CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(08): E742-E745
DOI: 10.1055/s-0043-112246
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Variability in, and factors associated with, sizing of polyps by endoscopists at a large community practice

Saleh Elwir
1   Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
,
Aasma Shaukat
1   Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
2   Division of Gastroenterology and Hepatology, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
,
Michael Shaw
1   Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
,
John Hughes
3   Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, Colorado, USA
,
Joshua Colton
4   Minnesota Gastroenterology, PA, St. Paul, Minnesota, USA
› Author Affiliations
Further Information

Publication History

submitted 25 October 2016

accepted after revision 02 May 2017

Publication Date:
07 August 2017 (online)

Abstract

Background and aims Accurate sizing of polyps at time of colonoscopy is critical for determining surveillance intervals. Endoscopists routinely over- or underestimate the size of polyps at colonoscopy. We evaluated the variability in sizing of polyps among multiple endoscopists, and the effect of patient and physician related factors on polyp size estimation in a large community-based practice.

Methods Adult patients who underwent a colonoscopy with polypectomy at five endoscopy centers in Minneapolis/St. Paul by one of 52 endoscopists in 2013 were included in this study. Association of patient, physician, and procedure related factors on polyp sizing was assessed.

Results In the study time frame, 38 624 colonoscopies were performed at five ambulatory endoscopy centers. Of these, 16 336 had one or more polyp removed with size information available, and were included in this analysis. There was significant inter-physician variation for estimating polyp sizes larger than 5 mm (intraclass correlation coefficient [ICC] 0.13). Older patient age (OR 1.08, 95 %CI 1.06 – 1.11), and male physician gender (OR 1.92, 95 %CI 1.26 – 2.94) were associated with increased odds of physicians sizing polyps as larger in size. Surveillance procedures had a higher odds of larger polyp sizing compared to screening (OR 0.91, 95 %CI 0.86 – 0.97) and diagnostic procedures (OR 0.86, 95 %CI 0.78 – 0.94).

Conclusion In a large community setting, variation of polyp sizing estimates exists between physicians. Male physicians were more likely to size polyps as larger in size. Older patients and patients undergoing surveillance procedures were more likely to have polyps that were sized as larger in size.

 
  • References

  • 1 Shaukat A, Mongin SJ, Geisser MS. et al. Long-term mortality after screening for colorectal cancer. NEJM 2013; 369: 1106-1114
  • 2 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
  • 3 Gopalswamy N, Shenoy VN, Choudhry U. et al. Is in vivo measurement of size of polyps during colonoscopy accurate?. Gastrointest Endosc 1997; 46: 497-502
  • 4 Jin HY, Leng Q. Use of disposable graduated biopsy forceps improves accuracy of polyp size measurements during endoscopy. World J Gastroenterol 2015; 21: 623-628
  • 5 Leng Q, Jin HY. Measurement system that improves the accuracy of polyp size determined at colonoscopy. World J Gastroenterol 2015; 21: 2178-2182
  • 6 Rex DK, Rabinovitz R. Variable interpretation of polyp size by using open forceps by experienced colonoscopists. Gastrointest Endosc 2014; 79: 402-407
  • 7 Winawer SJ, Zauber AG, O’Brien MJ. et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. NEJM 1993; 328: 901-906
  • 8 Chaptini L, Chaaya A, Depalma F. et al. Variation in polyp size estimation among endoscopists and impact on surveillance intervals. Gastrointest Endosc 2014; 80: 652-659
  • 9 Margulies C, Krevsky B, Catalano MF. How accurate are endoscopic estimates of size?. Gastrointest Endosc 1994; 40: 174-177
  • 10 Moug SJ, Vernall N, Saldanha J. et al. Endoscopists’ estimation of size should not determine surveillance of colonic polyps. Colorectal Dis 2010; 12: 646-650
  • 11 Bates D, Maechler M, Bolker B. et al. Fitting linear mixed-effects models using lme4. J Stat Softw 2015; 67: 1-48
  • 12 Eichenseer PJ, Dhanekula R, Jakate S. et al. Endoscopic mis-sizing of polyps changes colorectal cancer surveillance recommendations. Dis Colon Rectum 2013; 56: 315-321
  • 13 Anderson BW, Smyrk TC, Anderson KS. et al. Endoscopic overestimation of colorectal polyp size. Gastrointest Endosc 2016; 83: 201-208
  • 14 Fennerty MB, Davidson J, Emerson SS. et al. Are endoscopic measurements of colonic polyps reliable?. Am J Gastroenterol 1993; 88: 496-500
  • 15 Lieberman DA, Williams JL, Holub JL. et al. Race, ethnicity, and sex affect risk for polyps > 9 mm in average-risk individuals. Gastroenterology 2014; 147: 351-358 ; quiz e14–e15
  • 16 Klein JL, Okcu M, Preisegger KH. et al. Distribution, size and shape of colorectal adenomas as determined by a colonoscopist with a high lesion detection rate: Influence of age, sex and colonoscopy indication. United Eur Gastroenterol J 2016; 4: 438-448
  • 17 Corley DA, Jensen CD, Marks AR. et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol 2013; 11: 172-180
  • 18 Ferlitsch M, Reinhart K, Pramhas S. et al. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA 2011; 306: 1352-1358
  • 19 Sanaka MR, Gohel T, Podugu A. et al. Adenoma and sessile serrated polyp detection rates: variation by patient sex and colonic segment but not specialty of the endoscopist. Dis Colon Rectum 2014; 57: 1113-1119
  • 20 Abu Dayyeh BK, Thosani N. et al. ASGE Technology Committee. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81: 502.e1-502.e16
  • 21 Rex DK, Overhiser AJ, Chen SC. et al. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol 2009; 104: 149-153
  • 22 Ignjatovic A, East JE, Suzuki N. et al. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 2009; 10: 1171-1178
  • 23 Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol 2010; 8: 865-869 , 869.e1–869.e3