Maintaining low non-neoplastic polypectomy rates in high-quality screening colonoscopy.Melson J, Berger D, Greenspan M, Bayoumi M, Jakate S. Gastrointest Endosc. 2016 Sep 2. [Epub ahead of print]

BACKGROUND AND AIMS:Non-neoplastic polypectomies (NNP) add pathology and procedural costs but do not reduce cancer risk and should be minimized.

We sought to define the minimal non-neoplastic polypectomy rate for those colonoscopists achieving high-quality colorectal cancer screening based on adenoma detection rates.METHODS:Non-neoplastic polypectomy rates (NNPR) for colonoscopists achieving high-quality adenoma detection rates (ADR) were reported to determine minimal NNPR goals. Two approaches to tracking NNPR monitoring were compared: (1) total NNPR - a non-neoplastic polypectomy rate inclusive of all non-neoplastic specimens with exclusion of only hyperplastic polyp, sessile serrated polyp, and adenoma; and (2) normal tissue only NNPR - a non-neoplastic polypectomy rate inclusive of those specimens with only normal colonic mucosa or lymphoid follicles.RESULTS:For those performing colonoscopy with high-quality ADR (≥ 25%), half (6/12) of the colonoscopists had a total NNPR of ≤ 8.5% and 2 gastroenterologists had a total NNPR of ≤ 3.4%. The mean total NNPR of the cohort was 8.7% versus the normal tissue only NNPR which was 7.5% (mean difference of 1.2%, standard deviation [SD] ± 0.97). The widest variation between total NNPR versus normal tissue only NNPR for any colonoscopist was 2.9%. The total NNPR ranged between 2.6% and 21.3% among 14 colonoscopists.CONCLUSIONS:Colonoscopy with a high-quality ADR can be achieved while maintaining a low total NNPR. A total NNPR, inclusive of all non-neoplastic specimens as an alternative to an approach in which all specimens require individual review in order to select out only normal tissue can be considered for monitoring of NNPR.

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