title: Adenoma detection rate in high-risk patients differs from that in average-risk patients.
abstract: BACKGROUND
  Adenoma detection rates (ADRs) are established as quality targets in average-risk (AR) individuals undergoing colorectal cancer (CRC) screening colonoscopy. Little is known about the ADR in high-risk (HR) individuals undergoing index or surveillance colonoscopy.
  
  
  OBJECTIVE
  To determine and compare ADR in HR versus AR individuals undergoing colonoscopy.
  
  
  METHODS
  Retrospective study, tertiary care center.
  
  
  METHODS
  We reviewed records of 7357 patients who underwent colonoscopy by 66 multispecialty endoscopists at our institution during the period 2008 to 2009. Both screening and surveillance colonoscopies in AR and HR patients for CRC were studied. HR patients were further divided into 3 subgroups: those with a (1) personal history of polyps (PHP), (2) family history of polyps (FHP), and (3) family history of CRC (FHCRC). Multivariable logistic regression analysis was performed to evaluate differences in ADR between the groups after adjusting for possible confounders.
  
  
  METHODS
  ADR in HR patients.
  
  
  RESULTS
  The study included 4141 patients, of whom 2170 were AR and 1971 were HR. Patients in the HR group were older (64.5 ± 9.1 years vs 59.1 ± 7.9 years, P < .001). HR patients were more likely to have adenomas (30.7% vs 25.6%, P < .001). Adenomas were detected more often in the proximal colon than in the distal colon (29.3% vs 21.0%, P < .001 and 22.8% vs 15.8%, P < .001, respectively). Patients with a PHP had the highest ADR (33.1%, P < .001). However, after adjusting for confounders, HR status was not found to be associated with ADR (odds ratio [OR] 1.2; 95% confidence interval [CI], 0.93-1.6; P = .15 for females and 0.93; 95% CI, 0.70-1.2; P = .61 for males). HR females were found to have a 40% greater likelihood of having proximal adenomas than AR females (1.4; 95% CI, 1.01-2; P = .04).
  
  
  CONCLUSIONS
  Retrospective design, single tertiary center.
  
  
  CONCLUSIONS
  Patients with a PHP have a significantly higher ADR compared with AR patients. Defining a minimum target ADR for individuals with a PHP undergoing surveillance colonoscopy is important.
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Rai
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Udaykumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Tushar D
authors.initials: TD
authors.lastname: Gohel
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Amareshwar
authors.initials: A
authors.lastname: Podugu
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Prashanthi N
authors.initials: PN
authors.lastname: Thota
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Burke
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003111:Colonic Polyps / Q000175:diagnosis*; D020685:Colonoscopes; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012306:Risk; D012737:Sex Factors