Endoscopist characteristics that influence the quality of colonoscopy

Jover, Rodrigo; Zapater, Pedro; Bujanda, Luís; Hernández, Vicent; Cubiella, Joaquín; Pellisé, María; Ponce, Marta; Ono, Akiko; Lanas, Ángel; Seoane, Agustín; Marín-Gabriel, JC; Chaparro, María; Cacho, Guillermo; Herreros–de–Tejada, Alberto; Fernández-Díez, Servando; Peris, Antonio; Nicolás–Pérez, David; Murcia, Óscar; Castells, Antoni; Quintero, Enrique; investigators, Colonprev study

doi:10.1055/s-0042-100185

Cited by 46 publications

(45 citation statements)

References 26 publications

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“…Practice guidelines recommend post-polypectomy surveillance intervals based on the estimated risk of metachronous neoplasia, which depends on the size, number, and histology of adenomas and serrated lesions found at baseline. [1][2][3] However, adenoma and serrated polyp detection rates, as well as other quality standards, [4][5][6] vary widely among endoscopists, highly influencing the chance of post-colonoscopy cancers, maybe more than the advised interval. 7 Different guidelines on surveillance underscore the need for high-quality baseline colonoscopy before appropriate follow-up recommendations can be made.…”

Section: Introductionmentioning

confidence: 99%

Colonoscopy quality requisites for selecting surveillance intervals: A World Endoscopy Organization Delphi Recommendation

Jover

Dekker

Schoen

et al. 2018

Digestive Endoscopy

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Section: Introductionmentioning

confidence: 99%

Colonoscopy quality requisites for selecting surveillance intervals: A World Endoscopy Organization Delphi Recommendation

Jover

Dekker

Schoen

et al. 2018

Digestive Endoscopy

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“…In fact, "younger" endoscopists, public practice setting, low volume of procedures per week and no CRC screening program are items related to more deficiencies. As a recent study has concluded, endoscopic experience, which is commonly reflected by age, volume of procedures per week and participation in a CRC screening program, affects the ADR (38). Our results prove these factors affect ADR but also many of the proposed quality indicators, such as polypectomy under antiplatelets and/or oral anticoagulants therapy, histology and complications feedback, photodocumentation of normal and abnormal findings, use of cleansing scales, complete colonoscopy definition, and use of split dosages.…”

Section: Discussionmentioning

confidence: 99%

A survey-based analysis on endoscopic quality indicators compliance among Spanish endoscopists

et al. 2016

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Introduction: Endoscopy plays a key role for the diagnosis and management of gastrointestinal disorders. Therefore, quality indicators have been widely proposed in order to optimize endoscopic practice. The aims of this study, promoted by the Spanish Society of Digestive Diseases (SEPD), were to assess the knowledge and compliance to endoscopy quality indicators among Spanish gastroenterologists.Methods: A 31-questionnaire survey was created based on the endoscopy quality indicators proposed by international guidelines. The survey was distributed among Spanish gastroenterologists who are members of the society. Using only fully completed surveys, a descriptive analysis was performed. Those factors related with a suboptimal quality performance were also investigated.Results: A total of 1,543 surveys were sent and 281 (18.2%) were received completed. Based on the answers obtained, the management of 14 (70%) out of 20 assessed quality indicators was poor: 5 (83.3%) out of 6 pre-procedure items, 7 (58.3%) out of 12 intra-procedure items and 2 (100%) out of 2 post-procedure items. Young age, public setting, no colorectal cancer (CRC) screening program at the institution and a low volume of procedures/week are factors related to poorer management of the assessed quality indicators.Conclusions: A significant proportion of Spanish endoscopists do not comply with main endoscopic quality indicators. Factors such as "young" age, public setting, no colorectal cancer screening program and low volume of procedures/week are related to a poorer management of the assessed quality indicators and should be the target for future formative activities.

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“…6,8 For the purposes of this study, endoscopist quality metrics and other demographic characteristics (age, years as physician, years as specialist, exclusive dedication to endoscopy, total lifelong number of colonoscopies, number of colonoscopies the previous year, weekly hours dedicated to endoscopy, and number of formative activities the previous year) were assessed. The ADR was defined as the percentage of colonoscopies performed by each endoscopist in which at least one adenoma was found.…”

Section: Variablesmentioning

confidence: 99%

“…2 On the other hand, colonoscopy quality varies considerably among endoscopists, with important variations in fulfillment of quality indicators, such as adenoma detection rate (ADR) or adenomas per colonoscopy rate (APCR). [4][5][6] This variation suggests that the existence of multiple adenomas in a particular patient depends not only on putative biological factors that would put this patient at risk of developing future lesions but also on the ability of the endoscopist who performs the colonoscopy to detect adenomas. This association gives rise to the paradox that higher-quality baseline colonoscopies would lead to the indication for more surveillance colonoscopies according to current guidelines.…”

Section: Introductionmentioning

confidence: 99%

Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection‐surveillance paradox

Mangas-Sanjuán¹,

Zapater

Cubiella³

et al. 2018

UEG Journal

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Background: Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. Objective: The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. Methods: This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. Results: A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p ¼ 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19-0.97) and ADR (HR 0.94; 95% CI 0.89-0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89-0.99). Conclusions: Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy. Key summarySummarize the established knowledge on this subject . Surveillance after polyp excision is based on an estimation of risk of metachronous advanced neoplasia. . Surveillance recommendations are made depending on size, number and pathology of polyps found at baseline. . Quality of baseline colonoscopy could influence findings at follow-up.What are the significant and/or new findings of the study?. Having advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy. . Baseline adenoma detection rate remained the only quality-related independent risk factor for advanced neoplasia at follow-up.

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Endoscopist characteristics that influence the quality of colonoscopy

Abstract: This study found that the experience of the endoscopist and exclusive dedication to endoscopy practice, but not annual colonoscopy volume, were associated with better colonoscopy quality.

Cited by 46 publications

References 26 publications

Colonoscopy quality requisites for selecting surveillance intervals: A World Endoscopy Organization Delphi Recommendation

Colonoscopy quality requisites for selecting surveillance intervals: A World Endoscopy Organization Delphi Recommendation

A survey-based analysis on endoscopic quality indicators compliance among Spanish endoscopists

Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection‐surveillance paradox

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