Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Factors influencing endoscopic estimation of colon polyp size in a colon model

  • Koen Robert Beukema (Department of Gastroenterology and Hepatology, Medisch Spectrum Twente) ;
  • Jaimy A. Simmering (Department of Gastroenterology and Hepatology, Medisch Spectrum Twente) ;
  • Marjolein Brusse-Keizer (Department of Gastroenterology and Hepatology, Medisch Spectrum Twente) ;
  • Sneha John (Department of Gastroenterology, Gold Coast University Hospital) ;
  • Rutger Quispel (Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis) ;
  • Peter B. Mensink (Department of Gastroenterology and Hepatology, Medisch Spectrum Twente)
  • Received : 2021.12.03
  • Accepted : 2022.02.20
  • Published : 2022.07.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation. Methods: Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope's tip. Participants were asked to estimate the diameter and volume of each polyp. Results: Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62-0.71) for diameter and 0.56 (95% CI, 0.50-0.62) for volume. Polyp size estimated at 3 cm from the colonoscope's tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size. Conclusions: Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.

Keywords

References

  1. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993;329:1977-1981. https://doi.org/10.1056/NEJM199312303292701
  2. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687-696. https://doi.org/10.1056/NEJMoa1100370
  3. de Jonge V, Sint Nicolaas J, van Leerdam ME, et al. Systematic literature review and pooled analyses of risk factors for finding adenomas at surveillance colonoscopy. Endoscopy 2011;43:560-572. https://doi.org/10.1055/s-0030-1256306
  4. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844-857. https://doi.org/10.1053/j.gastro.2012.06.001
  5. van Heijningen EM, Lansdorp-Vogelaar I, Kuipers EJ, et al. Features of adenoma and colonoscopy associated with recurrent colorectal neoplasia based on a large community-based study. Gastroenterology 2013;144:1410-1418. https://doi.org/10.1053/j.gastro.2013.03.002
  6. Hassan C, Quintero E, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013;45:842-851. https://doi.org/10.1055/s-0033-1344548
  7. Hassan C, Antonelli G, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - update 2020. Endoscopy 2020;52:687-700. https://doi.org/10.1055/a-1185-3109
  8. Gupta S, Lieberman D, Anderson JC, et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US multi-society task force on colorectal cancer. Am J Gastroenterol 2020;115:415-434. https://doi.org/10.14309/ajg.0000000000000544
  9. Wieszczy P, Kaminski MF, Franczyk R, et al. Colorectal cancer incidence and mortality after removal of adenomas during screening colonoscopies. Gastroenterology 2020;158:875-883.e5. https://doi.org/10.1053/j.gastro.2019.09.011
  10. Ponugoti PL, Cummings OW, Rex DK. Risk of cancer in small and diminutive colorectal polyps. Dig Liver Dis 2017;49:34-37. https://doi.org/10.1016/j.dld.2016.06.025
  11. Yoshida N, Naito Y, Siah KT, et al. High incidence of metachronous advanced adenoma and cancer after endoscopic resection of colon polyps ≥20 mm in size. Dig Endosc 2016;28:194-202. https://doi.org/10.1111/den.12551
  12. Rex DK. Real-time endoscopic pathology assessment of colorectal polyps. Curr Gastroenterol Rep 2013;15:354.
  13. Kessler WR, Imperiale TF, Klein RW, et al. A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps. Endoscopy 2011;43:683-691. https://doi.org/10.1055/s-0030-1256381
  14. Schoen RE, Gerber LD, Margulies C. The pathologic measurement of polyp size is preferable to the endoscopic estimate. Gastrointest Endosc 1997;46:492-496. https://doi.org/10.1016/S0016-5107(97)70002-6
  15. Moug SJ, Vernall N, Saldanha J, et al. Endoscopists' estimation of size should not determine surveillance of colonic polyps. Colorectal Dis 2010;12:646-650. https://doi.org/10.1111/j.1463-1318.2009.01870.x
  16. Rubio CA, Hoog CM, Brostrom O, et al. Assessing the size of polyp phantoms in tandem colonoscopies. Anticancer Res 2009;29:1539-1545.
  17. Eichenseer PJ, Dhanekula R, Jakate S, et al. Endoscopic mis-sizing of polyps changes colorectal cancer surveillance recommendations. Dis Colon Rectum 2013;56:315-321. https://doi.org/10.1097/DCR.0b013e31826dd138
  18. Anderson BW, Smyrk TC, Anderson KS, et al. Endoscopic overestimation of colorectal polyp size. Gastrointest Endosc 2016;83:201-208. https://doi.org/10.1016/j.gie.2015.06.058
  19. Watanabe T, Kume K, Yoshikawa I, et al. Usefulness of a novel calibrated hood to determine indications for colon polypectomy: visual estimation of polyp size is not accurate. Int J Colorectal Dis 2015;30:933-938. https://doi.org/10.1007/s00384-015-2203-0
  20. Gopalswamy N, Shenoy VN, Choudhry U, et al. Is in vivo measurement of size of polyps during colonoscopy accurate? Gastrointest Endosc 1997;46:497-502. https://doi.org/10.1016/S0016-5107(97)70003-8
  21. Margulies C, Krevsky B, Catalano MF. How accurate are endoscopic estimates of size? Gastrointest Endosc 1994;40:174-177. https://doi.org/10.1016/S0016-5107(94)70162-8
  22. Kaz AM, Anwar A, O'Neill DR, et al. Use of a novel polyp "ruler snare" improves estimation of colon polyp size. Gastrointest Endosc 2016;83:812-816. https://doi.org/10.1016/j.gie.2015.08.082
  23. Kim JH, Park SJ, Lee JH, et al. Is forceps more useful than visualization for measurement of colon polyp size? World J Gastroenterol 2016;22:3220-3226. https://doi.org/10.3748/wjg.v22.i11.3220
  24. Plumb AA, Nickerson C, Wooldrage K, et al. Terminal digit preference biases polyp size measurements at endoscopy, computed tomographic colonography, and histopathology. Endoscopy 2016;48:899-908. https://doi.org/10.1055/s-0042-108727
  25. Sakata S, Klein K, Stevenson ARL, et al. Measurement bias of polyp size at colonoscopy. Dis Colon Rectum 2017;60:987-991. https://doi.org/10.1097/DCR.0000000000000859
  26. Elwir S, Shaukat A, Shaw M, et al. Variability in, and factors associated with, sizing of polyps by endoscopists at a large community practice. Endosc Int Open 2017;5:E742-E745. https://doi.org/10.1055/s-0043-112246
  27. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15:155-163. https://doi.org/10.1016/j.jcm.2016.02.012
  28. Morales TG, Sampliner RE, Garewal HS, et al. The difference in colon polyp size before and after removal. Gastrointest Endosc 1996;43:25-28. https://doi.org/10.1016/S0016-5107(96)70255-9
  29. Komeda Y, Suzuki N, Sarah M, et al. Factors associated with failed polyp retrieval at screening colonoscopy. Gastrointest Endosc 2013;77:395-400. https://doi.org/10.1016/j.gie.2012.10.007
  30. Barancin C, Pickhardt PJ, Kim DH, et al. Prospective blinded comparison of polyp size on computed tomography colonography and endoscopic colonoscopy. Clin Gastroenterol Hepatol 2011;9:443-445. https://doi.org/10.1016/j.cgh.2011.01.020
  31. Summers RM. Polyp size measurement at CT colonography: what do we know and what do we need to know? Radiology 2010;255:707-720. https://doi.org/10.1148/radiol.10090877
  32. Pickhardt PJ, Pooler BD, Kim DH, et al. The natural history of colorectal polyps: overview of predictive static and dynamic features. Gastroenterol Clin North Am 2018;47:515-536. https://doi.org/10.1016/j.gtc.2018.04.004
  33. Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008;359:1207-1217. https://doi.org/10.1056/NEJMoa0800996
  34. Leng Q, Jin HY. Measurement system that improves the accuracy of polyp size determined at colonoscopy. World J Gastroenterol 2015;21:2178-2182. https://doi.org/10.3748/wjg.v21.i7.2178
  35. Hyun YS, Han DS, Bae JH, et al. Graduated injection needles and snares for polypectomy are useful for measuring colorectal polyp size. Dig Liver Dis 2011;43:391-394. https://doi.org/10.1016/j.dld.2010.12.015
  36. Jin HY, Leng Q. Use of disposable graduated biopsy forceps improves accuracy of polyp size measurements during endoscopy. World J Gastroenterol 2015;21:623-628. https://doi.org/10.3748/wjg.v21.i2.623
  37. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2017;49:270-297. https://doi.org/10.1055/s-0043-102569