Based On Short-Term Repeated Colonoscopy-Analysis Of Related Factors Affecting The Miss Rate Of Colorectal Adenoma

Objective:The incidence and mortality of colorectal cancer(CRC)are increasing worldwide,seriously threatening the physical and mental well-being of the whole population.Colonoscopy is an efficient method to prevent CRC by detecting and removing precancerous colorectal lesions.In recent years,postcolonoscopy CRCs have become a major challenge related to the quality of colonoscopy.Reducing the rate of missed lesions during colonoscopy is the key factor in decreasing the incidence of colorectal interval cancer.However,there is a relatively lack of data on the status of missed lesions during colonoscopy and the clinical application value of relevant auxiliary equipment in clinical work.Based on this,in order to evaluate the lesion miss rate during colonoscopy in clinical practice and further analyze the relevant influencing factors of missed adenoma and the clinical application value of relevant auxiliary equipment,this study included patients who had repeated colonoscopy in a short time for analysis.Methods:This study retrospectively included adult patients who underwent repeat colonoscopies within one year at the Gastrointestinal Endoscopy Center of Affiliated Hospital of Yangzhou University from January 2018 to December 2021.Relevant clinical details about the subjects,including general clinical information and findings regarding the two colonoscopies,were recorded through the In-patient Medical Record System and Gastrointestinal Endoscopy System of the hospital.Calculate the colorectal adenoma miss rate(AMR)and patient miss rate,and verify the relevant factors that may affect the missed colorectal lesions of patients by univariate and multivariate Logistic regression analysis.Statistical significance was defined by P<0.05.Results:A total of 1,082 subjects were ultimately included in this study.There were 1630 adenomas in 1082 patients,and 332 missed adenomas in 198 patients,with an overall AMR of 20.37% and a per-patient AMR of 18.30%.Among the different colon segments,the AMR ranged from 16.1% to 35.6%(P<0.001).The AMR was relatively higher in proximal colon,advanced adenomas,and diameters between 6 and 9 mm(P<0.05).Based on the individual subjects,there was no significant difference in the per-patient AMR among different endoscopists(7.41% to 27.50%).The per-patient adenoma/polyp miss rate was higher in patients with an withdrawal of less than 6minutes,a previous history of hypertension,or an interval time of more than 1 month between repeat colonoscopies(P<0.05).In addition,adequate bowel preparation,cecal intubation and use of plastic cap decreased the likelihood of patients missing adenomas,but the difference was not statistically significant.According to univariate and multivariate Logistic regression analysis,patients’ gender,age,interval time between repeated colonoscopy and withdrawal time were related to the per-patient AMR.Patients’ gender(P=0.016),age(P=0.003)and interval time between repeated colonoscopy(P=0.001)were independent risk factors for missed adenoma of patients.The patient’s gender,age,previous history of hypertension,the interval time between repeated colonoscopy and withdrawal time were related to the per-patient miss rate of polyp.The patient’s gender(P=0.007),age(P=0.018)and the interval between repeated colonoscopy(P=0.001)were independent risk factors for missed polyp of patients.Conclusion:This study reflects the missed colonoscopic lesions in clinical practice.The AMR and the patient miss rate are effective indicators to evaluate the quality of colonoscopy,which is worth considering in the future recommendations and guidelines for colonoscopy quality indicators.The overall AMR was 20.37%,the per-patient AMR was 18.30%,and the per-patient polyp miss rate was 60.63% in the Gastrointestinal Endoscopy Center of Affiliated Hospital of Yangzhou University.There was no significant difference in the per-patient AMR among different endoscopists(7.41% to27.50%).The AMR of the proximal colon(caecum and ascending colon)was significantly higher than that of other colon segments.In the future,additional measures are needed to enhance the detection of adenomas in the proximal colon.Patients’ gender,age and the interval time between repeated colonoscopy were independent risk factors for missed adenomas and polyps of patients.It is necessary to individualize the follow-up surveillance recommendations according to the health information from participants undergoing screening or surveillance colonoscopy.