Prevalence of polyps greater than 9 mm in a consortium of diverse clinical practice settings in the United States.
OBJECTIVE
Colonoscopy is often performed with the goal of identification of patients with serious colon neoplasia. We determined the prevalence of colon masses or polyps greater than 9 mm on the basis of age, gender, race, and procedure indication in diverse clinical practice settings and compared occurrence in patients receiving colonoscopy for screening, surveillance, or evaluation of symptoms.


METHODS
We obtained patient demographics, procedure indication, and endoscopic findings from colonoscopy reports in the Clinical Outcomes Research Initiative data repository, which receives endoscopy reports from 73 diverse practice sites in the United States. A multivariate model was developed to measure risk variables for a mass or polyps >9 mm. Absolute risk was calculated in the model on the basis of the number needed to endoscope (NNE) to identify 1 patient with a mass or polyp >9 mm.


RESULTS
From 2000-2002, colonoscopies in 141,413 unique patients were analyzed. Sixty-nine percent of the reports came from private practice (nonacademic) settings. Increasing age, male gender, and black race were associated with increased risk of mass or polyps >9 mm. In the 50- to 59-year-old average-risk group, 28 women and 18 men would need to have screening colonoscopy to identify 1 patient with a mass/polyp >9 mm. Patients with positive fecal occult blood test results, hematochezia, and anemia had lower NNE, whereas men older than 60 years receiving adenoma surveillance and patients with irritable bowel symptoms had similar NNE compared with average-risk subjects.


CONCLUSIONS
The prevalence of a colon lesion >9 mm varies on the basis of age, gender, race, and procedure indication. Understanding utilization and outcomes can lead to more optimal use of colonoscopy.
Lieberman
David A
DA
Division of Gastroenterology, Oregon Health & Science University, Portland VA Medical Center, Oregon 97239, USA. lieberma@ohsu.edu
Holub
Jennifer
J
Eisen
Glenn
G
Kraemer
Dale
D
Morris
Cynthia D
CD
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D003110:Colonic Neoplasms / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008551:Melena / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D015995:Prevalence; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D015431:Weight Loss