title: Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study.
abstract: OBJECTIVE
  Although the adenoma detection rate is used as a measure of colonoscopy quality, there are limited data on the quality of endoscopic resection of detected adenomas. We determined the rate of incompletely resected neoplastic polyps in clinical practice.
  
  
  METHODS
  We performed a prospective study on 1427 patients who underwent colonoscopy at 2 medical centers and had at least 1 nonpedunculated polyp (5-20 mm). After polyp removal was considered complete macroscopically, biopsies were obtained from the resection margin. The main outcome was the percentage of incompletely resected neoplastic polyps (incomplete resection rate [IRR]) determined by the presence of neoplastic tissue in post-polypectomy biopsies. Associations between IRR and polyp size, morphology, histology, and endoscopist were assessed by regression analysis.
  
  
  RESULTS
  Of 346 neoplastic polyps (269 patients; 84.0% men; mean age, 63.4 years) removed by 11 gastroenterologists, 10.1% were incompletely resected. IRR increased with polyp size and was significantly higher for large (10-20 mm) than small (5-9 mm) neoplastic polyps (17.3% vs 6.8%; relative risk = 2.1), and for sessile serrated adenomas/polyps than for conventional adenomas (31.0% vs 7.2%; relative risk = 3.7). The IRR for endoscopists with at least 20 polypectomies ranged from 6.5% to 22.7%; there was a 3.4-fold difference between the highest and lowest IRR after adjusting for size and sessile serrated histology.
  
  
  CONCLUSIONS
  Neoplastic polyps are often incompletely resected, and the rate of incomplete resection varies broadly among endoscopists. Incomplete resection might contribute to the development of colon cancers after colonoscopy (interval cancers). Efforts are needed to ensure complete resection, especially of larger lesions. ClinicalTrials.gov Number: NCT01224444.
authors.affiliation: Department of Gastroenterology, VA Medical Center, White River Junction, Vermont, USA. heiko.pohl@dartmouth.edu
authors.forename: Heiko
authors.initials: H
authors.lastname: Pohl
authors.forename: Amitabh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Steve P
authors.initials: SP
authors.lastname: Bensen
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.forename: Richard I
authors.initials: RI
authors.lastname: Rothstein
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.forename: L Campbell
authors.initials: LC
authors.lastname: Levy
authors.forename: Arifa
authors.initials: A
authors.lastname: Toor
authors.forename: Todd A
authors.initials: TA
authors.lastname: Mackenzie
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosch
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Robertson
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D012044:Regression Analysis