Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 2, April 2023, pages 96-104

Is There a Difference in Adenoma Detection Rates According to Indication? An Experience in a Panamanian Colorectal Cancer Screening Program

Figure 1. Non-screening colonoscopy indications. DD: diverticular disease; IBD: inflammatory bowel disease; C. diarrhea: chronic diarrhea; WL: weight loss; LGB: low gastrointestinal bleeding.

Figure 2. Polyp detection rate, adenoma detection rate and serrated polyp detection rate according to sex and indication of screening vs. non-screening colonoscopy.

Figure 3. Multivariable logistic regression model predicting detection of polyps (a), adenomatous polyps (b), and serrated polyps (c) according to overall colonoscopies model and adjusted by Boston Bowel Preparation Scale. FH: family history of colon cancer; WT: withdrawal time in minutes; CIR: cecal intubation rate; OR: odds ratio values (mean and 95% confidence interval).

**Table 1.** Characteristics of Patients, Colonoscopy Quality Measures and Polyps Resected According to Screening vs. Non-Screening Colonoscopy Indication
Variable	Screening (n = 365)	Non-screening (n = 1,129)	P value
CIR: cecal intubation rate; WT: withdrawal time; BBPS: Boston Bowel Preparation Scale; SD: standard deviation.
Age (years)	56.9 ± 0.42	60.7 ± 0.42	0.003
Sex			0.004
Male	89 (24.4%)	365 (32.3%)
Female	272 (74.5%)	753 (66.7%)
Non-specified	4 (1%)	11 (1%)
Endoscopist			0.0021
Endoscopist 1	27 (8.2%)	96 (9.23%)
Endoscopist 2	25 (7.6%)	118 (11.4%)
Endoscopist 3	40 (12.1%)	113 (10.9%)
Endoscopist 4	36 (10.9%)	85 (8.2%)
Endoscopist 5	50 (15.1%)	109 (10.5%)
Endoscopist 6	91 (27.5%)	324 (31.2%)
Endoscopist 7	38 (11.5%)	145 (13.9%)
Non-specified	17 (5.1%)	20 (1.9%)
Total	331 (100%)	1,040 (100%)
CIR (%)	340 (93.1%)	1,049 (92.9%)	0.174
WT (min)	10.19 (SD: 0.49)	9.20 (SD: 0.24)	0.034
Colonoscopy working time	19.03 (SD: 1.2)	17.35 (SD: 0.96)	0.001
BBPS ≥ 6 (%)	273 (74.5%)	892 (79.0%)	0.075
Family history of colon cancer (%)	80 (24.2%)	151 (14.5%)	0.002
Diverticulosis (%)	143 (43.2%)	385 (37%)	0.102
Inflammatory bowel disease (%)	6 (1.8%)	52 (15.7%)	0.001
Angiodysplasia (%)	2 (0.6%)	2 (0.2%)	0.732
Hemorroids (%)	84 (25.4%)	277 (26.6%)	0.471
Polyps (%)	106 (32.0%)	257 (24.7%)	0.082
Polyp size			0.13
≤ 5 mm	65 (61.3%)	165 (64.2%)
6 - 10 mm	21 (19.8%)	53 (20.6%)
11 - 20 mm	12 (11.3%)	17 (6.6%)
> 21 mm	0 (0)	5 (1.9%)
Non-specified	9 (8.4%)	17 (6.6%)
Polyp histology			0.551
Hyperplasic polyp	37 (34.9%)	91 (35.4%)
Tubular adenoma	47 (44.3%)	113 (43.9%)
Villous adenoma	0 (0)	3 (1.2%)
Tubulovillous adenoma	9 (8.5%)	16 (6.2%)
Traditional serrated polyp	0 (0)	0
Serrated polyp	0 (0)	0
No-classified	13 (12.3%)	11 (9.7%)
Dysplasia	46 (13.9%)	108 (10.4%)	0.041
Colon cancer	5 (1.5%)	12 (1.2%)	0.055

Table 1. Characteristics of Patients, Colonoscopy Quality Measures and Polyps Resected According to Screening vs. Non-Screening Colonoscopy Indication

Variable

Screening (n = 365)

Non-screening (n = 1,129)

P value

CIR: cecal intubation rate; WT: withdrawal time; BBPS: Boston Bowel Preparation Scale; SD: standard deviation.

Age (years)

56.9 ± 0.42

60.7 ± 0.42

0.003

Sex

0.004

Male

89 (24.4%)

365 (32.3%)

Female

272 (74.5%)

753 (66.7%)

Non-specified

4 (1%)

11 (1%)

Endoscopist

0.0021

Endoscopist 1

27 (8.2%)

96 (9.23%)

Endoscopist 2

25 (7.6%)

118 (11.4%)

Endoscopist 3

40 (12.1%)

113 (10.9%)

Endoscopist 4

36 (10.9%)

85 (8.2%)

Endoscopist 5

50 (15.1%)

109 (10.5%)

Endoscopist 6

91 (27.5%)

324 (31.2%)

Endoscopist 7

38 (11.5%)

145 (13.9%)

Non-specified

17 (5.1%)

20 (1.9%)

Total

331 (100%)

1,040 (100%)

CIR (%)

340 (93.1%)

1,049 (92.9%)

0.174

WT (min)

10.19 (SD: 0.49)

9.20 (SD: 0.24)

0.034

Colonoscopy working time

19.03 (SD: 1.2)

17.35 (SD: 0.96)

0.001

BBPS ≥ 6 (%)

273 (74.5%)

892 (79.0%)

0.075

Family history of colon cancer (%)

80 (24.2%)

151 (14.5%)

0.002

Diverticulosis (%)

143 (43.2%)

385 (37%)

0.102

Inflammatory bowel disease (%)

6 (1.8%)

52 (15.7%)

0.001

Angiodysplasia (%)

2 (0.6%)

2 (0.2%)

0.732

Hemorroids (%)

84 (25.4%)

277 (26.6%)

0.471

Polyps (%)

106 (32.0%)

257 (24.7%)

0.082

Polyp size

0.13

≤ 5 mm

65 (61.3%)

165 (64.2%)

6 - 10 mm

21 (19.8%)

53 (20.6%)

11 - 20 mm

12 (11.3%)

17 (6.6%)

> 21 mm

0 (0)

5 (1.9%)

Non-specified

9 (8.4%)

17 (6.6%)

Polyp histology

0.551

Hyperplasic polyp

37 (34.9%)

91 (35.4%)

Tubular adenoma

47 (44.3%)

113 (43.9%)

Villous adenoma

0 (0)

3 (1.2%)

Tubulovillous adenoma

9 (8.5%)

16 (6.2%)

Traditional serrated polyp

0 (0)

Serrated polyp

0 (0)

No-classified

13 (12.3%)

11 (9.7%)

Dysplasia

46 (13.9%)

108 (10.4%)

0.041

Colon cancer

5 (1.5%)

12 (1.2%)

0.055

**Table 2.** Histological Features in Resected Polyp According to Size, Location, and Presence of Dysplasia
Features	Tubular adenoma (N = 160)	Villous adenoma (N = 3)	Tubulovillous adenoma (N = 25)	Hyperplasic polyp (N = 128)	No classified (N = 24)	Colon cancer (N = 17)
Localization
Proximal	58 (36.3%)	0 (0)	5 (20%)	51 (39.8%)	7 (29.2%)	8 (47.5%)
Distal	52 (32.5%)	2 (66.6%)	11 (44%)	62 (48.4%)	9 (37.5%)	9 (52.5%)
Synchronous	50 (31.3%)	1 (33.3%)	9 (36%)	15 (11.7%)	8 (33.3%)
Size
< 5 mm	100 (62.5%)	0 (0)	12 (48%)	92 (71.8%)	17 (70.8%)	4 (23.5%)
10 mm	33 (20.6%)	1 (33.3%)	4 (16%)	27 (21.1%)	6 (25%)	2 (11.7%)
11 - 20 mm	15 (9.4%)	1 (33.3%)	6 (24%)	3 (2.3%)	1 (4.2%)	3 (17.6%)
> 21 mm	3 (1.9%)	1 (33.3%)	1 (4%)	0 (0)	0 (0)	8 (47.1%)
No-specified	9 (5.6%)	0 (0)	0 (0)	6 (4.7%)	0 (0)	0 (0)
Dysplasia
No	31 (19.4%)	1 (33.3%)	4 (16%)	127 (99.2%)	21 (87.5%)	0
Low grade	117 (73.1%)	1 (33.3%)	16 (64%)	1 (0.8%)	3 (12.5%)	0
High grade	12 (7.5%)	1 (33.3%)	5 (20%)	0 (0)	0	0

Table 2. Histological Features in Resected Polyp According to Size, Location, and Presence of Dysplasia

Features

Tubular adenoma (N = 160)

Villous adenoma (N = 3)

Tubulovillous adenoma (N = 25)

Hyperplasic polyp (N = 128)

No classified (N = 24)

Colon cancer (N = 17)

Localization

Proximal

58 (36.3%)

0 (0)

5 (20%)

51 (39.8%)

7 (29.2%)

8 (47.5%)

Distal

52 (32.5%)

2 (66.6%)

11 (44%)

62 (48.4%)

9 (37.5%)

9 (52.5%)

Synchronous

50 (31.3%)

1 (33.3%)

9 (36%)

15 (11.7%)

8 (33.3%)

Size

< 5 mm

100 (62.5%)

0 (0)

12 (48%)

92 (71.8%)

17 (70.8%)

4 (23.5%)

10 mm

33 (20.6%)

1 (33.3%)

4 (16%)

27 (21.1%)

6 (25%)

2 (11.7%)

11 - 20 mm

15 (9.4%)

1 (33.3%)

6 (24%)

3 (2.3%)

1 (4.2%)

3 (17.6%)

> 21 mm

3 (1.9%)

1 (33.3%)

1 (4%)

0 (0)

8 (47.1%)

No-specified

9 (5.6%)

0 (0)

6 (4.7%)

0 (0)

Dysplasia

31 (19.4%)

1 (33.3%)

4 (16%)

127 (99.2%)

21 (87.5%)

Low grade

117 (73.1%)

1 (33.3%)

16 (64%)

1 (0.8%)

3 (12.5%)

High grade

12 (7.5%)

1 (33.3%)

5 (20%)

0 (0)

**Table 3.** Colonoscopy Quality Indicators According to Indication of Screening vs. Non-Screening Colonoscopy
Endoscopist	Screening group BBPS ≥ 6 (%)	Non-screening group BBPS ≥ 6 (%)	P	Screening group CIR (%)	Non-screening group CIR (%)	P	Screening group WT (min)	Non-screening group WT (min)	P
BBPS: Boston Bowel Preparation Scale; CIR: cecal intubation rate; WT: withdrawal time.
Endoscopist 1	22/23 (95.7%)	69/78 (88.5%)	0.031	27/30 (90%)	91/101 (90.1%)	0.177	9.48 ± 1.49	6.46 ± 0.47	0.011
Endoscopist 2	15/22 (68.2%)	83/112 (74.1%)	0.124	23/31 (74.2%)	117/138 (84.8%)	0.041	7.45 ± 0.67	8.45 ± 0.79	0.578
Endoscopist 3	32/35 (91.4%)	76/106 (71.7%)	0.002	37/45 (82.2%)	108/124 (87.1%)	0.055	7.43 ± 1.75	6.66 ± 0.39	0.531
Endoscopist 4	24/31 (77.5%)	45/67 (67.2%)	0.044	32/40 (80.0%)	67/87 (77.0%)	0.081	7.74 ± 0.99	7.06 ± 0.71	0.532
Endoscopist 5	38/51 (74.5%)	83/101 (82.2%)	0.049	50/52 (96.1%)	101/111 (90.9%)	0.069	12.1 ± 1.22	12.61 ± 0.98	0.759
Endoscopist 6	56/90 (62.2%)	193/291 (66.3%)	0.321	90/91 (98.9%)	296/322 (91.9%)	0.181	12.35 ± 1.04	10.17 ± 0.44	0.013
Endoscopist 7	33/36 (91.7%)	104/135 (77.0%)	0.006	37/41 (90.2%)	129/149 (86.6%)	0.065	11.27 ± 1.68	10.56 ± 0.58	0.306
Total	273/365 (74.5%)	892/1,129 (79.0%)	0.075	340/365 (93.1%)	1,049/1,129 (92.9%)	0.174	10.19 ± 0.49	9.20 ± 0.24	0.046

Table 3. Colonoscopy Quality Indicators According to Indication of Screening vs. Non-Screening Colonoscopy

Endoscopist

Screening group BBPS ≥ 6 (%)

Non-screening group BBPS ≥ 6 (%)

Screening group CIR (%)

Non-screening group CIR (%)

Screening group WT (min)

Non-screening group WT (min)

BBPS: Boston Bowel Preparation Scale; CIR: cecal intubation rate; WT: withdrawal time.

Endoscopist 1

22/23 (95.7%)

69/78 (88.5%)

0.031

27/30 (90%)

91/101 (90.1%)

0.177

9.48 ± 1.49

6.46 ± 0.47

0.011

Endoscopist 2

15/22 (68.2%)

83/112 (74.1%)

0.124

23/31 (74.2%)

117/138 (84.8%)

0.041

7.45 ± 0.67

8.45 ± 0.79

0.578

Endoscopist 3

32/35 (91.4%)

76/106 (71.7%)

0.002

37/45 (82.2%)

108/124 (87.1%)

0.055

7.43 ± 1.75

6.66 ± 0.39

0.531

Endoscopist 4

24/31 (77.5%)

45/67 (67.2%)

0.044

32/40 (80.0%)

67/87 (77.0%)

0.081

7.74 ± 0.99

7.06 ± 0.71

0.532

Endoscopist 5

38/51 (74.5%)

83/101 (82.2%)

0.049

50/52 (96.1%)

101/111 (90.9%)

0.069

12.1 ± 1.22

12.61 ± 0.98

0.759

Endoscopist 6

56/90 (62.2%)

193/291 (66.3%)

0.321

90/91 (98.9%)

296/322 (91.9%)

0.181

12.35 ± 1.04

10.17 ± 0.44

0.013

Endoscopist 7

33/36 (91.7%)

104/135 (77.0%)

0.006

37/41 (90.2%)

129/149 (86.6%)

0.065

11.27 ± 1.68

10.56 ± 0.58

0.306

Total

273/365 (74.5%)

892/1,129 (79.0%)

0.075

340/365 (93.1%)

1,049/1,129 (92.9%)

0.174

10.19 ± 0.49

9.20 ± 0.24

0.046