| Background: Colonoscopy can effectively reduce the incidence of colorectalcancer and related mortality,mainly due to it’s detection and removal of colorectaladenomatous polyps. If there are adenomatous polyps missedin screening colonoscopy, the risk of incidence of interval colorectal cancer willincrease a lot. How to improve the quality of screening colonoscopy has risen to bean important issue, the detection rate of colorectaladenoma (adenoma detection, rate, ADR) is the only known indicatorto evaluate quality of colonoscopy and effect of protection from intervalcancer. Although no specific measures ever been established toimprove ADR,many factors are found to be related to it. These factors include:colonoscopy withdrawal time (WT), cecal intubation, bowel preparation, physicianqualifications and professional background, patient related factors (patient position,receiving sedation or not), size or level of thecolonoscopy unit, auxiliary observation and advanced imaging method, clinicalpathological characteristics of adenoma[5].Objective:1.Discuss factors influencing adenoma detection rate and analyze therelationship between ADR and PDR in left and right colon.2. Find out whether thepathological types of the removed polyps is associated with anatomic location, polyp size, patient sex and age. Summarize the clinical pathological characteristicsof colorectal polyps.Method:437cases of the patients undergoing colonoscopy in the endoscopy centerin the Bethune first hospital of Jilin university were collected. MultivariableLogistic Regression and chi-square test were used to analyze the influencingfactors of ADR including patient related factors (sex, age, receiving sedation ornot), physician qualifications and professional background, colonoscopy type,bowel preparation, cecal intubation, withdrawal time (WT) and colon segment.Chi-square test was also applied to analyze the influencing factors of thepathological constitution of colorectal polyps.Result:1.ADR-related factors analysis:1) Univariable Chi square test: Men’s ADRwas higher than that of women(P=0.008), and the difference is mainly reflected inthe≥60year-old group (P=0.018); ADR in≥60year-old group was higher than thatof <40year-old group (P=0.000) and that of40~59group （P=0.002）. ADR of <40group showed no statistical difference with that of40~59year-old group (P=0.105);ADR of Bowel preparation level III was lower than that of level I (P=0.005)andlevel II(P=0.042) while difference of ADR between level I and II showed nostatistical significance (P=0.095). ADR of male physician was higher than that offemale physician (P=0.005), ADR had an overall statistical difference amongdifferent TCC groups(P=0.011), but no incremental trend observed with TCC level;Academic title of physician also led to an overall statistical difference of ADR(P=0.000). ADR of the attending physician was the highest (32.26%)compared with other kinds of titles (P<0.05); No statistical difference of ADR seen among differentNYC groups(P=0.461). Anesthesia did not cause statistical difference in ADRcompared with non-anesthesia group(P=0.050); Olympus group had a higher ADRcompared with Pentax group(P=0.001); ADR of "Cecal intubation" goup wassignificantly higher than that of "no intubation" group, but no statistical significanceshowed(P=1.000); WT: From group t＜4min to t≥8min, ADR increased with time(P＜0.05), only ADR of6min<t＜8min and t≥8min were not showing statisticaldifference(P=0.207).2) Logistic Regression:Sex （OR：2.324，95%CI：1.386~3.899）,Age of patien（tOR：0.563，95%CI：0.382~0.831）,Sex of endoscopist（OR：3.111，95%CI：1.848~5.238）,bowel preparation（OR：2.411，95%CI：1.310~4.436） and withdrawal time（OR：0.505，95%CI：0.407~0.627） areindependent predictors of ADR.2. PDR of left colon was higher than that ofright colon (P=0.000) while no statistical difference existed between ADR of leftcolon and right colon (P=0.671).3. Polyps removed from≥60age group had alarger proportion of adenomas than that of＜60age group(P=0.029);Polypsremoved from male patient had no difference in proportion of adenomas with that offemale patient(P=0.562); Adenoma proportion in0.5cm~1.0cm group and≥1.0cmgroup were both larger than that of＜0.5cm group (P＜0.05); Adenoma proportionof right colon was greater than that of left colon (P=0.013).Conclusion:1. Independent risk factors of ADR included gender of patients, age,gender of endoscopic physician, bowel preparation, WT. Male, age of≥60year-oldpatients had a relatively higher ADR, if a colonoscopy was conducted by male endoscopists, under good bowel preparation, with a WT of≥8min, a higher ADRcan be achieved.2.Predilection site of colorectal polyps was in the left colon,therewas a higher proportion of non-adenomatous polyps removed from left colon whencompared with right colon; Left and right colon suffered similar risk of colorectaladenoma.3.Adenomatous polyp and non-adenomatous polyp had differences inpolyp size and distribution: if a polyp≥0.5cm or located in the right colon, it wasmore likely to be an adenoma; Adenomatous polyp and non-adenomatous polypwere both more common in size＜0.5cm and location of left colon. |
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