Significant Variation in the Detection Rates of Proximal Serrated Polyps Among Academic Gastroenterologists, Community Gastroenterologists, and Colorectal Surgeons in a Single Tertiary Care Center

Proximal Sessile Polyps: Raised Expectations for the Detection of Flat Lesions

“…In conclusion, Mandaliya et al [5] have shown that there is a significant difference in the PSPDR among academic gastroenterologists, community gastroenterologists, and colorectal surgeons. Their findings, in the context of the existing literature, suggest that the low and variable PSPDR among endoscopists is likely a result of a combination of differences in training, practice volume, and continuing education.…”

“…Although changes in attitudes toward recognizing the importance of proximal serrated polyps and colorectal cancer have led to the introduction of consensus guidelines regarding serrated polyps as recently as 2012, translation into practice may be lagging [9]. The authors of this paper suggest a minimum PSPDR of 9% based on the current literature as a benchmark metric, which many endoscopists fall below in the current literature [5]. While evidence-based benchmarks are important, equally important are suggestions on how to raise the standards of the national colonoscopy community to a new designated level.…”

“…Many of these prior studies are limited by having data restricted to that of a single institution; this study is no different [5]. This is an important factor when considering the results of this study as it has been previously shown that there is wide variability on PSPDR at the endoscopy center level, suggesting that practice culture of an individual institution or education curriculum may impact the standard practices of its endoscopists [8].…”

“…In this issue of Digestive Diseases and Sciences, Mandaliya et al [5] compare the rate of proximal serrated polyp detection in three different groups of physicians performing screening colonoscopies: academic gastroenterologists, community gastroenterologists, and colorectal surgeons. In this single-institution retrospective review, all complete screening colonoscopies were performed on patients > age 50 with good or excellent bowel preparation performed by 18 endoscopists between July 2015 and December 2017.…”

“…Importantly, prior studies compare cohorts of endoscopists that are more mixed-often combining general surgeons and colorectal surgeons, or all non-gastroenterologists into a single group. Although the authors of the current study appropriately separate their endoscopists into three groups which may differ in training background, volume, and practice locations, their analysis is limited in that they did not adjust for other procedural or patient characteristics [5].…”