Adenoma detection rate correlates with risk for mortality in colorectal cancer
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High quality colonoscopy correlated with a lower risk for death in patients with colorectal cancer, according to research published in Clinical Gastroenterology and Hepatology.
“Both performance quality of the endoscopist as well as specific characteristics of resected adenomas at colonoscopy are associated with CRC mortality," Elisabeth A. Waldmann, departments of internal medicine, division of gastroenterology and hepatology at the Medical University of Vienna, Austria, and colleagues wrote. “Performance quality of an endoscopist is measured by the adenoma detection rate (ADR). ... It is inversely associated with risk of post-colonoscopy CRC and fatal CRC. Although the association between ADR and metachronous CRC is well studied and ADR varies considerably among endoscopists, it has not yet been incorporated in current surveillance recommendations.”
To investigate the combined effect of ADR and lesion characteristics on the risk for CRC mortality, researchers evaluated 259,885 colonoscopies performed by 361 endoscopists. They further compared the mortality rates of patients with low-risk adenomas, patients with high-risk adenomas and patients with negative colonoscopies performed by endoscopists with an ADR less than 25% and endoscopists with an ADR greater than 25%.
During a follow-up period of up to 12.2 years, 165 CRC-related deaths occurred; higher mortality rates were associated with colonoscopies performed by endoscopists with an ADR less than 25%. Compared with patients with a negative colonoscopy performed by an endoscopist with an ADR greater than 25%, CRC mortality rates were similar for patients with low-risk adenomas (ADR 25%: adjusted HR = 1.22; 95% CI, 0.59-2.49 and ADR < 25%: aHR = 1.25; 95% CI, 0.64-2.43) as well as patients with a negative colonoscopy performed by an endoscopist with an ADR less than 25% (aHR = 1.27; 95% CI, 0.81-2). Conversely, patients with high-risk adenomas had a higher risk for CRC mortality when colonoscopy was performed by an endoscopist with an ADR less than 25% compared with endoscopists with an ADR greater than 25% (aHR = 2.25; 95% CI, 1.18-4.31 vs. aHR = 1.35; 95% CI, 0.61-3.02).
“High quality colonoscopy was associated with a lower risk for CRC death in all risk groups,” Waldmann and colleagues concluded. “These findings add important new evidence for mandatory assessment of performance quality. Achieving required quality standards is particularly associated with post screening CRC mortality for individuals with high-risk adenomas, who require intensive surveillance and hence higher health care resource utilization.”
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