No abstract

colonoscopy performance between endoscopy services. Methods: Prospectively collected data recorded in the Dutch Gastrointestinal Endoscopy Audit (DGEA) between 01-01-2016 and 31-12-2019 were analyzed. The DGEA is the national colonoscopy registry of endoscopy services in the Netherlands. Academic, non-academic and private endoscopy services are participating in the DGEA. Performance on cecal intubation rate (CIR) and rate of adequate bowel preparation (ABPR) were studied in the total study population per endoscopy service. The polyp detection rate (PDR) was studied in fecal immunochemical test (FIT)-positive screening colonoscopies. Variation in case-mix factors (age, sex, ASA score and indication) between endoscopy services was assessed. Expected outcomes for the CIR, ABPR and PDR were calculated, based on the case-mix factors of all patients per endoscopy service, using a multivariable logistic regression model. Results: During the 4-year study period, 363,840 colonoscopies were recorded from 51 endoscopy services in the DGEA. Significant differences in the mean percentage per endoscopy service were observed for several case-mix factors; age higher than 65 years (range (r): 33.4 -53.6%, p < 0.001), male patients (r: 46.2 -58.2%, p < 0.001), ASA 3 or higher (r: 0.2 -24.9%, p < 0.001) and diagnostic colonoscopies (r: 18.5 -85.8%, p < 0.001). In the FIT-positive population (n Z 77.536), the mean percentages per endoscopy service for the following case-mix factors were significantly different: age higher than 65 years (r: 36.0 -62.7%, p < 0.001), male patients (r: 51.8 -67.3%, p Z 0.001) and ASA 3 or higher (r: 0.3 -30.8%, p < 0.001). The case-mix factors age, sex, ASA classification and indication for colonoscopy were significantly associated with CIR and ABPR. Age, sex and ASA classification were significantly associated with PDR in the FIT-positive population. The expected CIR, ABPR and PDR per endoscopy service ranged from 95.0% to 96.9%, from 93.5% to 96.4% and from 75.7% to 79.0%, respectively. Conclusion: Variation in case-mix factors between endoscopy services results in variation in expected outcomes for colonoscopy between these endoscopy services. Our findings emphasize that for comparison of colonoscopy performance measures between endoscopy services, adjustment for case-mix factors should be considered.

Context Primary aldosteronism (PA) is the most common endocrine cause of hypertension. The final diagnostic step involves subtyping, using adrenal vein sampling (AVS), to determine if PA is unilateral or bilateral. The complete PA diagnostic process is time and resource intensive, which can impact rates of diagnosis and treatment. Previous studies have developed tools to predict bilateral PA before AVS. Objective Evaluate the sensitivity and specificity of published tools that aim to identify bilateral subtypes of PA. Methods Medline and Embase databases were searched to identify published models that sought to subtype PA, and algorithms to predict bilateral PA are reported. Meta-analysis and meta-regression were then performed. Results There were 35 studies included, evaluating 55 unique algorithms to predict bilateral PA. The algorithms were grouped into 6 categories; those combining biochemical, radiological and demographic characteristics (A), confirmatory testing alone or combined with biochemical, radiological and demographic characteristics (B), biochemistry results alone (C), adrenocorticotropic hormone stimulation testing (D), anatomical imaging (E) and functional imaging (F). Across the identified algorithms, sensitivity and specificity ranged from 5-100% and 36-100%, respectively. Meta-analysis of 30 unique predictive tools from 32 studies showed that the Group-A algorithms had the highest specificity for predicting bilateral PA, while Group-F had the highest sensitivity. Conclusions Despite the variability in published predictive algorithms, they are likely important for decision-making regarding the value of AVS. Prospective validation may enable medical treatment upfront for people with a high likelihood of bilateral PA without the need for an invasive and resource-intensive test.