Screening colonoscopy volume and detection of colorectal neoplasms: a state-wide study from Bavaria, Germany

Abstract

Screening colonoscopy enables early detection of colorectal cancer and its precancerous lesions. The aim of this study was to assess the association of screening colonoscopy volume with colorectal neoplasm detection rate in routine practice. A registry-based study of individuals aged at least 55 years who underwent screening colonoscopy in Bavaria, Germany, between 2007 and 2009 was performed. Colorectal neoplasm detection rates (95% confidence intervals) were determined per physician. Physicians were grouped according to the number of screening colonoscopies performed per year (<50, 50-99, 100-199, ≥200). A total of 203 363 individuals (median age 64 years, 55.2% women) underwent screening colonoscopy between 2007 and 2009. Colonoscopies were performed by 509 physicians. The detection rate of any neoplasm increased with screening colonoscopy volume from 21.9% among physicians conducting fewer than 50 screening colonoscopies per year to 27.5% among physicians conducting 200 or more screening colonoscopies per year (P-value for trend <0.0001). Increases in detection rates with colonoscopy volume were also observed for advanced neoplasms and for colorectal cancer (P-value for trend 0.16 and <0.0001, respectively). Differences were largest between physicians conducting fewer than 50 screening colonoscopies per year and other physicians. These results support a potential role of a minimum colonoscopy volume for high-quality colonoscopy screening. Differences in neoplasm detection rates were high between physicians conducting fewer than 50 screening colonoscopies per year and physicians with higher screening colonoscopy volume.

Real-World National Colonoscopy Volume in Korea: A Nationwide Population-Based Study over 12 Years

“…In addition, we cannot assess detailed clinical information for the cause of an early repeat colonoscopy within 12 months. We defined high-volume facility (i.e., annual colonoscopy volume ≥200) based on some evidence, 16,17 but it may still be arbitrary as it was a criterion for an endoscopist, not a healthcare facility. In a German screening colonoscopy registry, the detection rate of any neoplasm was better for annual colonoscopy volume ≥200 than annual colonoscopy volume <50 (27.5% vs 21.9%, p<0.001).…”

“…In a German screening colonoscopy registry, the detection rate of any neoplasm was better for annual colonoscopy volume ≥200 than annual colonoscopy volume <50 (27.5% vs 21.9%, p<0.001). 16 Spanish Society of Gastrointestinal Endoscopy also recommended at least 200 annual screening colonoscopies to maintain colonoscopy quality in CRC screening. 17 In conclusion, the national volume of colonoscopy has been progressively increasing regardless of sex, age group, and healthcare facility types for the past 12 years in Korea.…”

“…A high-volume facility was defined as a facility with an annual colonoscopy volume more than 200 cases, because the minimum volume of annual colonoscopy to maintain competency for colonoscopy was 200 cases per year and other universal definition is not available. 16,17 As a unique situation in Korea, primary healthcare facility includes profit health promotion centers which account for most of high-volume center. As the information used in this study was related only to pseudonyms, the requirement of informed consent was waived.…”

Disparities in Utilization of Medical Specialists for Colonoscopy

“…Finally, medical specialists who perform colonoscopy tend to perform a higher volume of procedures, 24,38 which may be a major driving force behind better quality and colorectal outcomes. 39,40 Some studies have found that despite volume or experience, GEs have superior quality outcomes. 11,41 Other studies have shown that primary care physicians have the ability to have comparable metrics with colonoscopy specialists with the appropriate training and support.…”

Diagnosis accuracy of Raman spectroscopy in colorectal cancer

“…Historically, detecting cancer at early stage and removing adenoma is a critical measure to reduce the incidence and mortality of colorectal cancer (CRC). [1,2] However, worldwide CRC is the second most common cancer in males (9%) and the third most common cancer in females (8%) with an estimated 1.2 million new cases per year, and ranks fourth in mortality with an approximately 0.5 million deaths annually [3–5] due to the lack of efficient diagnostic tools and effective therapy. Currently, colonoscopy based on biopsy or on endoscopic tissue characterization and classification in vivo using chromoendoscopy and Kudo classifications is main auxiliary examination for colorectal lesions.…”