Adenoma detection rates vary minimally with time of day and case rank: a prospective study of 2139 first screening colonoscopies

Leffler, Daniel A.; Kheraj, Rakhi; Bhansali, Arjun; Yamanaka, Hanako; Neeman, Naama; Sheth, Sunil G.; Sawhney, Mandeep S.; LaMont, J. Thomas; Aronson, Mark D.

doi:10.1016/j.gie.2011.11.021

Cited by 27 publications

(21 citation statements)

References 38 publications

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“…31,32 The reasons for these remarkable results from the UK studies are not clear, although in the past it has been shown that the individual endoscopist can have as great an impact on ADR as patient age and sex. 6 Overall AADR in this study was 6.9%, which is similar to the results reported in some studies 14,19,21,24 but lower than in others (AADR of up to 13%). 9,27 Advanced adenomas are the final precursor lesions to colorectal carcinoma and, compared with small tubular adenomas, patients with advanced adenomas have a higher risk for developing metachronous advanced adenomas and cancers.…”

Section: Discussionsupporting

confidence: 89%

“…These results meet NBCSP and ASGE/ACG targets and are consistent with the results of other recent large studies of screening colonoscopies of average-risk patients, in which ADRs ranged from 20% to 33%. 7,8,[18][19][20][21][22][23][24][25][26][27][28] In this study, ADR was 37% and AADR was 24% for patients above 50 years of age undergoing first-time screening colonoscopy after a positive FOBT. These are also consistent with other studies of FOBT-triggered screening colonoscopies 9,29 and compare favorably with the results of the NBCSP pilot program (ADR, 19.8%; AADR, 13.9%), 30 although they are lower than the ADRs of some individual endoscopists in the UK Bowel Cancer Screening Programme who reported ADRs of up to 60%.…”

Section: Discussionmentioning

confidence: 99%

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Adenoma Detection Rate in Colonoscopy

Yang

Wong

2016

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Adenoma Detection Rate in Colonoscopy

Yang

Wong

2016

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The current available data on the effect of fellow involvement in colonoscopy on ADR is conflicting, with some studies supporting a positive correlation 24, whereas others suggesting no effect or a lower ADR 25. This discrepancy among studies may be in part associated with differences in the level of training of fellows included as well as with the degree of supervision provided by the staff endoscopist at the time of the procedure.…”

Section: Discussionmentioning

confidence: 98%

Does carbon dioxide insufflation impact adenoma detection rate? A single-center retrospective analysis

et al. 2016

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Background and study aims: Carbon dioxide (CO2) has been associated with reduced post-procedural pain and improved patient satisfaction when compared to air insufflation (AI). The effect of CO2 insufflation (CO2I) on the adenoma detection rate (ADR) remains unclear. The aims of this study are to compare ADR in patients undergoing screening colonoscopy with AI vs. CO2I and identify predictors of ADR. Patients and methods: Single-center retrospective cohort study of 2,107 patients undergoing screening colonoscopy at the University of Florida Hospital between November 2011 and June 2015. Patient demographics, procedural parameters, and histology results were retrospectively obtained from a prospectively maintained colonoscopy database. Univariate and multivariate analysis were performed to identify predictors of ADR. Results: A total of 2107 colonoscopies (644 with AI and 1463 with CO2I) were analyzed. Overall ADR was 27.8 %. There was no significant difference in ADR between AI (27.6 %) vs. CO2I (27.8 %) (P = 0.93). Method of insufflation (AI vs. CO2I) was not significantly associated with ADR (OR 0.9; 95 % CI:0.7 – 1.2). Older age (OR: 1.02; 95 % CI: 1.001 – 1.03 per year increase), male gender (OR 1.48; 95 % CI: 1.17 – 1.87), and longer scope withdraw time (OR 1.13; 95 % CI: 1.1 – 1.16 per minute) were associated with a higher ADR. Fellow involvement was negatively associated with ADR (OR 0.60; 95 % CI: 0.47 – 0.77). Conclusion: ADR was similar between patients who underwent screening colonoscopy with AI vs. CO2I. While CO2I has been associated with improved patient comfort and post-procedural recovery time, there is no definitive evidence to suggest that this method of luminal distention enhances ADR.

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“…Studies on individual endoscopists’ procedure volume in gastroenterology are limited to colonoscopy. Although colonoscopies by high-volume providers have a higher successful completion rate [18], they may also have a lower rate of polyp identification and removal [19], possibly owing to fatigue during afternoon procedures [20]. The significance of this effect is unclear, as two studies have found no association between high-volume endoscopists and incidences of colorectal cancer after screening colonoscopy [21,22].…”

Section: Discussionmentioning

confidence: 99%

Procedure volume influences adherence to celiac disease guidelines

Lebwohl

Genta²,

Kapel

et al. 2013

European Journal of Gastroenterology & Hepatology

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Background Although the prevalence of celiac disease in the USA approaches 1%, most cases are undiagnosed, in part, because of low adherence to the recommendation of submitting at least four specimens during duodenal biopsy. We aimed to determine whether physician and practice characteristics are associated with adherence to this recommendation. Materials and methods We used a large national pathology database to identify all adult patients who underwent duodenal biopsy during 2006–2009. Hierarchical modeling was used to determine whether procedure volume, the number of gastroenterologists per endoscopy suite, and the number of gastroenterologists per capita of the zip code of the practice were associated with adherence. Results We identified 92 580 patients (67% female, mean age 53.5 years) who met our inclusion/exclusion criteria. Specimens were submitted by 669 gastroenterologists from 200 endoscopy suites, located in 191 zip codes, with a mean of 3.4 gastroenterologists per suite. On multivariate analysis, a higher procedure volume was associated with a decreased adherence [odds ratio (OR) for each additional 100 procedures, 0.92; 95% confidence interval (CI), 0.88–0.97; P = 0.002]. An increased adherence was reported for gastroenterologists working at suites with higher numbers of gastroenterologists (OR for each additional gastroenterologist, 1.08; 95% CI, 1.04–1.13; P < 0.001) but not for a higher gastroenterologist density in the zip code of the practice (OR for each additional gastroenterologist per capita, 1.01; 95% CI, 0.99–1.03; P = 0.21). Conclusion High-volume physicians exhibit lower rates of adherence to biopsy guidelines, possibly because of the additional time required to submit at least four specimens. In contrast, a greater number of endoscopists working in an endoscopy suite are associated with an increased adherence, possibly because of peer education.

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Adenoma detection rates vary minimally with time of day and case rank: a prospective study of 2139 first screening colonoscopies

Cited by 27 publications

References 38 publications

Adenoma Detection Rate in Colonoscopy

Adenoma Detection Rate in Colonoscopy

Does carbon dioxide insufflation impact adenoma detection rate? A single-center retrospective analysis

Procedure volume influences adherence to celiac disease guidelines

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