Adenoma detection rate by colonoscopy in real-world population-based studies: a systematic review and meta-analysis.

IF 11.5 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Endoscopy Pub Date : 2025-01-01 Epub Date: 2024-09-03 DOI:10.1055/a-2382-5795
Carlos Fernandes, Manuela Estevinho, Manuel Marques Cruz, Leonardo Frazzoni, Pedro Pereira Rodrigues, Lorenzo Fuccio, Mário Dinis-Ribeiro
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Abstract

Background: Adenoma detection rate (ADR) is a quality indicator set at a minimum of 25% in unselected populations by the European Society of Gastrointestinal Endoscopy (ESGE). Nevertheless, a lack of pooled observational data resembling real-world practice limits support for this threshold. We aimed to perform a systematic review with meta-analysis to evaluate the pooled rates for conventional adenoma detection, polyp detection (PDR), cecal intubation, bowel preparation, and complications in population-based studies.

Methods: The PubMed, Scopus, and Web of Science databases were searched until May 2023 for populational-based studies reporting overall ADR in unselected individuals. A random-effects model was used for meta-analysis.

Results: 31 studies were included, comprising 3 644 561 subjects. A high quality of procedures was noticeable, with a high cecal intubation rate and low complication rate. The overall pooled ADR, PDR, and rate of cancer detection were 26.5% (95%CI 23.3% to 29.7%), 38.3% (95%CI 32.5% to 44.1%), and 2.7% (95%CI 1.5% to 3.9%), respectively. ADR varied according to indication: screening 33.3% (95%CI 24.5% to 42.2%), surveillance 42.9% (95%CI 36.9% to 49.0%), and diagnostic 24.7% (95%CI 19.5% to 29.9%), with subgroup analysis revealing rates of 34.4% (95%CI 22.0% to 40.5%) for post-fecal occult blood test and 26.6% (95%CI 22.6% to 30.5%) for primary colonoscopy screening. Diminutive conventional adenomas yielded a pooled rate of 59.9% (95%CI 43.4% to 76.3%). The pooled rate for overall serrated lesion detection was 12.4% (95%CI 8.8% to 16.0%). Male sex and higher age were significantly associated with an ADR above the benchmark.

Conclusion: This first meta-analysis relying on real-world observational studies supports the ESGE benchmark for ADR, while suggesting that different benchmarks might be used according to indication, sex, and age.

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基于真实世界人群研究的结肠镜检查腺瘤检出率:系统回顾和荟萃分析。
背景:腺瘤检出率(ADR)是欧洲消化内镜学会(ESGE)设定的一项质量指标,在非选择人群中的检出率至少为 25%。然而,由于缺乏与真实世界实践相似的综合观察数据,限制了对这一阈值的支持。我们旨在通过荟萃分析进行系统性回顾,评估基于人群的研究中常规腺瘤检测、息肉检测 (PDR)、盲肠插管、肠道准备和并发症的汇总率:方法:在 PubMed、Scopus 和 Web of Science 数据库中检索了截至 2023 年 5 月报告未入选者总体 ADR 的基于人群的研究。采用随机效应模型进行荟萃分析:结果:共纳入 31 项研究,包括 3 644 561 名受试者。结果:31 项研究共纳入了 3 644 561 名受试者,研究过程质量较高,盲肠插管率较高,并发症发生率较低。总体汇总的ADR、PDR和癌症检出率分别为26.5%(95%CI为23.3%至29.7%)、38.3%(95%CI为32.5%至44.1%)和2.7%(95%CI为1.5%至3.9%)。ADR因适应症而异:筛查33.3%(95%CI为24.5%至42.2%),监测42.9%(95%CI为36.9%至49.0%),诊断24.7%(95%CI为19.5%至29.9%),亚组分析显示粪便隐血试验后的ADR率为34.4%(95%CI为22.0%至40.5%),初筛结肠镜检查的ADR率为26.6%(95%CI为22.6%至30.5%)。微小常规腺瘤的汇总率为 59.9%(95%CI 为 43.4% 至 76.3%)。锯齿状病变的总检出率为 12.4%(95%CI 8.8% 至 16.0%)。男性和较高的年龄与高于基准的 ADR 显著相关:这项首次基于真实世界观察研究的荟萃分析支持 ESGE 的 ADR 基准,同时建议可根据适应症、性别和年龄采用不同的基准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Endoscopy
Endoscopy 医学-外科
CiteScore
5.80
自引率
11.80%
发文量
1401
审稿时长
2 months
期刊介绍: Endoscopy is a leading journal covering the latest technologies and global advancements in gastrointestinal endoscopy. With guidance from an international editorial board, it delivers high-quality content catering to the needs of endoscopists, surgeons, clinicians, and researchers worldwide. Publishing 12 issues each year, Endoscopy offers top-quality review articles, original contributions, prospective studies, surveys of diagnostic and therapeutic advances, and comprehensive coverage of key national and international meetings. Additionally, articles often include supplementary online video content.
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