Temporal trends and variability of colonoscopy performance in a gastroenterology practice

Clercq, Chantal M. C. le; Mooi, Rick; Winkens, Björn; Salden, Bouke; Bakker, C. M.; Nunen, Annick B. van; Keulen, Eric; Ridder, Rogier J. De; Masclee, Ad; Sanduleanu, Silvia

doi:10.1055/s-0041-111117

Cited by 14 publications

(11 citation statements)

References 33 publications

(43 reference statements)

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“…The improvement in SSADR and PSLDR likely reflects the learning effect associated with increased exposure to serrated lesions over time, as the colonoscopist’s practice expanded since graduating from the training program. This learning effect is similarly demonstrated in a Dutch study, where a significant improvement in ADR and SSADR was observed in participating colonoscopists after a standardized education program was implemented (ADR 22.5 % vs 25.8 %; P < 0.001) and SSADR (10.0 % vs 13.5 %; P < 0.001) 8 .…”

Section: Discussionsupporting

confidence: 64%

Increasing rates of SSA/P detection in a large open-access Australian colonoscopy cohort

et al. 2019

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Background and study aims There are limited longitudinal data regarding detection rates for sessile serrated adenoma/polyps (SSADR) and right-sided hyperplastic polyps (RHPDR) that constitute the proximal serrated lesion detection rate (PSLDR). Recently, a minimum PSLDR of 4.5 % has been suggested. This study was designed to assess SSADR, PSLDR and adenoma detection rate (ADR) for a newly qualified gastroenterologist and compare them to published data and to assess the change in SSADR, PSLDR and ADR over time for potential improvement with experience. Patients and methods All colonoscopies performed by a single colonoscopist (AM), at one Australian ambulatory direct-access endoscopy center over 4 years from 2011 to 2015 were retrospectively analyzed. Histology was reported by a single expert pathologist (SL). ADR, SSADR, RHPDR and PSLDR were recorded. Results A total of 841 colonoscopies were performed on 637 patients. Of them, 454 (54 %) were males. Mean age was 59 years. Of the colonoscopies, 87 % were performed for patients with ASA scores of 1 – 2, 422 (50.2 %) were for screening or surveillance, 374 (44.5 %) for investigation of symptoms and 45 (5.4 %) had therapeutic indications. Conventional adenomas were detected in 346 colonoscopies (ADR = 41.1 %), SSA/P in 124 (SSADR = 14.7 %) and RHP in the absence of SSA/P in 35 (RHPDR = 4.2 %). PSLDR was 18.9 %. ADR was stable over time (range 33 %-50 %). SSADR and PSLDR increased over time [SSADR: 8.6 % (2011), 8.4 % (2012), 14.9 % (2013), 18.5 % (2014), 25.0 % (2015); PSLDR: 10.5 % (2011), 11.3 % (2012), 16.8 % (2013), 27.2 % (2014), 29.4 % (2015)]. There was a statistically significant improvement in SSADR (IRR 1.37) and PSLDR (IRR 1.36) over the study period (P < 0.001), whereas the ADR remained stable (IRR 1.04, P = 0.334). Conclusions SSADR and PSLDR in this unselected direct-access cohort are high and exceed previously reported detection rates in the final 2 years. Detection rates improved with experience, likely representing a learning effect. The minimum expected PSLDR may need to be revised upwards and further studies are required, particularly in areas where screening colonoscopies are offered only for patients with increased colorectal cancer risk (family history or fecal immunochemical test-positive).

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Section: Discussionsupporting

confidence: 64%

Increasing rates of SSA/P detection in a large open-access Australian colonoscopy cohort

et al. 2019

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“…Despite the loss of one health worker in this outbreak, it is noteworthy that none of the Health care workers at BSUTH to whom most cases were referred to remained asymptomatic. This could be a signal to the improved barrier nursing methods adopted in care and support of patients [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…These sites were found in two local government areas namely, Makurdi and Okpokwu Local Government Areas. Markurdi Local Government Area is one of the 23 LGAs that make up State. It is situated on the northern part of the State and is the first Local Government to be accessed if entering Benue State through the Abuja-Nasarawa route.…”

Section: Sites Of Investigationmentioning

confidence: 99%

Lassa Fever Epidemic in Nigeria - Outbreak Investigation, Risk Factors and Empirical Analysis from 2012 To 2016

Saka¹,

Gubio²,

Kerecvel³

et al. 2017

J Comm Pub Health Nurs

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Lassa haemorrhagic fever caused by the Lassa virus is an acute, highly infectious zoonotic disease. Magnitude of disease is becoming greater with increasing mortality and morbidity and spread to other area in Nigeria. The study accessed outbreak outcome, risk factors and empirical analysis from 2012 to 2016.Active case search conducted included health facilities that treated confirmed and suspect cases, as well as their residential and business premises using questionnaire and Laboratory analysis. All cases were identified based on the adopted case definition of a person with severe illness of <3 weeks duration and temperature ≥ 38ºC. Individuals with potential direct exposure to Lassa virus through contact with a case were risk assessed. Evidence from data LF cases recorded for five years were analysis using Epi Info 6.A total of Eight (8) cases were seen during the period of investigation. Three (3) was confirmed, one of the confirmed case who was a doctor died. Case fatality rate is 37.5%. Over 50% of the cases are aged between 25-40 years. Median age is 26 year with range 1-55years. Five of the eight cases (62.5%) are males. 100% of patients live in Markudi but 86.5% are Ibo settlers. Out of the 53 contacts that were assessed for risk, 25 (47.2%) were categorized as no risk, 25 (47.2%) were categorized as low risk, while 3 (5.6%) were high risk contacts. Between the period of five years 5051 cases conformed, with 3891 death from LF with case fatality of 77.03%. Risk factors for transmission not limited ethical believe, ignorance and misinformation.LF infection is on increase, affecting both health and non-health workers Over half of the contacts had direct contact with this case. Adopting proper standard precautions in hospitals as well as communities is recommended.

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“…[15, 25–27] Nevertheless, there is evidence that endoscopic detection of SSA/Ps is improving over time. [15, 28, 29]…”

Section: Endoscopic Detectionmentioning

confidence: 99%

Management of Serrated Polyps of the Colon

Fan

Younis

Bookhout

et al. 2018

Curr Treat Options Gastro

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Patients with SSA/Ps are at an increased risk of future colorectal neoplasia, including advanced polyps and cancer. Reasonable benchmarks for SP detection rates are 5-7% for SSA/Ps and 10-12% for proximal SPs. Certain endoscopic techniques such as chromoendoscopy, narrow band imaging, water immersion, and wide-angle viewing may improve SSA/P detection. Emerging endoscopic techniques such as underwater polypectomy, suction pseudopolyp technique, and piecemeal cold snare polypectomy are helpful tools for the endoscopist's armamentarium for removing SSA/Ps. Proper orientation of SSA/P specimens can improve the accuracy of pathology readings. Patients with confirmed SSA/Ps and proximal HPs should undergo surveillance at intervals similar to what is recommended for patients with conventional adenomas. Patients with SSA/Ps may also be able to lower their risk of future polyps by targeting modifiable risk factors including tobacco and alcohol use and high-fat diets. NSAIDs and aspirin appear to be protective agents. SPs and SSA/Ps in particular are important colorectal cancer precursors that merit special attention to ensure adequate detection, resection, and surveillance.

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Temporal trends and variability of colonoscopy performance in a gastroenterology practice

Abstract: http://www.trialregister.nl.

Cited by 14 publications

References 33 publications

Increasing rates of SSA/P detection in a large open-access Australian colonoscopy cohort

Increasing rates of SSA/P detection in a large open-access Australian colonoscopy cohort

Lassa Fever Epidemic in Nigeria - Outbreak Investigation, Risk Factors and Empirical Analysis from 2012 To 2016

Management of Serrated Polyps of the Colon

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