Variation in Colonoscopy Performance Measures According to Procedure Indication

Mangas-Sanjuán, Carolina; Santana, E; Cubiella, Joaquín; Rodríguez-Camacho, Elena; Seoane, Agustín; Álvarez, Marco Antonio Santamaría; Suárez, Adolfo; Álvarez-García, Verónica; González, Natalia; Lué, Alberto; Cid-Gómez, Lucia Amelia; Ponce, Marta; Bujanda, Luís; Portillo, Isabel; Pellisé, María; Díez-Redondo, Pilar; Herráiz, Maite; Ono, Akiko; Pizarro, Ángeles; Zapater, Pedro; Jover, Rodrigo; Casellas, Juan Antonio; Ruiz-Gómez, Francisco Antonio; Serrano, Eva Bejar; Mira, Cristina; Castaño, Olegario; Blanco, Lorena; Lara, Javier L.; Quintero, Enrique; Clinic, Headache; Rivero, Liseth; Llach, Josep; Córdova, Henry; Araujo, Isis K.; Sánchez, Ariadna; Ordás, Íngrid; Lisette, Karina; Mar, Hsiu-Feng; Carot, Laura; Ibáñez, Inés; Riu, Faust; Pantaleón, Miguel; Dedéu, Josep Maria; Barranco, Luis; Baiocchi, Franco; Tejido, Coral; Idígoras, Isabel; Bilbao, Isabel; Carretero, Cristina; Betés, Maite; Bustamante, Marco; Pons, Vicente; Argüello, Lídia; Satorres, Carla; Núñez, Henar; Busto, V.; Hernández, Vicent; Castro, Luísa; Fernández-Fernández, Nereida; Martínez-Turnes, Alfonso; Romero-Mosquera, Beatriz; Fernández-Poceiro, Romina; Lanas, Ángel; Ferrández, Ángel; Roncales, Pilar

doi:10.1016/j.cgh.2019.08.035

Cited by 27 publications

(23 citation statements)

References 27 publications

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“…This study also provides evidence that ADRs are generally higher in surveillance exams than in screening exams, a finding that has recently been recognized by others as well [17,18]. Importantly, this effect is similar for colonoscopies with and without trainee participation.…”

Section: Discussionsupporting

confidence: 78%

Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up

Eckardt¹,

Kheder

Basil

et al. 2020

Endosc Int Open

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Background and study aims Training future endoscopists is essential to meet rising demands for screening and surveillance colonoscopies. Studies have shown conflicting results regarding the influence of trainees on adenoma detection rates (ADR). It is unclear whether trainee participation during screening adversely affects ADR at subsequent surveillance and whether it alters surveillance recommendations. Patients and methods A retrospective analysis of average-risk screening colonoscopies and surveillance exams over a subsequent 10-year period was performed. The initial inclusion criteria were met by 5208 screening and 2285 surveillance exams. Patients with poor preparation were excluded. The final analysis included 7106 procedures, including 4922 screening colonoscopies and 2184 surveillance exams. Data were collected from pathology and endoscopy electronic databases. The primary outcome was the ADR with and without trainee participation. Surveillance recommendations were analyzed as a secondary outcome. Results Trainees participated in 1131 (23 %) screening and in 232 (11 %) surveillance exams. ADR did not significantly differ (P = 0.19) for screening exams with trainee participation (19.5 %) or those without (21.4 %). ADRs were higher at surveillance exams with (22.4 %) and without (27.5 %) trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous colonoscopy. Shorter surveillance intervals were given more frequently if trainees participated during the initial screening procedure (P = 0.0001). Conclusions ADR did not significantly differ in screening or surveillance colonoscopies with or without trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous screening exam. However, trainee participation may result in shorter surveillance recommendations.

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Section: Discussionsupporting

confidence: 78%

Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up

Eckardt¹,

Kheder

Basil

et al. 2020

Endosc Int Open

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“…The proportion with advanced adenomas, despite some colonoscopies being brought forward because of a positive FIT, were comparable to that of the entire population, and within 3% of the rate seen by others in a similar programme. 43 In addition, our FIT positivity rate for the 32 413 completed tests was similar to that reported in Scandinavian 44 and Australian screening populations. 45 The former reported positivity rates of 7.2% and 4.2% for a 2-sample and 1-sample FIT respectively at cut-off 20 ug/g, compared with our findings of 7.0% and 4.4%.…”

Section: Open Accesssupporting

confidence: 84%

Detection of advanced colorectal neoplasia and relative colonoscopy workloads using quantitative faecal immunochemical tests: an observational study exploring the effects of simultaneous adjustment of both sample number and test positivity threshold

Young

Woodman

Symonds

2020

BMJ Open Gastroenterol

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ObjectiveWhen screening for colorectal cancer (CRC) using quantitative faecal immunochemical tests (FIT), test parameters requiring consideration are the faecal haemoglobin concentration (f-Hb) positivity cut-off and the number of stools sampled. This observational study explored variation in f-Hb between samples and the relationship between sensitivity for advanced neoplasia (AN, cancer or advanced adenoma) and colonoscopy workload across a range of independently-adjusted parameter combinations.DesignQuantitative FIT data (OC-Sensor) were accessed from individuals undergoing personalised colonoscopic screening with an offer of 2-sample FIT in the intervening years. We estimated variation in f-Hb between samples in 12 710 completing 2-sample FIT, plus test positivity rates (colonoscopy workload) and sensitivity for AN according to parameter combinations in 4037 instances where FIT was done in the year preceding colonoscopy.ResultsThere was large within-subject variability between samples, with the ratio for the second to the first sample f-Hb ranging up to 18-fold for all cases, and up to 56-fold for AN cases. Sensitivity for AN was greatest at lower f-Hb cut-offs and/or using 2-sample FIT. Colonoscopy workload varied according to how parameters were combined. Using different cut-offs for 1-sample FIT and 2-sample FIT to return similar sensitivity, workload was less with 2-sample FIT when the sensitivity goal exceeded 35%.ConclusionVariation in f-Hb between samples is such that both parameters are crucial determinants of sensitivity and workload; independent adjustment of each should be considered. The 2-sample FIT approach is best for detecting advanced adenomas as well as CRC provided that the colonoscopy workload is feasible.

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“…Even when an advanced adenoma has been removed, the risk of finding colorectal cancer three years later is anecdotal and the likelihood of finding advanced adenomas is very low (15). This was confirmed by a recent multicenter Spanish study (16). Thus, the European Society of Gastrointestinal Endoscopy proposes referring these cases back to the screening program or performing a colonoscopy ten years after the resection of ≤ 4 small adenomas (17), instead of repeating it in three years as previously.…”

Section: Discussionmentioning

confidence: 94%

Evaluation of endoscopy requests in the resumption of activity during the SARS-CoV-2 pandemic: denial of nonindicated requests and prioritization of accepted requests

et al. 2020

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Variation in Colonoscopy Performance Measures According to Procedure Indication

Cited by 27 publications

References 27 publications

Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up

Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up

Detection of advanced colorectal neoplasia and relative colonoscopy workloads using quantitative faecal immunochemical tests: an observational study exploring the effects of simultaneous adjustment of both sample number and test positivity threshold

Evaluation of endoscopy requests in the resumption of activity during the SARS-CoV-2 pandemic: denial of nonindicated requests and prioritization of accepted requests

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