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World J Gastroenterol. Aug 21, 2014; 20(31): 10927-10937
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10927
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10927
Table 1 Demographic and clinical characteristics of patients with different types of colorectal adenomas n (%)
Patients | Total(n = 2093) | Flat adenoma(n = 177) | Flat and protruding adenoma (n = 514) | Protruding adenoma(n = 1402) | P value |
Sex | |||||
Male | 1369 | 91 (51.4) | 329 (64.0) | 949 (67.7) | < 0.001 |
Female | 724 | 86 (48.6) | 185 (34.0) | 453 (32.3) | < 0.001 |
Age (mean ± SD, yr) | 55.91 ± 12.68 | 59.30 ± 12.47 | 54.78 ± 13.24 | < 0.001 | |
Alarm symptoms | 1621 | 134 (75.7) | 388 (75.5) | 1099 (78.4) | 0.341 |
Diverticulosis | 123 | 10 (5.6) | 27 (5.3) | 86 (6.1) | 0.761 |
Family history of CRC | 131 | 11 (6.2) | 32 (6.2) | 88 (6.3) | 0.999 |
History of adenomas | 475 | 40 (22.6) | 139 (27.0) | 296 (21.1) | 0.023 |
History of abdominal surgery | 149 | 3 (1.7) | 35 (6.8) | 111 (7.9) | 0.010 |
Cases with adenomas ≥ 3 at first colonoscopy | 458 | 8 (4.5) | 222 (43.2) | 228 (16.3) | < 0.001 |
Table 2 Clinicopathologic characteristics of different types of colorectal adenomas n (%)
Characteristic | Total (n = 4632) | Flat (n = 916) | Protruding (n = 3716) | χ2test | P value |
Location | 61.902 | < 0.001 | |||
Rectum | 1003 | 184 (20.1) | 819 (22.0) | ||
Left colon | 2054 | 322 (35.2) | 1732 (46.6) | ||
Right colon | 1575 | 410 (44.8) | 1165 (31.4) | ||
Size | 95.954 | < 0.001 | |||
< 6 mm | 1223 | 353 (38.5) | 870 (23.4) | ||
6-9 mm | 2159 | 391 (42.7) | 1768 (47.6) | ||
≥ 10 mm | 1250 | 172 (18.8) | 1078 (29.0) | ||
Pathological classification | 13.775 | 0.001 | |||
Tubular | 3910 | 745 (81.3) | 3165 (85.2) | ||
Tubulovillous and villous | 666 | 151 (16.5) | 515 (13.9) | ||
Serrated | 56 | 20 (2.2) | 36 (1.0) | ||
Dysplasia | 7.534 | 0.006 | |||
Low | 4370 | 847 (92.5) | 3523 (94.8) | ||
High | 262 | 69 (7.5) | 193 (5.2) | ||
Advanced adenoma | 19.606 | < 0.001 | |||
No | 3322 | 711 (77.6) | 2611 (70.3) | ||
Yes | 1310 | 205 (22.4) | 1105 (29.7) |
Table 3 “Per-adenoma” miss rates and the risk factors in detection of flat adenomas during colonoscopy n (%)
Risk factor | Total(n = 916) | Diagnosed(n = 510) | Missed(n = 406) | Univariate analysis | Multivariate analysis | ||
χ2test | P value | OR (95%CI) | P value | ||||
Patient-related | |||||||
Age | 9.021 | 0.003 | |||||
< 60 (yr) | 493 | 297 (60.2) | 196 (39.8) | 1 | |||
≥ 60 (yr) | 423 | 213 (50.4) | 210 (49.6) | 2.062 (1.390-3.061) | < 0.001 | ||
Sex | 1.586 | 0.208 | |||||
Male | 559 | 302 (54.0) | 257 (46.0) | ||||
Female | 357 | 208 (58.3) | 149 (41.7) | ||||
Anesthesia | 0.197 | 0.657 | |||||
Yes | 239 | 136 (56.9) | 103 (43.1) | ||||
No | 677 | 374 (55.2) | 303 (44.8) | ||||
History of adenomas | |||||||
Yes | 243 | 129 (53.1) | 114 (46.9) | 0.899 | 0.343 | ||
No | 673 | 381 (56.6) | 292 (43.4) | ||||
Previous surgery | 0.105 | 0.746 | |||||
Yes | 45 | 24 (53.3) | 21 (46.7) | ||||
No | 871 | 486 (55.8) | 385 (44.2) | ||||
Diverticulosis | 0.013 | 0.909 | |||||
Yes | 51 | 28 (54.9) | 23 (45.1) | ||||
No | 865 | 482 (55.7) | 383 (44.3) | ||||
Numbers at first colonoscopy | 0.163 | 0.686 | |||||
< 3 | 580 | 320 (55.2) | 260 (44.8) | ||||
≥ 3 | 336 | 190 (56.5) | 146 (43.5) | ||||
Concomitance with protruding adenoma(s) at first colonoscopy | 127.154 | < 0.001 | |||||
No | 280 | 234 (83.6) | 46 (16.4) | 1 | |||
Yes | 636 | 276 (43.4) | 360 (56.6) | 7.759 (4.420-13.618) | < 0.001 | ||
Bowel preparation | 45.773 | < 0.001 | |||||
Good | 757 | 460 (60.8) | 297 (39.2) | 1 | |||
Poor | 159 | 50 (31.4) | 109 (68.6) | 4.389 (2.314-8.352) | < 0.001 | ||
Adenoma-related | |||||||
Size | 122.706 | < 0.001 | |||||
≥ 10 mm | 172 | 159 (92.4) | 13 (7.6) | 1 | |||
6-9 mm | 391 | 202 (51.7) | 189 (48.3) | 9.239 (4.306-19.824) | < 0.001 | ||
< 6 mm | 353 | 149 (42.2) | 204 (57.8) | 19.613 (8.984-42.822) | < 0.001 | ||
Location | 74.571 | < 0.001 | |||||
Rectum | 184 | 152 (82.6) | 32 (17.4) | 6.81 | 0.0091 | 1 | |
Left colon | 322 | 175 (54.3) | 147 (45.7) | 2.866 (1.623-5.062) | < 0.001 | ||
Right colon | 410 | 183 (44.6) | 227 (55.4) | 3.259 (1.819-5.838) | < 0.001 | ||
Advanced adenoma | 113.850 | < 0.001 | |||||
Yes | 205 | 181 (88.3) | 24 (11.7) | ||||
No | 711 | 329 (46.3) | 382 (53.7) | ||||
Pathologic classification | 74.745 | < 0.001 | |||||
Tubular | 745 | 366 (49.1) | 379 (50.9) | ||||
Tubulovillous and villous | 151 | 132 (87.4) | 19 (12.6) | ||||
Serrated | 20 | 12 (60.0) | 8 (40.0) | ||||
Procedure-related | |||||||
Proficiency | 28.18 | < 0.001 | |||||
> 1000 cases | 585 | 363 (62.1) | 222 (37.9) | 1 | |||
500-1000 cases | 234 | 109 (46.6) | 125 (53.4) | 2.219 (1.397-3.525) | 0.001 | ||
< 500 cases | 97 | 38 (39.2) | 59 (60.8) | 3.003 (1.568-5.754) | 0.001 | ||
Specialty | 6.86 | 0.009 | |||||
Gastroenterologist | 739 | 427 (57.8) | 312 (42.2) | ||||
Non-gastroenterologist | 177 | 83 (46.9) | 94 (53.1) | ||||
Operative mode | 4.862 | 0.027 | |||||
One-person technique | 721 | 415 (57.6) | 306 (42.4) | ||||
Two-person technique | 195 | 95 (48.7) | 100 (51.3) | ||||
Withdrawal time | 6.069 | 0.014 | |||||
≥ 6 min | 254 | 158 (62.2) | 96 (37.8) | 1 | |||
< 6 min | 662 | 352 (53.2) | 310 (46.8) | 1.958 (1.276-3.006) | 0.020 |
Table 4 “Per-adenoma” miss rates and risk factors in detection of advanced flat adenomas during colonoscopy n (%)
Factor | Total (n = 205) | Diagnosed (n = 181) | Missed (n = 24) | χ2test | P value |
Size | 17.796 | < 0.001 | |||
< 10 mm | 33 | 22 (66.7) | 11 (33.3) | ||
≥ 10 mm | 172 | 159 (92.4) | 13 (7.6) | ||
Location | 11.838 | 0.003 | |||
Rectum | 68 | 67 (98.5) | 1 (1.5) | 1.127 | 0.2881 |
Left colon | 36 | 32 (88.9) | 4 (11.1) | ||
Right colon | 101 | 82 (81.2) | 19 (18.8) | ||
Pathologic classification | 0.025 | 0.874 | |||
Tubular | 57 | 50 (87.7) | 7 (12.3) | ||
Tubulovillous and villous | 148 | 131 (88.5) | 17 (11.5) | ||
Age (yr) | 1.157 | 0.282 | |||
< 60 | 98 | 89 (90.8) | 9 (9.2) | ||
≥ 60 | 107 | 92 (86.0) | 15 (1.4) | ||
Bowel preparation | 13.815 | < 0.001 | |||
Good | 162 | 150 (92.6) | 12 (7.4) | ||
Poor | 43 | 31 (72.1) | 12 (27.9) | ||
Proficiency | 1.078 | 0.583 | |||
> 1000 cases | 135 | 120 (88.9) | 15 (11.1) | ||
500-1000 cases | 55 | 49 (89.1) | 6 (10.9) | ||
< 500 cases | 15 | 12 (80.0) | 3 (20.0) | ||
Specialty | 6.167 | 0.013 | |||
Gastroenterologist | 156 | 146 (93.6) | 10 (6.4) | ||
Non- gastroenterologist | 49 | 35 (71.4) | 14 (28.6) | ||
Operative mode | 2.272 | 0.132 | |||
One-person technique | 161 | 145 (90.1) | 16 (9.9) | ||
Two-person technique | 44 | 36 (81.8) | 8 (18.2) | ||
Withdrawal time | |||||
≥ 6 min | 145 | 129 (89.0) | 16 (11.0) | 0.217 | 0.641 |
< 6 min | 60 | 52 (86.7) | 8 (13.3) |
- Citation: Xiang L, Zhan Q, Zhao XH, Wang YD, An SL, Xu YZ, Li AM, Gong W, Bai Y, Zhi FC, Liu SD. Risk factors associated with missed colorectal flat adenoma: A multicenter retrospective tandem colonoscopy study. World J Gastroenterol 2014; 20(31): 10927-10937
- URL: https://www.wjgnet.com/1007-9327/full/v20/i31/10927.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i31.10927