Polypectomy techniques, endoscopist characteristics, and serious gastrointestinal adverse events

Abstract

Background A use of polypectomy techniques by endoscopist specialty (primary care, surgery, and gastroenterology) and experience (volume), and associations with serious gastrointestinal adverse events, were examined. Methods A retrospective follow-up study with ambulatory surgery and hospital discharge datasets from Florida, 1999–2001, was used. Thirty-day hospitalizations due to colonic perforations and gastrointestinal bleeding were investigated for 323,585 patients. Results Primary care endoscopists and surgeons used hot biopsy forceps/ablation, while gastroenterologists provided snare polypectomy or complex colonoscopy. Low-volume endoscopists were more likely to use simpler rather than complex procedures. For hot forceps/ablation and snare polypectomy, low- and medium-volume endoscopists reported higher odds of adverse events. For complex colonoscopy, higher odds of adverse events were reported for primary care endoscopists (1.74 [95% CI, 1.18–2.56]) relative to gastroenterologists. Conclusions Endoscopists regardless of specialty and experience can safely use cold biopsy forceps. For hot biopsy and snare polypectomy, low volume, but not specialty, contributed to increased odds of adverse events. For complex colonoscopy, primary care specialty, but not low volume, added to the odds of adverse events. Comparable outcomes were reported for surgeons and gastroenterologists. Cross-training and continuing medical education of primary care endoscopists in high-volume endoscopy settings are recommended for complex colonoscopy procedures.

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 …”

“…The extent to which providers in different specialties perform colonoscopies in the general population is unknown. Yet, changes in the distribution of provider specialties performing colonoscopy, the complexity, duration and adequacy of supervised training, and the volume of colonoscopies performed could have a downstream influence on colonoscopy quality . Our study aimed to examine the extent to which colonoscopy providers of different specialties perform colonoscopies in South Carolina (SC), a state that serves a large, rural population (34% based on 2010 Census), which may present unique challenges to the provision of high‐quality colonoscopies.…”

“…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.…”

“…[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. Yet, changes in the distribution of provider specialties performing colonoscopy, the complexity, duration and adequacy of supervised training, and the volume of colonoscopies performed could have a downstream influence on colonoscopy quality.…”

“…Yet, changes in the distribution of provider specialties performing colonoscopy, the complexity, duration and adequacy of supervised training, and the volume of colonoscopies performed could have a downstream influence on colonoscopy quality. 27,34,35 Our study aimed to examine the extent to which colonoscopy providers of different specialties perform colonoscopies in South Carolina (SC), a state that serves a large, rural population (34% based on 2010 Census 36 ), which may present unique challenges to the provision of high-quality colonoscopies. We also examined geographic and temporal variation in practice settings (hospital vs ambulatory surgery centers [ASCs]) and annual procedure volume by physician medical specialty.…”