ADR is a well-accepted measure of colonoscopy quality. Higher ADRs decrease the risk of interval CRC after screening colonoscopy. The US Multi-Society Task Force guideline for screening c- scopies in average-risk population: Minimum ADR: 25% in men and 15% in women 3/5/2015 3

4 Delavari AR, et al. Characteristics of Colorectal Polyps and Cancer; a Retrospective Review of Colonoscopy Data in Iran. Middle East J Dig Dis 2014;6: /5/2015 4

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6 Histology of the colonic lesions Tubular adenomas: 62.3% Tubulo-villous adenomas: 10.3% Villous adenomas: 6.6% Sessile Serrated polyps/adenomas: 3.6% Hyperplastic/inflammatory polyps: 17.2% 3/5/2015 6

7 Delavari AR, et al. Adenoma detection rates in an opportunistic screening colonoscopy program in Iran, a country with rising colorectal cancer incidence. BMC Gastroenterology 2014, 14:196 doi: /s /5/2015 7

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10 Table 3. Factors associated with ADR (n=713) Adenoma detection rate no* (percentage, 95% CI) Gender Female 96/333 (28.83, ) Male 139/380 (36.58, ) Age <60 83/307 (27.03, ) /406 (37.44, ) Bowel preparation Poor/unsatisfactory 57/264 (21.59, ) Good/fair 178/449 (39.64, ) <0.001 Cecal reach No 36/123 (29.27, ) Yes 199/590 (33.73, ) /5/ P

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12 Polyp/adenoma predictors Patient-related factors Physician-related factors Other factors 3/5/

13 Polyp/adenoma predictors Patient-related factors Age Gender Race (African-Americans vs. Caucasians) Personal history of polyps (>9mm proximal) Family history of CRC BMI Abdominal obesity Lack of physical activity Smoking Quality of bowel prep Bowel cleansing regimen 3/5/

14 Polyp/adenoma predictors Physician-related factors Mean procedure time CIR Expertise: fellows, attending, surgeons Fatigue/ Time of performance Technical issues Other factors Endoscope Dual observation of screening colonoscopies by an experienced endoscopy nurse. Research setting vs. routine practice setting Data reporting system Automated linkage between endoscopic data & path dataset Polyp retrieval rate 3/5/

15 Bowel Prep 3/5/

16 Bowel prep rating 3/5/

17 Rating the Quality of Bowel Prep During Colonoscopy Measurement of the rate of adequate colon prep should be conducted routinely Adequacy of bowel pre should be assessed: after all efforts to clear residual debris have been completed Adequate pre: allows a recommendation of a screening or surveillance interval appropriate to the findings of the examination, should be achieved in 85% or more of all examinations on a per-physician basis 3/5/

18 Bowel prep formulations Efficacy Safety Tolerability 3/5/

19 Selection of bowel-prep regimen Patient s medical history Patient s medications The adequacy of prior bowel prep if available 3/5/

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21 Predictors of inadequate prep Older age Male gender Higher body mass index Inpatient vs. outpatient status A prior inadequate preparation History of constipation Use of opioids or other constipating medications, Prior colon resection Diabetes mellitus Neurologic conditions (Spinal cord injury, Stroke, Parkinson s disease) Drugs (tricyclic antidepressants, narcotics) Lack of patients instruction Dosing and Timing Prep Regimens 3/5/

22 Dosing and Timing Prep Regimens Split-Dose Regimens Better compliance & acceptance Greater willingness to repeat the regimens vs. the day before regimens Better ADR Same-Day Regimens Effective alternative afternoon colonoscopy Better mucosal cleansing Less sleep disturbance Better tolerance Less impact on activities of daily living Greater patient preference scores 3/5/

23 Patient Education for Optimizing Preparation Increases patient compliance Improves quality of prep Decreases repeat examinations and costs Both verbal & written instructions, vs. written instructions an independent predictor of adequate bowel prep quality. Tailored approach 3/5/

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25 REFRENCES 1. David A. Johnson. Et al. Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2014;147: N. Jewel Samadder, et al. Increased Risk of Colorectal Neoplasia Among Family Members of Patients With Colorectal Cancer: A Population-Based Study in Utah. Gastroenterology 2014;147: Jane C. Figueiredo, et al. Smoking-associated risks of conventional adenomas and serrated polyps in the colorectum. Cancer Causes Control. DOI /s Øyvind Holme et al. Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality A Randomized Clinical Trial. JAMA. 2014;312(6): doi: /jama Young S et al. Lack of Impact on Polyp Detection by Fellow Involvement During Colonoscopy: A Meta-Analysis. Dig Dis Sci (2013) 58: DOI /s Rex et al.quality indicators for colonoscopy. GASTROI NTESTI NAL ENDOSCOPY : 2006 :Volume 63, No Nishizawa T, Suzuki H, Takahashi M, et al. Trainee participation during colonoscopy adversely affects polyp and adenoma detection rates. Digestion. 2011;84: Lee CK, Park DI, Lee SH, et al. Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: a multicenter, prospective, randomized study. Gastrointest Endosc. 2011;74: Sanaka MR et al. Adenomas are detected more often in morning than in afternoon colonoscopy Am J Gastroenterol Jul;104(7): ; 10. Suryakanth R Gurudu et al. Adenoma Detection Rate Is Not Influenced by the Timing of Colonoscopy When Performed in Half-Day Blocks. Am J Gastroenterol 2011; 106: Cheskin LJ, & Prosser BJ. Obesity and the risk of colon polyps. J Clin Gastroenterol 2007;41: Siddiqui A, et al. Obesity is associated with an increased prevalence of advanced adenomatous colon polyps in a male veteran population. 3/5/

26 Thank you! 3/5/