Journal List > Korean J Gastroenterol > v.63(1) > 1007194

Choi, Park, Lee, Cha, Lee, Whangbo, Eun, Han, Lee, and Shin: Usefulness of Polyp and Adenoma Detection Rate in the Proximal and Distal Colon

Abstract

Background/Aims

The polyp detection rate (PDR) has been suggested as a surrogate for adenoma detection rate (ADR). The purpose of this study was to determine the level of agreement between PDR and ADR in the proximal and distal colon.

Methods

A total of 1,937 consecutive, asymptomatic individuals aged 40 years and older who underwent colonoscopies at six academic teaching hospitals in Korea were included in this study. PDR and ADR were calculated for each colonic segment. PDR was compared with ADR in the proximal and distal colon.

Results

During 1,937 colonoscopies, 1,862 polyps were removed; 1,421 (76%) were adenomas. The PDR and ADR in the proximal colon was 25.8% and 22.8%, respectively (kappa value=0.917, p=0.26), and that in the distal colon was 28.9% and 22.2%, respectively (p<0.001). There was a strong correlation between PDR and ADR in the proximal colon, but diverged in sigmoid colon and rectum.

Conclusions

PDR and ADR correlate well in the proximal colon, but not in the distal colon, especially sigmoid and rectum. PDR should be measured for each colonic segment when using PDR as a surrogate for ADR. PDR is a valid proxy for ADR in the proximal colon.

References

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Fig. 1.
Distribution of adenomas and polyps by colon segment.
kjg-63-11f1.tif
Fig. 2.
Polyp detection rate (PDR) and adenoma detection rate (ADR) by colon segment. The PDR and ADR in the proximal colon was 25.8% and 22.8%, respectively (kappa value [K]=0.917, p=0.26), and that in the distal colon was 28.9% and 22.2%, respectively (p<0.001).
kjg-63-11f2.tif
Fig. 3.
(A) Polyp detection rate (PDR) and adenoma detection rate (ADR) by colon segment in men. The PDR and ADR in the proximal colon was 31.6% and 28.3%, respectively (kappa value [K]=0.916, p=0.077), and that in the distal colon was 34.4% and 26.4%, respectively (p<0.001).(B) PDR and ADR by colon segment in women. The PDR and ADR in the proximal colon was 18.5% and 16.1%, respectively (kappa value=0.915, p=0.161), and that in the distal colon was 22.2% and 16.9%, respectively (p=0.004).
kjg-63-11f3.tif
Table 1.
Demographic Features of Patients
Factor   Value 
Sex    
 Male 1,079 (55.7)
 Female 858 (44.3)
Age (yr)  
Mean 55.4 (40–84)
 40–49 251 (13.0)
 50–59 962 (49.7)
 60–69 537 (27.7)
 70–79 179 (9.2)
 80–84 8 (0.4)

Values are presented as n (%) or mean (range).

Table 2.
Endoscopic Features of Patients
Factor   Value 
Withrawal time (min) 9.7 (6–50)
Aronchick scale  
 Excellent 449 (23.2)
 Good 997 (51.5)
 Fair 491 (25.3)
PDR (%) 49.9
 PDR of male 41.6
 PDR of female 40.1
ADR (%) 36.6
 ADR of male 31.2
 ADR of female 28.2
AADR (%) 5.8
 AADR of male 5.2
 AADR of female 3.9  

Values are presented as mean (range), n (%) or percent only. PDR, polyp detection rate; ADR, adenoma detection rate; AADR, advanced adenoma detection rate.

Table 3.
Proportion of Adenomas/Polyps by Size and Morphology
Location Size (mm)
Morphology
>9 6–9 1–5 Is Isp Ip LST
Proximal colon              
 Cecum 1/3 (33) 2/4 (50) 29/36 (81) 26/34 (76) 4/4 (100) 1/3 (33) 1/2 (50)
 Ascending colon 16/20 (80) 39/40 (98) 146/157 (93) 160/173 (92) 26/29 (90) 10/10 (100) 5/5 (100)
 Hepatic flexure 2/3 (67) 8/8 (100) 29/31 (94) 32/34 (94) 6/6 (100) 1/1 (100) 0/1 (0)
 Transverse colon 17/22 (77) 27/28 (96) 147/166 (89) 149/169 (88) 26/29 (90) 14/16 (88) 2/2 (100)
Distal colon              
 Splenic flexure 2/2 (100) 2/2 (100) 10/11 (91) 14/15 (93) 0 0 0
 Descending colon 15/17 (88) 18/21 (86) 93/113 (82) 96/118 (81) 15/16 (94) 6/8 (75) 9/9 (100)
 Sigmoid colon 17/26 (65) 39/43 (91) 173/206 (84) 190/226 (84) 25/32 (78) 9/10 (90) 5/7 (71)
 Rectum 12/18 (67) 20/26 (77) 60/110 (55) 62/113 (55) 22/27 (81) 7/11 (64) 1/3 (33)

Values are presented as n (%).

LST, lateral spreading tumor.

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