Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies

Katharina Zimmermann-Fraedrich, Susanne Sehner, Douglas Rex, Tonya Kaltenbach, Roy Soetikno, Michael Wallace, Wai K. Leung, Chuanguo Guo, Ian M. Gralnek, Eelco C. Brand, Stefan Groth, Guido Schachschal, Hiroaki Ikematsu, Peter D. Siersema, Thomas Rösch

Research output: Contribution to journalArticle

Abstract

Background & Aims: Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors. Methods: We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness. Results: Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75–1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6–9 mm was 0.62 (95% CI, 0.44–0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95% CI, 0.33–0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16–2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49–4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34–1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47–1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21–1.33) than women (0.86; 95% CI, 0.80–0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57–0.94). Conclusions: In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men.

Original languageEnglish (US)
Pages (from-to)660-671.e2
JournalGastroenterology
Volume157
Issue number3
DOIs
StatePublished - Sep 1 2019

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Colonoscopy
Adenoma
Odds Ratio
Transverse Colon

Keywords

  • Colorectal Cancer
  • Comparison
  • Detection
  • Endoscopy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Zimmermann-Fraedrich, K., Sehner, S., Rex, D., Kaltenbach, T., Soetikno, R., Wallace, M., ... Rösch, T. (2019). Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies. Gastroenterology, 157(3), 660-671.e2. https://doi.org/10.1053/j.gastro.2019.05.011

Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies. / Zimmermann-Fraedrich, Katharina; Sehner, Susanne; Rex, Douglas; Kaltenbach, Tonya; Soetikno, Roy; Wallace, Michael; Leung, Wai K.; Guo, Chuanguo; Gralnek, Ian M.; Brand, Eelco C.; Groth, Stefan; Schachschal, Guido; Ikematsu, Hiroaki; Siersema, Peter D.; Rösch, Thomas.

In: Gastroenterology, Vol. 157, No. 3, 01.09.2019, p. 660-671.e2.

Research output: Contribution to journalArticle

Zimmermann-Fraedrich, K, Sehner, S, Rex, D, Kaltenbach, T, Soetikno, R, Wallace, M, Leung, WK, Guo, C, Gralnek, IM, Brand, EC, Groth, S, Schachschal, G, Ikematsu, H, Siersema, PD & Rösch, T 2019, 'Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies', Gastroenterology, vol. 157, no. 3, pp. 660-671.e2. https://doi.org/10.1053/j.gastro.2019.05.011
Zimmermann-Fraedrich, Katharina ; Sehner, Susanne ; Rex, Douglas ; Kaltenbach, Tonya ; Soetikno, Roy ; Wallace, Michael ; Leung, Wai K. ; Guo, Chuanguo ; Gralnek, Ian M. ; Brand, Eelco C. ; Groth, Stefan ; Schachschal, Guido ; Ikematsu, Hiroaki ; Siersema, Peter D. ; Rösch, Thomas. / Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies. In: Gastroenterology. 2019 ; Vol. 157, No. 3. pp. 660-671.e2.
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abstract = "Background & Aims: Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors. Methods: We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8{\%} of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness. Results: Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95{\%} CI, 0.75–1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6–9 mm was 0.62 (95{\%} CI, 0.44–0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95{\%} CI, 0.33–0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95{\%} CI, 1.16–2.85) and flat adenomas (OR, 2.47; 95{\%} CI, 1.49–4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95{\%} CI, 0.34–1.37 and OR for sessile serrated adenomas, 0.87; 95{\%} CI, 0.47–1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95{\%} CI, 1.21–1.33) than women (0.86; 95{\%} CI, 0.80–0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95{\%} CI, 0.57–0.94). Conclusions: In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men.",
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T1 - Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies

AU - Zimmermann-Fraedrich, Katharina

AU - Sehner, Susanne

AU - Rex, Douglas

AU - Kaltenbach, Tonya

AU - Soetikno, Roy

AU - Wallace, Michael

AU - Leung, Wai K.

AU - Guo, Chuanguo

AU - Gralnek, Ian M.

AU - Brand, Eelco C.

AU - Groth, Stefan

AU - Schachschal, Guido

AU - Ikematsu, Hiroaki

AU - Siersema, Peter D.

AU - Rösch, Thomas

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background & Aims: Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors. Methods: We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness. Results: Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75–1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6–9 mm was 0.62 (95% CI, 0.44–0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95% CI, 0.33–0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16–2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49–4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34–1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47–1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21–1.33) than women (0.86; 95% CI, 0.80–0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57–0.94). Conclusions: In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men.

AB - Background & Aims: Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors. Methods: We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness. Results: Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75–1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6–9 mm was 0.62 (95% CI, 0.44–0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95% CI, 0.33–0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16–2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49–4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34–1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47–1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21–1.33) than women (0.86; 95% CI, 0.80–0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57–0.94). Conclusions: In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men.

KW - Colorectal Cancer

KW - Comparison

KW - Detection

KW - Endoscopy

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