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Polyp miss rate determined by tandem colonoscopy: a systematic review
Jeroen C van Rijn1, Johannes B Reitsma, Jaap Stoker
1Department of Clinical Epidemiology & Biostatistics, Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.
The American Journal of Gastroenterology
|February 4, 2006
Summary
Colonoscopy misses 22% of polyps, with smaller ones being more likely to be missed. Larger polyps (≥10 mm) are rarely missed, but the miss rate increases significantly for smaller adenomas.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Endoscopy
Background:
- Colonoscopy is the gold standard for colorectal polyp detection and removal.
- Gastroenterologists acknowledge colonoscopy's limitations, but precise polyp miss rates are unclear.
Purpose of the Study:
- To systematically review and estimate the polyp miss rate using tandem colonoscopy data.
- To provide summary estimates for missed colorectal polyps.
Main Methods:
- Systematic literature search of PUBMED, EMBASE, and Cochrane Library.
- Inclusion of studies with same-day tandem colonoscopies and polypectomy.
- Pooled estimation of miss rates using random effects models.
Main Results:
- Six studies with 465 patients were analyzed.
- Overall polyp miss rate was 22% (370/1,650 polyps).
- Miss rates varied by size: 2.1% for ≥10 mm, 13% for 5-10 mm, and 26% for 1-5 mm adenomas.
Conclusions:
- Colonoscopy rarely misses large polyps (≥10 mm).
- Miss rates significantly increase for smaller polyps.
- Evidence is limited by the small number of studies and heterogeneity in designs.