Mary A. Atia, MD, from the Department of Medicine, Division of Gastroenterology, Mayo Clinic Arizona in Scottsdale, Arizona, USA discusses this Original Article, “Nonneoplastic polypectomy during screening colonoscopy: the impact on polyp detection rate, adenoma detection rate, and overall cost.”
The frequency of non-neoplastic polypectomy (NNP) is tissue constituting normal colonic mucosa or lymphoid aggregates. Its impact on polyp detection rate (PDR) is unknown. The correlation between NNP rate and adenoma detection rate (ADR) has also not been investigated. The aims of our study were as follows: To determine the rate of NNP in screening colonoscopy, the impact of NNP on PDR, and the correlation of NNP with ADR. The subsequent associated increased cost of non-neoplastic polypectomy during screening colonoscopy was also calculated. Although colonoscopy represents a cost-effective means of screening for colorectal neoplasia, it still constitutes an invasive examination with inherent costs and risks. Additionally, the quality of the procedure is variable and dependent upon many factors at both the patient and endoscopist level. With the increasing scrutiny regarding the rising costs in healthcare, it is critical to deliver high quality screening colonoscopy in a cost-effective manner. Although much of the current literature has centered on increasing polyp detection and adenoma detection rate as a sign of quality, little research has focused on reducing the cost of colonoscopy.
Almost 2000 screening colonoscopies performed by 20 gastroenterologists were analyzed. Overall, the mean for PDR was 47%. Average ADR was 27%. The overall non-neoplastic polyp rate was 10.4% with a range of 2.4%-28.4%. Mean size of non-neoplastic polyps was 2.9 mm, and the distribution was similar in the proximal and distal colon.
The range for NNP per endoscopist was 2% to 28%. Endoscopists with a higher rate of NNP were more likely to detect an adenoma (OR 1.58, CI 1.1-1.2).
Sub-group analysis of non-neoplastic polypectomy found 203 (11%) procedures that met the criteria of at least one specimen bottle with non-neoplastic tissue. The total increased cost of non-neoplastic polypectomies was $32,963.17, increasing the cost of the procedure by 2% to 3%.
Thirteen percent of polyps removed during screening colonoscopy are non-neoplastic. There is a wide variation in NNP among endoscopists with a positive correlation with ADR. The etiology for these findings is unclear. Possibilities include misinterpretation of enhanced mucosa with the use of high definition imaging, higher vigilance when an adenoma is detected, or inherent meticulous personality of the endoscopist.
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