Heiko Pohl, M.D., from the VA Medical Center in White River Junction, Vermont, and colleagues obtained biopsies from resection margins of patients with at least one non-pedunculated polyp (5 to 20 mm) detected and removed during colonoscopy. The incomplete resection rate (IRR) was determined by the presence of neoplastic tissue in post-polypectomy biopsies.

The researchers found that 10.1 percent of the 346 neoplastic polyps (269 patients; 84.0 percent men; mean age, 63.4 years) removed by 11 gastroenterologists were incompletely resected. The IRR was significantly higher for large (10 to 20 mm) versus small (5 to 9 mm) neoplastic polyps (17.3 versus 6.8 percent; relative risk, 2.1), and also for sessile serrated adenomas/polyps versus conventional adenomas (31.0 versus 7.2 percent; relative risk, 3.7). The IRR ranged from 6.5 to 22.7 percent for endoscopists with at least 20 polypectomies. After adjustment for size and sessile serrated histology, there was a 3.4-fold difference between the highest and lowest IRR for endoscopists.

"Our results suggest a need for quality metrics evaluating polyp resection," the authors write. "The performance of high-quality and effective colonoscopy not only requires expertise in finding neoplastic polyps, but also removing them."

Abstract
Full Text
Editorial