Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis

Forbes, Nauzer; Boyne, Devon J.; Mazurek, Matthew; Hilsden, Robert J.; Sutherland, Robert L.; Pader, Joy; Ruan, Yibing; Shaheen, Abdel Aziz; Wong, Clarence; Lamidi, Mubasiru; Lorenzetti, Diane; Brenner, Darren R.; Heitman, Steven J.

doi:10.1016/j.cgh.2020.03.046

Cited by 28 publications

(32 citation statements)

References 63 publications

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“…We did not observe, as in most studies, any correlation between ADR and colonoscopy volume. 15,31,41 By contrast, low-volume endoscopists (<20 annual FIT-positive colonoscopies) had significantly lower CIRs and ProxSLDRs and higher NANSLDRs than high-volume endoscopists, so that their benefit/risk and cost-effectiveness ratios of polypectomy were significantly lower. The association between low volume and lesser care quality is well demonstrated for some other complex endoscopic procedures such as endoscopic retrograde cholangio-pancreatography.…”

Section: Discussionmentioning

confidence: 95%

Adenoma detection rate in fecal immunochemical test positive colonoscopies: a population-based observational study

Denis¹,

Gendre

Tuzin

et al. 2020

Preprint

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Background and aims: Neoplasia-related indicators, such as adenoma detection rate (ADR), are a priority in the quality improvement process for colonoscopy. Our aim was to assess and compare different detection and characterization indicators in fecal occult blood test (FOBT)-positive colonoscopies, to analyze the factors influencing their variance, and to propose benchmarks. Methods: Retrospective analysis of prospectively collected data from all colonoscopies performed between 2007 and 2019 after a positive guaiac-based FOBT or a fecal immunochemical test (FIT) in the population-based colorectal cancer (CRC) screening program conducted in Alsace, part of the French national program. Detection indicators included ADR, NewADR (including proximal serrated lesions), mean number of adenomas per colonoscopy, and proximal serrated lesion detection rate. Characterization indicators included non-neoplastic polyp detection rate. Results: Overall, 13.455 FIT-positive colonoscopies were performed by 116 endoscopists. The overall ADR was 57.6% (95%CI 56.8-58.5). For each 10 microg/g increase in fecal hemoglobin concentration, a 2% increase in ADR was observed. Endoscopists whose ADR was ≥55% were high detectors for all neoplasia, including proximal serrated lesions and number of adenomas. The non-neoplastic polyp detection rate was 39.5% in highest detectors (ADR >70%), significantly higher than in lower detectors (21.4%) (p<0.001). There was a strong correlation between detection and characterization indicators, e.g. between proximal serrated lesion and non-neoplastic polyp detection rates (Pearson = 0.73; p<0.01). Conclusions: A single indicator, NewADR, including proximal serrated lesions, is enough to assess the neoplasia yield of colonoscopy provided the target standard is raised between 55% and 70% in FIT-positive colonoscopies (65-80% in men, 45-60% in women).

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Section: Discussionmentioning

confidence: 95%

Adenoma detection rate in fecal immunochemical test positive colonoscopies: a population-based observational study

Denis¹,

Gendre

Tuzin

et al. 2020

Preprint

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“…Our prior work [8,18] and the work of Laanani [19] have demonstrated an association of lower endoscopist colonoscopy volume and higher rates of complication among colonoscopies for multiple indications. A recent meta-analysis of the potential association between endoscopist volume and colonoscopy quality by Forbes [20] demonstrated a non-significant trend of lower rates of adverse events overall with increasing annual volume. Some population-based colorectal screening programs have instituted overall monitoring of colonoscopy quality [21][22][23] audit and feedback to endoscopists [24] in addition to educational interventions for endoscopists [25] with some evidence of modest improvement in performance on measures of outcomes observed relatively frequently in our own work under review.…”

Section: Discussionmentioning

confidence: 99%

Perforation and post-polypectomy bleeding complicating colonoscopy in a population-based screening program

et al. 2021

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Background and study aims We aimed to estimate the rate of hospital admissions for perforation and for post-polypectomy bleeding, after outpatient colonoscopy following a first positive fecal occult blood test screen through the population-based ColonCancerCheck program in Ontario, Canada. Patients and methods We identified all individuals aged 50 to 74 years with a first positive CCC gFOBT screening result from 2008 to 2017 who underwent outpatient colonoscopy ≤ 6 months later and who did not receive a diagnosis of CRC ≤ 24 months later. We identified inpatient hospital admissions for colonic perforation ≤ 7 days after and for post-polypectomy bleeding ≤ 14 days following colonoscopy. Results Among 121,626 individuals who underwent colonoscopy, the rate of perforation was 0.6 per 1000 from 2008 to 2012 and 0.4 per 1000 from 2013 to 2017. The rate was elevated among those aged 70 to 74 years; those with comorbidities; when colonoscopy was performed by endoscopists other than gastroenterologists or endoscopists with low prior year volume; and when polypectomy was performed during colonoscopy. The rate of bleeding was 4.3 per 1000 and was elevated among those aged 70 to 74 years, those with comorbidity, and with complex polypectomy. Both outcomes were more common among those aged 70 to 74 years, those with a 5-year cumulative Charlson score ≥ 1, those with prior hospitalization for ischemic heart disease, and those with endoscopists whose prior year colonoscopy volume was in the three lower quartiles. Conclusions Colonic perforation and post-polypectomy bleeding, among participants of population-based colorectal screening programs who test positive in the absence of colorectal cancer, are infrequent but serious complications, which increase with participant age and comorbidity, and with endoscopist characteristics.

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“…In the present study, two board-certified gastroenterologists performed colonoscopies, among which one had performed more than 10,000 examinations before the study period with SC and the other had performed more than 3,000 examinations before the study period with CMC. Because there was no association between procedural volume and ADR, we assumed that procedural volume difference between the two doctors should not affect ADR [17]. Colonoscopies were performed after bowel preparation with 2 L polyethylene glycol plus ascorbic acid solution (Coolprep, Taejun, Seoul, Korea; Readyfree, Intropharm Tech., Gyeonggi-do, Korea).…”

Section: Methodsmentioning

confidence: 99%

Effect of combined cap-assisted, water-aided, and prone position colonoscopy for adenoma detection: A retrospective study

Ko¹,

Ko²,

Han³

et al. 2020

Preprint

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Background: The efficacy of cap-assisted, water-aided, and 12 o'clock-prone position colonoscopy as individual techniques for adenoma detection is well documented. However, the efficacy of the combination of the three colonoscopy methods is unclear. Therefore, the present study aimed to retrospectively compare the efficacy between combined-method colonoscopy (CMC) and standard colonoscopy (SC). Methods and Findings: A total of 746 patients who underwent either CMC or SC, performed by two board-certified gastroenterologists between December 2019 and March 2020 at Baekyang Jeil Internal Medicine Clinic, were retrospectively evaluated. We evaluated polyp detection rate (PDR), adenoma detection rate (ADR), and mean number of adenomas detected per procedure (MAP). Statistical analysis for comparison between the groups was performed using the Student's t-test, and ADR and PDR were analyzed using Fisher's exact test. The study population was predominantly women (55.4%). The mean patient age (standard deviation) was 62.87 (±7.83) years. There was no significant difference in sex, number of fecal occult blood test-positive patients, and age between the two groups. The PDR, ADR, and proximal colon MAP were significantly higher in the CMC group than in the SC group (PDR: 59.8% vs. 84.9%, p < 0.001; ADR: 49.2% vs. 70.1%, p < 0.001; proximal colon MAP: 0.55 vs. 1.24, p < 0.001). Conclusions: Compared with SC, CMC increases PDR, ADR, and MAP, especially proximal colon MAP. Therefore, CMC may be more useful than SC in clinical settings. This study is the first to evaluate the efficacy of the three techniques in combination.

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Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis

Cited by 28 publications

References 63 publications

Adenoma detection rate in fecal immunochemical test positive colonoscopies: a population-based observational study

Adenoma detection rate in fecal immunochemical test positive colonoscopies: a population-based observational study

Perforation and post-polypectomy bleeding complicating colonoscopy in a population-based screening program

Effect of combined cap-assisted, water-aided, and prone position colonoscopy for adenoma detection: A retrospective study

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