Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial

Abstract

ObjectiveSuboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial.Design40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders’ ADR. Mixed effect models using ORs and 95% CIs were computed.ResultsThe study included 24 582 colonoscopies performed by 38 leaders and 56 617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017).ConclusionsTeaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy.Trial registration numberNCT01667198.

Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy)

“…Inter-pathologist variability in adenomatous diagnosis is also very low, ensuring the comparability of such a quality indicator among the endoscopists 27. A suboptimal ADR is related to the post-colonoscopy interval cancer risk,13 14 28 29 and a suboptimal endoscopist's ADR is subject to improvement with training 30. Thus, the finding of a strict association between ADR and SSP detection rates in our series supports the use of ADR as a proxy for SSP detection.…”

Methodological considerations for surveillance in GI practice

“…Individuals with 3 or more adenomas, adenomas with high-grade dysplasia, villous components or size 10 mm or larger, are considered as high risk of CRC and are recommended surveillance after 1e3 years [4,54]. As awareness about the importance of adenoma detection rate increase among endoscopists [55,56], and as the training improves, and colonoscopes and imaging technique get better, then adenoma detection rate may increase, as has been reported from the German and Polish colonoscopy screening program [57,58]. Accordingly, more individuals are found to have adenomas, and the number of adenomas detected per individual increases.…”

Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection‐surveillance paradox

“…On the other hand, a number of reports have described how a quality improvement program can increase ADR 14 and decrease interval cancer. 15 Nevertheless, this knowledge about the link between quality indicators at baseline and findings at follow-up has not produced any variation in surveillance recommendations, which do not take into account the characteristics of the endoscopist performing the baseline procedure. Our study demonstrates huge differences in terms of advanced neoplasia at surveillance depending on the quality metrics of the endoscopist who performs the baseline colonoscopy, supporting the notion that periodically establishing these quality metrics would be of great value and aid in designing a follow-up strategy accordingly.…”