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The proximal adenoma detection rate; a newly proposed colonoscopy quality indicator to be used in addition to the adenoma detection rate?

- candidate number28281
- NTR NumberNTR6889
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR30-nov-2017
- Secondary IDsN/A 
- Public TitleThe proximal adenoma detection rate; a newly proposed colonoscopy quality indicator to be used in addition to the adenoma detection rate?
- Scientific TitleThe proximal adenoma detection rate; a newly proposed colonoscopy quality indicator to be used in addition to the adenoma detection rate?
- hypothesis
- Healt Condition(s) or Problem(s) studiedColoscopy, Colorectal polyps, Colorectal, Adenomas, Serrated polyps
- Inclusion criteriaWe only included the complete colonoscopies performed by endoscopists who performed at least 50 complete colonoscopies within the timeframe of the study.
- Exclusion criteriaColonoscopies performed in patients known with hereditary CRC syndrome, hereditary polyposis syndromes or inflammatory bowel disease (IBD) were excluded. All colonoscopies performed in fecal immunochemical test (FIT)-positive patients were excluded from the analyses as well.
- mec approval receivedyes
- multicenter trialno
- randomisedno
- group[default]
- TypeSingle arm
- Studytypeobservational
- planned startdate 1-jan-2011
- planned closingdate1-mrt-2018
- Target number of participants8000
- InterventionsThis is a cross-sectional study of data retrieved from a prospectively collected database of all colonoscopies performed in a single colonoscopy center according to the local daily practice. No formal interventions were perfromed for the sake of the study
- Primary outcomeThe occurence of variances in the proximal ADR and the PSPDR among gastroenterologists and senior gastroenterology residents
- Secondary outcomeThe association between the proximal ADR and the PSPDR with the ADR.
- TimepointsAnalysis date: 01-01-2018
- Trial web site
- status[default]
- CONTACT FOR PUBLIC QUERIESPhD Candidate Maxime E.S. Bronzwaer
- Sponsor/Initiator Academic Medical Center (AMC), Amsterdam
- Funding
(Source(s) of Monetary or Material Support)
- Publications
- Brief summaryColorectal cancer (CRC) is one of the most frequent causes of cancer related morbidity and mortality and arises from premalignant precursor lesions, such as adenomas and sessile serrated lesions (SSLs). Colonoscopy is the reference standard for the detection and resection of these premalignant colorectal polyps. However, colonoscopy is not fully protective for the development of post-colonoscopy CRCs (PCCRCs), as the majority of PCCRCs seem to arise from colonoscopy related factors, such as premalignant polyps being missed and incomplete polypectomies.
A significant proportion of PCCRCs seem to arise from proximal located premalignant polyps. Proximally located adenomas are frequently missed, as these adenomas commonly contain a flat morphology. The major cause of PCCRCs might be the proximally located serrated polyps (SPs) as their pale color combined with their flat appearance might result in even higher miss rates. As such, the proximal serrated polyp detection rate (PSPDR) has been proposed as a colonoscopy quality indicator.
The adenoma detection rate (ADR) is considered the most important colonoscopy quality indicator, as the ADR is inversely correlated with the occurrence of PCCRCs and CRC mortality in two landmark papers. Previous studies found moderate correlations between the ADR and PSPDR. It therefore seems amendable that endoscopists having a high ADR perform a thorough evaluation of the colon mucosa, leading to a higher detection of all polyps, including proximally located SPs. Howeve,r it remains unknown if endoscopists having a high ADR are also more likely to detect proximal adenomas, when missed these adenomas might be an important cause of PCCRCs as well.
- Main changes (audit trail)
- RECORD30-nov-2017 - 28-dec-2017

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