Variations between endoscopists in rates of detection of colorectal neoplasia and their impact on a regional screening program based on colonoscopy after fecal occult blood testing

Bretagne, Jean–François; Hamonic, Stéphanie; Piette, Christine; Manfrédi, Sylvain; Leray, Emmanuelle; Durand, Gérard; Riou, Françoise

doi:10.1016/j.gie.2009.08.032

Cited by 64 publications

(55 citation statements)

References 28 publications

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“…Polyp determination rates by endoscopists are therefore among significant criteria. In the study conducted by Bretagne JF et al (21), 1-, 2-, and 3-piece polyp detection rates of endoscopists were found to be 25%-46%, 5%-21%, and 2%-12%, respectively. According to the numbers of polyps sampled at our center, successful results were obtained.…”

Section: Discussionmentioning

confidence: 89%

Factors affecting successful colonoscopy procedures: Single-center experience

et al. 2018

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Objective: Colonoscopy is a gold standard procedure for several colon pathologies. Successful colonoscopy means demonstration of the ileocecal valve and determination of colon polyps. Here we aimed to evaluate our colonoscopy success and results. Material and Methods:This retrospective descriptive study was performed in İstanbul Eren hospital endoscopy unit between 2012 and 2015. Colonoscopy results and patient demographics were obtained from the hospital database. All colonoscopy procedures were performed under general anesthesia and after full bowel preparation. Results:In all, 870 patients were included to the study. We reached to the cecum in 850 (97.8%) patients. We were unable to reach the cecum in patients who were old and obese and those with previous lower abdominal operations. Angulation, inability to move forward, and tortuous colon were the reasons for inability to reach the cecum. Total 203 polyp samplings were performed in 139 patients. We performed 1, 2, and 3 polypectomies in 97, 28, and 10 patients, respectively. There were 29 (3.3%) colorectal cancers in our series. There was no mortality or morbidity in our study. Conclusion:General anesthesia and full bowel preparation may be the reason for increased success of colonoscopy. Increased experience and patient-endoscopist cooperation increased the rate of cecum access and polyp resection and decreased the complication rate.

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Section: Discussionmentioning

confidence: 89%

Factors affecting successful colonoscopy procedures: Single-center experience

et al. 2018

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“…In the current multivariate analysis, baseline ADR remained the only quality-related independent risk factor for advanced neoplasia at follow-up, showing better performance than APCR. Variation among endoscopists in quality metrics has been reported extensively, 4,10,11 and studies have demonstrated that the individual endoscopist is an independent predictive factor for adenoma detection. 4,11 The relationship between quality indicators at baseline colonoscopy and risk of future lesions already has been demonstrated in terms of interval cancer.…”

Section: Discussionmentioning

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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“…All these factors clearly show that the quality of colonoscopy is operator-dependent and adoption of quality improvement measures and continuous quality assessment, more than technical improvement, is imperative to improve the current effectiveness of CRC screening programs (20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%