Detection of neoplasia at colonoscopy: What next?

摘要

The large multicenter European tandem colonoscopy study reported in this issue of Endoscopy reminds us that colonoscopy misses many small and some large polyps and adenomas . The novel observation in this study of greatest value is that the miss rate of flat lesions is higher than that of sessile and pedunculated lesions. This result has not been previously tested directly in a tandem study [2-6], though other study designs have suggested it [7-14], Two findings in the study should be viewed with suspicion. First is that multiple polyps at baseline predict a lower miss rate. Other studies have found the opposite result and in postpolypectomy surveillance studies patients with three or more adenomas at baseline consistently have an increased risk of advanced adenomas at follow-up [15]. The explanation is certainly (at least in part) that the greater the number of adenomas the patient has, the greater the opportunity that one or more will be missed. Second, the observation that left-sided lesions are more likely to be missed also runs against findings of previous miss rate studies [2-6] as well as the observation that interval cancers tend to cluster in the right colon [16,17]. To their credit, the authors recognize these inconsistencies between their own and previous findings#