Adenoma detection rates in colonoscopies for positive fecal immunochemical tests versus direct screening colonoscopies

Asia-Pacific Working Group on Colorectal Cancer

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and Aims: Recent guidelines propose higher adenoma detection rate (ADR) benchmarks for colonoscopies performed for positive results for fecal immunochemical tests (FIT), but this is based on low-quality evidence. We aimed to compare ADR, advanced ADR (AADR), and number of adenomas per colonoscopy (APC) in direct screening colonoscopy (DSC) versus FIT-positive colonoscopy (FITC) in a multicenter Asia-Pacific cohort to justify differential targets. Methods: Asymptomatic average-risk patients ≥50 years of age who underwent screening colonoscopy directly or as follow-up for positive OC-Sensor FIT results were identified from 8 sites across the Asia-Pacific region. Overall, sex-specific ADR, overall AADR, and overall APC were compared between the 2 screening methods. Multivariable logistic regression was performed to adjust for confounding by differences in patient characteristics. Linear regression was used to correlate ADR with APC and to propose APC benchmarks. Results: A total of 2901 (mean age, 60.1 years; 57% men) individuals had DSC, and 2485 (mean age, 62.8 years; 57% men) underwent FITC. Overall ADR (53.6% vs 37.5%; odds ratio [OR], 1.93; P <.001), male-specific ADR (61.6% vs 44.6%; OR, 2; P <.001), female-specific ADR (43.2% vs 28.2%; OR, 1.94; P <.001) and overall AADR (29.9% vs 4.9%; OR, 8.2; P <.001) in FITC were significantly higher than the corresponding values for DSC. Differences remained significant after adjustment for patient characteristics. ADR was strongly and positively correlated to APC, with an ADR of 45% and 35% correlating to an APC of ∼1 and ∼0.65. Conclusions: Results from this international multicenter cohort study provide early evidence that newly proposed higher ADR targets are justified as quality indicators for FITC.

Original languageEnglish
Pages (from-to)607-613.e1
JournalGastrointestinal Endoscopy
Volume89
Issue number3
DOIs
Publication statusPublished - 2019 Mar

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Colonoscopy
Adenoma
Odds Ratio
Benchmarking
Multicenter Studies
Linear Models

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Asia-Pacific Working Group on Colorectal Cancer. / Adenoma detection rates in colonoscopies for positive fecal immunochemical tests versus direct screening colonoscopies. In: Gastrointestinal Endoscopy. 2019 ; Vol. 89, No. 3. pp. 607-613.e1.
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title = "Adenoma detection rates in colonoscopies for positive fecal immunochemical tests versus direct screening colonoscopies",
abstract = "Background and Aims: Recent guidelines propose higher adenoma detection rate (ADR) benchmarks for colonoscopies performed for positive results for fecal immunochemical tests (FIT), but this is based on low-quality evidence. We aimed to compare ADR, advanced ADR (AADR), and number of adenomas per colonoscopy (APC) in direct screening colonoscopy (DSC) versus FIT-positive colonoscopy (FITC) in a multicenter Asia-Pacific cohort to justify differential targets. Methods: Asymptomatic average-risk patients ≥50 years of age who underwent screening colonoscopy directly or as follow-up for positive OC-Sensor FIT results were identified from 8 sites across the Asia-Pacific region. Overall, sex-specific ADR, overall AADR, and overall APC were compared between the 2 screening methods. Multivariable logistic regression was performed to adjust for confounding by differences in patient characteristics. Linear regression was used to correlate ADR with APC and to propose APC benchmarks. Results: A total of 2901 (mean age, 60.1 years; 57{\%} men) individuals had DSC, and 2485 (mean age, 62.8 years; 57{\%} men) underwent FITC. Overall ADR (53.6{\%} vs 37.5{\%}; odds ratio [OR], 1.93; P <.001), male-specific ADR (61.6{\%} vs 44.6{\%}; OR, 2; P <.001), female-specific ADR (43.2{\%} vs 28.2{\%}; OR, 1.94; P <.001) and overall AADR (29.9{\%} vs 4.9{\%}; OR, 8.2; P <.001) in FITC were significantly higher than the corresponding values for DSC. Differences remained significant after adjustment for patient characteristics. ADR was strongly and positively correlated to APC, with an ADR of 45{\%} and 35{\%} correlating to an APC of ∼1 and ∼0.65. Conclusions: Results from this international multicenter cohort study provide early evidence that newly proposed higher ADR targets are justified as quality indicators for FITC.",
author = "{Asia-Pacific Working Group on Colorectal Cancer} and Wong, {John C.T.} and Chiu, {Han Mo} and Kim, {Hyun Soo} and Byeon, {Jeong Sik} and Takahisa Matsuda and Nozomu Kobayashi and Wu, {Deng Chyang} and Ong, {David E.} and Sung, {Joseph J.Y.}",
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Adenoma detection rates in colonoscopies for positive fecal immunochemical tests versus direct screening colonoscopies. / Asia-Pacific Working Group on Colorectal Cancer.

In: Gastrointestinal Endoscopy, Vol. 89, No. 3, 03.2019, p. 607-613.e1.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adenoma detection rates in colonoscopies for positive fecal immunochemical tests versus direct screening colonoscopies

AU - Asia-Pacific Working Group on Colorectal Cancer

AU - Wong, John C.T.

AU - Chiu, Han Mo

AU - Kim, Hyun Soo

AU - Byeon, Jeong Sik

AU - Matsuda, Takahisa

AU - Kobayashi, Nozomu

AU - Wu, Deng Chyang

AU - Ong, David E.

AU - Sung, Joseph J.Y.

PY - 2019/3

Y1 - 2019/3

N2 - Background and Aims: Recent guidelines propose higher adenoma detection rate (ADR) benchmarks for colonoscopies performed for positive results for fecal immunochemical tests (FIT), but this is based on low-quality evidence. We aimed to compare ADR, advanced ADR (AADR), and number of adenomas per colonoscopy (APC) in direct screening colonoscopy (DSC) versus FIT-positive colonoscopy (FITC) in a multicenter Asia-Pacific cohort to justify differential targets. Methods: Asymptomatic average-risk patients ≥50 years of age who underwent screening colonoscopy directly or as follow-up for positive OC-Sensor FIT results were identified from 8 sites across the Asia-Pacific region. Overall, sex-specific ADR, overall AADR, and overall APC were compared between the 2 screening methods. Multivariable logistic regression was performed to adjust for confounding by differences in patient characteristics. Linear regression was used to correlate ADR with APC and to propose APC benchmarks. Results: A total of 2901 (mean age, 60.1 years; 57% men) individuals had DSC, and 2485 (mean age, 62.8 years; 57% men) underwent FITC. Overall ADR (53.6% vs 37.5%; odds ratio [OR], 1.93; P <.001), male-specific ADR (61.6% vs 44.6%; OR, 2; P <.001), female-specific ADR (43.2% vs 28.2%; OR, 1.94; P <.001) and overall AADR (29.9% vs 4.9%; OR, 8.2; P <.001) in FITC were significantly higher than the corresponding values for DSC. Differences remained significant after adjustment for patient characteristics. ADR was strongly and positively correlated to APC, with an ADR of 45% and 35% correlating to an APC of ∼1 and ∼0.65. Conclusions: Results from this international multicenter cohort study provide early evidence that newly proposed higher ADR targets are justified as quality indicators for FITC.

AB - Background and Aims: Recent guidelines propose higher adenoma detection rate (ADR) benchmarks for colonoscopies performed for positive results for fecal immunochemical tests (FIT), but this is based on low-quality evidence. We aimed to compare ADR, advanced ADR (AADR), and number of adenomas per colonoscopy (APC) in direct screening colonoscopy (DSC) versus FIT-positive colonoscopy (FITC) in a multicenter Asia-Pacific cohort to justify differential targets. Methods: Asymptomatic average-risk patients ≥50 years of age who underwent screening colonoscopy directly or as follow-up for positive OC-Sensor FIT results were identified from 8 sites across the Asia-Pacific region. Overall, sex-specific ADR, overall AADR, and overall APC were compared between the 2 screening methods. Multivariable logistic regression was performed to adjust for confounding by differences in patient characteristics. Linear regression was used to correlate ADR with APC and to propose APC benchmarks. Results: A total of 2901 (mean age, 60.1 years; 57% men) individuals had DSC, and 2485 (mean age, 62.8 years; 57% men) underwent FITC. Overall ADR (53.6% vs 37.5%; odds ratio [OR], 1.93; P <.001), male-specific ADR (61.6% vs 44.6%; OR, 2; P <.001), female-specific ADR (43.2% vs 28.2%; OR, 1.94; P <.001) and overall AADR (29.9% vs 4.9%; OR, 8.2; P <.001) in FITC were significantly higher than the corresponding values for DSC. Differences remained significant after adjustment for patient characteristics. ADR was strongly and positively correlated to APC, with an ADR of 45% and 35% correlating to an APC of ∼1 and ∼0.65. Conclusions: Results from this international multicenter cohort study provide early evidence that newly proposed higher ADR targets are justified as quality indicators for FITC.

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