Substantial and sustained improvement of serrated polyp detection after a simple educational intervention: results from a prospective controlled trial

Bleijenberg, Arne; Leerdam, Monique E. van; Bargeman, Marloes; Koornstra, Jan J.; Herwaarden, Yasmijn van; Spaander, Manon; Sanduleanu, Silvia; Bastiaansen, Barbara A.; Schoon, Erik J.; Lelyveld, Niels van; Dekker, Evelien; IJspeert, Joep E. G.

doi:10.1136/gutjnl-2019-319804

Cited by 23 publications

(31 citation statements)

References 50 publications

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“…However, ADR also increased at the control sites (from 36% to 39%); therefore, there was only limited evidence of a training effect. 34 A randomised trial from Dutch hospitals showed that two 45 min training sessions improved the detection rate for SSPs from 9.3% to 15.6% 35 A meta-analysis of 12 intervention studies (1 randomised controlled trial (RCT) and 11 non-RCTs involving 154 endoscopists and 33 184 colonoscopies) compared ADR prefeedback and postfeedback interventions. 36 The pooled ADR at baseline was 30.5% and 36% after intervention.…”

Section: Discussionmentioning

confidence: 99%

Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy

Fraser

Rose²,

Wong³

et al. 2020

BMJ Open Gastroenterol

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BackgroundThe audit process may help improve performance indicators for colonoscopy quality but it is unclear whether this is sustained over several years.Methods44138 procedures for 28 endoscopists from 2004 to 2019 were analysed for polyp detection rate and withdrawal time. From 2012, 14 endoscopists were analysed with additional data on polyp histology and number of polyps removed.ResultsPolyp detection increased from 40.7% in 2004 to 62.2% in 2019; removal of polyps>1 cm remained constant (11%). Adenoma detection rate was 25.8% in 2012 and 28.3% in 2019. Sessile serrated polyp (SSP) detection rate increased from 4.5% to 14.7%; most of the increase was in the first 2 years of the histology part of the audit. There was a significant correlation of adenoma detection rate with mean number of adenomas (r=0.72, p=0.004) and a significant correlation of SSP detection with mean number of SSPs (r=0.85, p=0.0001).ConclusionThe audit process appears to encourage a higher rate of polyp detection. This was due to increased detection of smaller polyps and increased detection of SSPs.

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Section: Discussionmentioning

confidence: 99%

Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy

Fraser

Rose²,

Wong³

et al. 2020

BMJ Open Gastroenterol

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“…32 Increased awareness of the clinical importance of SSA/P through educational training had also been shown to improve SSA/PDR. 33 ADR and AADR are positively correlated with SSA/PDR. 7,8 However, unlike ADR, existing knowledge on SSA/P and their detection are considerably limited, which makes our report clinically relevant.…”

Section: Discussionmentioning

confidence: 87%

Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta‐analysis

Shao

Romero

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Sessile serrated adenoma/polyp (SSA/P) may contribute to interval cancer. In a recent meta-analysis, water exchange (WE) was shown to be superior to Endocuff and cap colonoscopy at adenoma and advanced adenoma detection. The strong positive correlation between adenoma detection rate (ADR), advanced adenoma detection rate (AADR), and sessile serrated adenoma/polyp detection rate (SSA/PDR) prompted us to hypothesize that WE could significantly improve SSA/PDR compared with Endocuff and cap colonoscopy. Methods: The literature was searched for all randomized controlled trials (RCTs) that reported SSA/PDR as an outcome and included the keywords colonoscopy, and water exchange, Endocuff, or cap. We performed traditional network meta-analyses with random effect models comparing SSA/PDR of each method using air insufflation as the control and reported the odds ratios (ORs) with 95% confidence interval (CI). Performances were ranked based on P-score. Results: A total of 531 articles resulted from initial keywords search. Eleven RCTs were included in the analysis. A total of 7856 patients underwent air insufflation, WE, Endocuff, or cap colonoscopy. WE significantly increased SSA/PDR (OR 2.04; 95% CI 1.33-3.13). Endocuff (OR 1.15; 95% CI 0.94-1.41) and cap (OR 1.08; 95% CI 0.42-2.74) did not significantly impact SSA/P detection. P-scores for WE (0.96), Endocuff (0.49), cap (0.37), and air insufflation (0.17) suggested that WE had the highest SSA/PDR. The results did not change after adjusting for mean withdrawal time and indication for colonoscopy. Conclusion: Water exchange significantly increases SSA/PDR and is superior to Endocuff and cap colonoscopy at detecting SSA/P.

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“…As the second point, we evaluated the CSSDR as well as the ADR and showed that just feedback without training made CSSDR rise. Bleijenberg et al 16 reported educational interventions improved proximal SP detection rate. However, our study indicated that just feedback might be enough.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we compared data before and after feedback in a short period. The long-term effect of the feedback is controversial 12 16 . Additionally, we did not clarify whether the simple feedback given only once or just the fact of being continuously observed after the feedback improved the studied outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopy training improved the ADR 10 11 12 13 , mean number of adenomas per procedure (MAP) 14 , sessile serrated lesion (SSL) detection rate 15 , and proximal SP detection rate 16 . Lam et al reported that colonoscopy training improved interval CRC rates from 0.15 % to 0.08 % and early interval CRC rates from 0.07 % to 0.04 % 17 .…”

Section: Introductionmentioning

confidence: 99%

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Simple feedback of colonoscopy performance improved the number of adenomas per colonoscopy and serrated polyp detection rate

et al. 2021

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Background and study aims High-quality endoscopy requires improvement of not only the adenoma detection rate (ADR) but also the serrated polyp (SP) detection rate and the mean number of adenomas per positive procedure (MAP +). We evaluated whether a simple feedback of colonoscopy performance improves those quality indicators using propensity-score matching. Patients and methods Eleven endoscopists were evaluated regarding colonoscopy performance including ADRs, SP detection rates, mean numbers of adenomas per procedure (MAPs), and MAPs + with their ranking in the clinic. Endoscopic performance was compared before and after the feedback. Results Colonoscopies were performed for 874 patients before the feedback and 1,272 patients after the feedback. Using propensity-score matching, 803 patients before the feedback and 803 patients after the feedback were matched. ADR after the feedback was significantly higher than that before the feedback (50.8 % and 40.8 %, respectively). MAP after feedback was significantly larger than that before the feedback (0.92 and 0.69, respectively), as well as MAP + (1.96 and 1.69, respectively). Clinically significant SP detection rate was also improved from 10.0 % to 14.9 %. Conclusions Feedback including ADR, MAP, MAP +, and clinically significant SR detection rate could improve on those quality indicators. Further studies are needed to effectively prevent colorectal cancer in colonoscopy practice.

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Substantial and sustained improvement of serrated polyp detection after a simple educational intervention: results from a prospective controlled trial

Cited by 23 publications

References 50 publications

Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy

Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy

Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta‐analysis

Simple feedback of colonoscopy performance improved the number of adenomas per colonoscopy and serrated polyp detection rate

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