Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

Jover, Rodrigo; Zapater, Pedro; Polanía, Eduardo; Bujanda, Luís; Lanas, Ángel; Hermo, José Antonio; Cubiella, Joaquín; Ono, Akiko; González-Méndez, Yanira; Peris, Antonio; Pellisé, María; Seoane, Agustín; Herreros–de–Tejada, Alberto; Ponce, Marta; Marín-Gabriel, JC; Chaparro, María; Cacho, Guillermo; Fernández-Díez, Servando; Arenas, Juan; Sopeña, Federico; de–Castro, Luisa; Vega, Pablo; Rodríguez–Soler, María; Carballo, Fernando; Sala, María; Morillas, Juan Diego; Andreu, Montserrat; Quintero, Enrique; Castells, Antoni

doi:10.1016/j.gie.2012.09.027

Cited by 123 publications

(109 citation statements)

References 29 publications

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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%

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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Section: Variablesmentioning

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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“…52 Split-dose preparations have also been shown to improve ADR, providing validation of the split-dose regimen. 53,54 A survey of US endoscopy units participating in the American Society for Gastrointestinal Endoscopy Endoscopy Unit Recognition Program indicates that 82% offered split dosing, although nonexclusively in 39%. 55 Same-day preparation represents a variation on the concept of split dosing.…”

Section: Preparation Dosing Strategiesmentioning

confidence: 99%

Advances in Bowel Preparation for Colonoscopy

Cohen

2015

Gastrointestinal Endoscopy Clinics of North America

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“…The adenoma detection rate (ADR), therefore, has become the most important indicator of the quality of colonoscopy [Kaminski et al 2010] because it is directly related to key outcome parameters, such as interval cancer, and indirectly reflects other surrogate markers including quality of preparation, colonoscopy completeness and withdrawal time, as well as dedication and experience of the endoscopist. In an ad hoc analysis of the ColonPrev study, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes [odds ratio (OR), 1.51; 95% CI, 1.17-1.96] and split bowel preparation (OR, 1.26; 95% CI, 1.01-1.57) [Jover et al 2013]. …”

Section: Colonoscopymentioning

confidence: 99%

Choosing the optimal method in programmatic colorectal cancer screening: current evidence and controversies

Castells

2015

Therap Adv Gastroenterol

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Colorectal cancer (CRC) is an important health problem all over the world, being the third most common cancer and the second leading cause of cancer-related death in Western countries. According to recent reports, it is the third most frequent neoplasm in men (663,000 new cases per year, 10.0% of the total) and the second in women (570,000 new cases per year, 9.4% of the total). Incidence rates vary 10-fold worldwide, the highest rates being observed in Australia/New Zealand and Western Europe, and the lowest in Africa and South-Central Asia. About 608,000 deaths from CRC were estimated worldwide in 2008, accounting for 8% of all cancer deaths [Ferlay et al. 2010]. CRC pathogenesisThe etiology of CRC involves the complex interaction of environmental carcinogen exposure and genetic factors in the population. Indeed, most CRC cases are sporadic, occurring in individuals without any known familial predisposition. Approximately 10-30% of cases have a positive family history of this neoplasm , although the predisposing genetic factors involved in such a setting have not yet been identified [Tomlinson et al. 2008; Abuli et al.]. Highly penetrant inherited CRC syndromes are less common, accounting for only 5% of all CRC cases . They can be divided into 'polyposis' and 'nonpolyposis' syndromes, being the first group subclassified into adenomatous, hamartomatous and hyperplastic polyposis [Balmana et al. 2010]. The most prevalent nonpolyposis inherited form is Lynch syndrome, formerly known as hereditary nonpolyposis CRC, which accounts for up to 3% of the CRC burden and it is caused by germline mutations in the DNA mismatch repair genes [Piñol et al. 2005;Moreira et al. 2012].Choosing the optimal method in programmatic colorectal cancer screening: current evidence and controversies Antoni CastellsAbstract: Colorectal cancer (CRC) is an important health problem all over the world, being the third most common cancer and the second leading cause of cancer-related death in Western countries. The most important strategy for CRC prevention is screening (i.e. secondary prevention). Since it is widely accepted that adenomas and serrated polyps are the precursors of the vast majority of CRC, early detection and removal of these lesions is associated with a reduction of CRC incidence and, consequently, mortality. Moreover, cancers detected by screening are usually diagnosed at early stages and, therefore, curable by endoscopic or surgical procedures. This review will be address CRC screening strategies in average-risk population, which is defined by those individuals, men and women, 50 years of age or older, without any additional personal or familial predisposing risk factor. In order to maximize the impact of screening and ensure high coverage and equity of access, only organized screening programs (i.e. programmatic screening) should be implemented, as opposed to case-finding or opportunistic screening. For that reason and considering that the optimal approach for colorectal screening may differ depending on the scenario, this...

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Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies

Cited by 123 publications

References 29 publications

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

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

Advances in Bowel Preparation for Colonoscopy

Choosing the optimal method in programmatic colorectal cancer screening: current evidence and controversies

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