Endoscopist specialty is associated with colonoscopy quality

Abstract

BackgroundSome studies have shown that endoscopist specialty is associated with colorectal cancers missed by colonoscopy. We sought to examine the relationship between endoscopist specialty and polypectomy rate, a colonoscopy quality indicator. Polypectomy rate is defined as the proportion of colonoscopies that result in the removal of one or more polyps.MethodsA cross-sectional study was conducted of endoscopists and their patients from 7 Montreal and 2 Calgary endoscopy clinics. Eligible patients were aged 50–75 and covered by provincial health insurance. A patient questionnaire assessed family history of colorectal cancer, history of large bowel conditions and symptoms, and previous colonoscopy. The outcome, polypectomy status, was obtained from provincial health administrative databases. For each city, Bayesian hierarchical logistic regression was used to estimate the odds ratio for polypectomy comparing surgeons to gastroenterologists. Model covariates included patient age, sex, family history of colorectal cancer, colonoscopy indication, and previous colonoscopy.ResultsIn total, 2,113 and 538 colonoscopies were included from Montreal and Calgary, respectively. Colonoscopies were performed by 38 gastroenterologists and 6 surgeons in Montreal, and by 31 gastroenterologists and 5 surgeons in Calgary. The adjusted odds ratios comparing surgeons to gastroenterologists were 0.48 (95% CI: 0.32–0.71) in Montreal and 0.73 (95% CI: 0.43–1.21) in Calgary.ConclusionsAn association between endoscopist specialty and polypectomy was observed in both cities after adjusting for patient-level covariates. Results from Montreal suggest that surgeons are half as likely as gastroenterologists to remove polyps, while those from Calgary were associated with a wide, non-significant Bayesian credible interval. However, residual confounding from patient-level variables is possible, and further investigation is required.

Metachronous colorectal cancers result from missed lesions and non-compliance with surveillance

“…Recent data challenged the quality of colonoscopy by non-gastroenterologists. [44][45][46] Insufficient experience, especially on the detection and resection of subtle-appearing lesions can limit the effectiveness of colonoscopy in preventing CRC. In a study that used administrative data of 14,064 patients from Ontario, Baxter et al 44 found that endoscopist's specialty (non-gastroenterologist) and setting (non-hospitalbased colonoscopy) were likely associated with a greater risk of postcolonoscopy CRC.…”

Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada

“…Prospective study of primary care in Canada along with primary care trends in diverse post-ACA communities across America will substantially augment trial findings and identify ways to maximize ACA protections. Prospective study of specialized care, gastroenterology for colon cancer care [ 59 – 62 ] and diverse specialist physicians for other health domains will also be needed to fully inform physician supply policies in both countries.…”

Who Performs Colonoscopy? Workforce Trends Over Space and Time

“…With increasing use of colonoscopy, there also has been increasing variability in the types of providers performing colonoscopies (eg, gastroenterologists, family medicine [FM], internal medicine [IM], general, and colorectal surgeons, as well as physician extenders such as physician assistants) . While studies have found that nongastroenterologist providers can provide safe and cost‐effective colonoscopy, other studies have reported increased risk of complications (particularly for complex colonoscopies), as well as lower adenoma detection rates, exam completion rates, and cecal intubation rates among nongastroenterologists . These poor outcomes may be due in part to lower procedure volumes …”

“…13 While studies have found that nongastroenterologist providers can provide safe and cost-effective colonoscopy, [14][15][16][17][18][19][20][21][22][23][24] other studies have reported increased risk of complications (particularly for complex colonoscopies), as well as lower adenoma detection rates, exam completion rates, and cecal intubation rates among nongastroenterologists. [25][26][27][28][29][30][31] These poor outcomes may be due in part to lower procedure volumes. 20,21,27,29,[32][33][34] The extent to which providers in different specialties perform colonoscopies in the general population is unknown.…”