Endoscopist Can Be More Powerful than Age and Male Gender in Predicting Adenoma Detection at Colonoscopy

Chen, Shawn C.; Rex, Douglas K.

doi:10.1111/j.1572-0241.2006.01054.x

Cited by 379 publications

(272 citation statements)

References 29 publications

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“…Increases in ADR are inversely correlated with CRC mortality and post colonoscopy CRC rates (4,14,(16)(17)(18)(19). These findings have led the American College of Gastroenterology Task Force on Quality in Endoscopy and the American Society for Gastrointestinal Endoscopy to update their ADR targets to >30% for men and >20% for women (20).…”

Section: Discussionmentioning

confidence: 97%

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

Baek

Jackson

Lunn

et al. 2017

J. Gastrointest. Oncol.

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Background: Colorectal cancer (CRC) is the second most common cause of cancer related deaths in the United States. Colonoscopy is the gold standard for the detection of CRC. There are many colonoscopy quality measures and among these the adenoma detection rate (ADR) has demonstrated a significant impact in reducing mortality from CRC. The primary aim of our study was to compare ADR and distribution of polyp type in patients undergoing Endocuff-assisted colonoscopy (EAC) versus standard colonoscopy (SC) in a VA system. Methods: Retrospective data was collected from 496 patients who underwent routine screening, surveillance and diagnostic colonoscopies either via SC from January 6, 2014 through March 12, 2014 or EAC from September 24, 2014 through February 19, 2015. A total of 54 patients were excluded based on a personal history of CRC and prior resection, incomplete colonoscopy due to poor bowel preparation, and removal or loss of Endocuff (EC). Primary outcomes measured and compared were ADR and types of polyps found. Results: The overall ADR in the EAC group was higher at 59.91% versus 50.66% for SC, accounting for a 9% increase (P=0.0508). EAC was able to detect a total of 59 sessile serrated adenoma/polyps (SSA/Ps) compared to SC only detecting 8 (P≤0.0001). There was a significant increase in the SSA/P detection rate with EAC at 15% versus 3% in the SC group (P≤0.0001). Conclusions: EAC significantly increases the detection of SSA/P and has shown a trend in improving ADR in our veteran population.

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Section: Discussionmentioning

confidence: 97%

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

Baek

Jackson

Lunn

et al. 2017

J. Gastrointest. Oncol.

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“…The adenoma detection rates of endoscopists, including those within groups of gastroenterologists, vary widely [35][36][37][38] . No substantial study examining adenoma detection rates has ever shown a less than 2.5 fold difference between the highest and lowest detectors in the same group, and this variation has ranged to up to 8 fold [35][36][37][38] .…”

Section: Case-control Studies Of Colonoscopy On Right-sided Incidencementioning

confidence: 99%

Colonoscopy: The Current King of the Hill in the USA

Rex

2014

Dig Dis Sci

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Colonoscopy is the dominant colorectal cancer screening strategy in the United States.There are no randomized controlled trials completed of screening colonoscopy, but multiple lines of evidence establish that colonoscopy reduces colorectal cancer incidence in both the proximal and distal colon. Colonoscopy is highly operator dependent, but systematic efforts to measure and improve quality are impacting performance.Colonoscopy holds a substantial advantage over other strategies for detection of serrated lesions, and a recent case-control study suggests that once-only colonoscopy or colonoscopy at 20 year intervals, by a high level detector, could ensure lifetime protection from colorectal cancer for many patients. 3Introduction and historical perspective on screening colonoscopy

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“…Numerous studies have demonstrated marked (twofold to sixfold) variability in ADRs among endoscopists working in the same endoscopy unit [4]. Although some of this variability might be due to patient factors such as age, gender, or adequacy of bowel preparation, individual endoscopists appear to be the single most predictive factor in adenoma detection [7], implying that the efficacy of colonoscopy is highly dependent on the individual skill of the endoscopist. To compound matters, Brenner [8] and Lakoff [9] presented data from Germany and Canada that showed that while colonoscopy does decrease the rate of distal CRCs by approximately 67-79%, it was not at all protective for proximal colon cancers, suggesting that there is a substantial need for improvement in colonoscopy quality by all endoscopists.…”

mentioning

confidence: 99%

“…Nonetheless, there is now substantial data, including from the US that colonoscopy quality varies by specialty training in both a statistically and clinically meaningful manner with gastroenterologists typically having the lowest overall interval CRC rates. This issue has been discussed repeatedly [4,[6][7][8][9][10][11][12][13][14][15]; it is time for the medical community to act on this information.…”

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confidence: 99%

Isn’t It Time to Stop Talking About Colonoscopy Quality and Start Doing Something About It?

Patel

Ahnen

2011

Dig Dis Sci

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Colonoscopy is central to one of the great success stories of the war on cancer. Although colorectal cancer (CRC) is still the second leading cause of cancer death in the United States, both the incidence and mortality has been declining by 2-3% per year for the last 15 years. This decline has been largely attributed to increasing rates of CRC screening. Although guidelines list other screening options (stool tests/imaging/flexible sigmoidoscopy) colonoscopy has become the dominant CRC screening test in the US while fecal testing has declined slowly, and flexible sigmoidoscopy has declined markedly over the last decade [1].Colonoscopy is widely viewed in the US as the single best test for both detection and removal of pre-cancerous lesions. The efficacy of colonoscopic polypectomy was initially highlighted by the National Polyp Study (NPS), which estimated a 76-90% reduction in incidence of colorectal cancer after polyp removal [2]. Subsequent studies [3], which often have not shown as robust a CRC risk reduction as the NPS, have highlighted the importance of the quality of colonoscopy as a critical element in its efficacy.There is compelling evidence that colonoscopy quality is highly variable [4] and guidelines for a high-quality colonoscopy have been published [5], but in the end, quality needs to be assessed by whether a test accomplishes its primary goal. In the case of colonoscopy, directly measuring whether a colonoscopy has prevented a CRC is not feasible in the short term. Instead, more measurable surrogates of quality such as cecal intubation rates, withdrawal times, and particularly adenoma detection rates (ADR) have been used as quality measures. Kaminski et al. found that ADR appeared to be an acceptable surrogate for real colonoscopy quality as it was an independent predictor of the risk of interval colorectal cancer [6]. Numerous studies have demonstrated marked (twofold to sixfold) variability in ADRs among endoscopists working in the same endoscopy unit [4]. Although some of this variability might be due to patient factors such as age, gender, or adequacy of bowel preparation, individual endoscopists appear to be the single most predictive factor in adenoma detection [7], implying that the efficacy of colonoscopy is highly dependent on the individual skill of the endoscopist. To compound matters, Brenner [8] and Lakoff [9] presented data from Germany and Canada that showed that while colonoscopy does decrease the rate of distal CRCs by approximately 67-79%, it was not at all protective for proximal colon cancers, suggesting that there is a substantial need for improvement in colonoscopy quality by all endoscopists.The variability in colonoscopy quality among providers and the dubious utility of colonoscopy in preventing rightsided colon cancers have called into question the overall efficacy of colonoscopy as it is used today and would seem to be a clear mandate for endoscopists and professional organizations to critically examine colonoscopist performance and address areas in need of improvement...

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Endoscopist Can Be More Powerful than Age and Male Gender in Predicting Adenoma Detection at Colonoscopy

Cited by 379 publications

References 29 publications

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

Colonoscopy: The Current King of the Hill in the USA

Isn’t It Time to Stop Talking About Colonoscopy Quality and Start Doing Something About It?

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