Maintaining low non-neoplastic polypectomy rates in high-quality screening colonoscopy.
OBJECTIVE
Non-neoplastic polypectomies (NNPs) add pathology and procedural costs but do not reduce cancer risk and should be minimized. We sought to define the minimal non-neoplastic polypectomy rate (NNPR) for those colonoscopists achieving high-quality colorectal cancer screening based on adenoma detection rates (ADRs).


METHODS
NNPRs for colonoscopists achieving high-quality adenoma detection rates were reported to determine minimal NNPR goals. Two approaches to tracking NNPR monitoring were compared: (1) total NNPR, an NNPR inclusive of all non-neoplastic specimens with exclusion of only hyperplastic polyp, sessile serrated polyp, and adenoma; and (2) normal tissue-only NNPR, an NNPR inclusive of those specimens with only normal colonic mucosa or lymphoid follicles.


RESULTS
For those performing colonoscopy with high-quality ADRs (≥25%), half (6/12) of the colonoscopists had a total NNPR of ≤8.5% and 2 gastroenterologists had a total NNPR of ≤3.4%. The mean total NNPR of the cohort was 8.7% versus the normal tissue only NNPR, which was 7.5% (mean difference of 1.2%, standard deviation ± 0.97). The widest variation between total NNPR versus normal tissue only NNPR for any colonoscopist was 2.9%. The total NNPR ranged between 2.6% and 21.3% among 14 colonoscopists.


CONCLUSIONS
Colonoscopy with a high-quality ADR can be achieved while maintaining a low total NNPR. A total NNPR, inclusive of all non-neoplastic specimens as an alternative to an approach in which all specimens require individual review in order to select out only normal tissue can be considered for monitoring of NNPR.
Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
Joshua
J
Melson
Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
Daniel
D
Berger
Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
Michael
M
Greenspan
Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
Mohamed
M
Bayoumi
Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA.
Shriram
S
Jakate
D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D000072102:Gastroenterologists; D006801:Humans; D006965:Hyperplasia; D008221:Lymphoid Tissue / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D019564:Unnecessary Procedures