Maintaining low non-neoplastic polypectomy rates in high-quality screening colonoscopy

Area of Science:

• Gastroenterology
• Endoscopy
• Cancer Screening

Background:

• Non-neoplastic polypectomies (NNPs) incur costs and do not reduce cancer risk.
• Minimizing NNPs is essential for efficient colorectal cancer screening.
• High-quality screening is often benchmarked by adenoma detection rates (ADRs).

Purpose of the Study:

• To determine the minimal non-neoplastic polypectomy rate (NNPR) achievable in high-quality colonoscopies.
• To establish benchmarks for NNPR in the context of high ADRs.
• To evaluate methods for monitoring NNPR.

Main Methods:

• Analyzed NNPRs of colonoscopists with high ADRs (≥25%).
• Compared two NNPR monitoring approaches: total NNPR and normal tissue-only NNPR.
• Reported minimal NNPR goals based on observed data.

Main Results:

• Among colonoscopists with high ADRs, half had a total NNPR ≤8.5%.
• Two specialists achieved a total NNPR ≤3.4%.
• The mean total NNPR was 8.7%, compared to 7.5% for normal tissue-only NNPR.

Conclusions:

• High-quality colonoscopy with high ADRs is achievable with a low total NNPR.
• A total NNPR, encompassing all non-neoplastic specimens, is a viable monitoring strategy.
• This approach simplifies NNPR monitoring compared to individual specimen review.