The impact of exclusion criteria on a physician’s adenoma detection rate

Marcondes, Felippe O.; Dean, Katie; Schoen, Robert E.; Leffler, Daniel A.; Rose, Sherri; Morris, Michele; Mehrotra, Ateev

doi:10.1016/j.gie.2014.12.056

Cited by 26 publications

(13 citation statements)

References 39 publications

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“…For example, Abdul-Baki H. et al found a variation between ADR results obtained prior to the introduction of public reporting of colonoscopy quality (ADR 34.3 %) and those obtained once the transition to public reporting was completed (ADR 39.2 %) 19 . The overall ADR result of the current study is reasonably in line with those reported by others for screening colonoscopies, for example: in the United States 35.9 % 20 and in Brazil 27.1 % (females 25.3 % and males 30.6 %) 16 . In Peru there were two reports of ADRs for colonoscopies with indications other than screening: 10 % 21 and 27 %.…”

Section: Discussionsupporting

confidence: 92%

ADR evaluation of screening colonoscopies during 2016 – 2017 in a private health clinic in Peru

Moreno¹

2018

Endosc Int Open

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Background and study aims High-quality colonoscopy is fundamental for preventing colorectal cancer (CRC). The adenoma detection rate (ADR) is a key colonoscopy quality measure. The aim of this study was to establish the screening colonoscopy ADR of a tertiary referral center in Peru, identify the relationship between the ADR and patient age, sex and the colonoscopist, and determine the endoscopic and histopathological characteristics of the lesions found. Patients and methods A retrospective observational longitudinal study was undertaken between January 2016 and June 2017. Results Eight colonoscopists performed screening colonoscopies on 620 patients scoring ≥ 6 points on the Boston Bowel Preparation Scale (BBPS); cecal intubation was complete in 595 patients (cecal intubation rate [CIR] 95.9 %). The overall ADR was 29.7 % (females 25.4 %, males 33.1 %, P = 0.040, 95 %Cl). The ADR colonoscopist range was 25.0 % to 34.4 %. The highest ADR (41.2 %, P = 0.013, 95 %Cl) was for patients aged 65 to 75 years. Adenoma colon locations were: left 49 %, transverse 21.6 % and right 29.4 %. Adenoma dysplasia grades: low 98 %, high 2 %. Sixty-three percent of the lesions were 5 mm to 10 mm. Resections performed: 78.5 % cold biopsy forceps (CBF), 3.4 % cold snare polypectomy (CSP) and 18.1 % endoscopic mucosal resection (EMR). Conclusions The ADR established was in line with the joint American College of Gastroenterology (ACG)/American Society for Gastrointestinal Endoscopy (ASGE) recommendations and related to patient age and gender but not to the colonoscopist. Colonoscopists should ensure rigorous application of the colonoscopy quality actions. ADR should be evaluated frequently.

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Section: Discussionsupporting

confidence: 92%

ADR evaluation of screening colonoscopies during 2016 – 2017 in a private health clinic in Peru

Moreno¹

2018

Endosc Int Open

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“…The moderate discriminative ability of our patient-factor based prediction model for adenoma detection is in line with a recent study in which adjustment of the ADR for age, sex, race/ethnicity, and family history of CRC did reduce the variability in ADRs but had only a small effect on the differences of ADRs between physicians. [ 41 ] In another study excluding different patient subgroups from ADR calculations changed ADRs substantially, but had only a small effect on the ADR ranking among physicians[ 42 ] suggesting that factors, such as physician-related, procedural or technological factors, are likely to influence the ADR. A physician-effect might also be part of the explanation of the ADR increase during the first ten years of the German CRC screening program, because physicians who started to perform screening colonoscopy detected more adenomas compared to physicians who stopped performing colonoscopies.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates

et al. 2017

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ObjectiveThe adenoma detection rate (ADR) varies widely between physicians, possibly due to patient population differences, hampering direct ADR comparison. We developed and validated a prediction model for adenoma detection in an effort to determine if physicians’ ADRs should be adjusted for patient-related factors.Materials and methodsScreening and surveillance colonoscopy data from the cross-sectional multicenter cluster-randomized Endoscopic Quality Improvement Program-3 (EQUIP-3) study (NCT02325635) was used. The dataset was split into two cohorts based on center. A prediction model for detection of ≥1 adenoma was developed using multivariable logistic regression and subsequently internally (bootstrap resampling) and geographically validated. We compared predicted to observed ADRs.ResultsThe derivation (5 centers, 35 physicians, overall-ADR: 36%) and validation (4 centers, 31 physicians, overall-ADR: 40%) cohort included respectively 9934 and 10034 patients (both cohorts: 48% male, median age 60 years). Independent predictors for detection of ≥1 adenoma were: age (optimism-corrected odds ratio (OR): 1.02; 95%-confidence interval (CI): 1.02–1.03), male sex (OR: 1.73; 95%-CI: 1.60–1.88), body mass index (OR: 1.02; 95%-CI: 1.01–1.03), American Society of Anesthesiology physical status class (OR class II vs. I: 1.29; 95%-CI: 1.17–1.43, OR class ≥III vs. I: 1.57; 95%-CI: 1.32–1.86), surveillance versus screening (OR: 1.39; 95%-CI: 1.27–1.53), and Hispanic or Latino ethnicity (OR: 1.13; 95%-CI: 1.00–1.27). The model’s discriminative ability was modest (C-statistic in the derivation: 0.63 and validation cohort: 0.60). The observed ADR was considerably lower than predicted for 12/66 (18.2%) physicians and 2/9 (22.2%) centers, and considerably higher than predicted for 18/66 (27.3%) physicians and 4/9 (44.4%) centers.ConclusionThe substantial variation in ADRs could only partially be explained by patient-related factors. These data suggest that ADR variation could likely also be due to other factors, e.g. physician or technical issues.

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“…Since our intent was to examine the ADR for screening colonoscopies, surveillance colonoscopies (N = 15,661), diagnostic colonoscopies (N = 10,237) and colonoscopies with no indication (N = 2,129) were not included in this analysis 22 . A surveillance indication was specified for a colonoscopy performed on patients with a personal history of CRC and/or personal history of polyps and on patients with familial polyposis or hereditary non-polyposis colon cancer or inflammatory bowel disease (IBD).…”

Section: Methodsmentioning

confidence: 99%

Adenoma Detection Rates for Screening Colonoscopies in Smokers and Obese Adults

Anderson

Weiss

Robinson³

et al. 2017

Journal of Clinical Gastroenterology

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Goal To examine screening adenoma detection rates (ADR) and serrated detection rates (SDR) among smokers and obese adults in the New Hampshire Colonoscopy Registry. Background ADR, a quality measure for screening colonoscopies, is associated with protection from interval colorectal cancer (CRC). Currently, only sex-specific ADR benchmarks are reported. However, obesity and smoking ≥ 20 pack-years are strong predictors for colorectal neoplasia, as highlighted by the 2009 American College of Gastroenterology CRC Screening Guidelines. Data comparing ADR in smokers and obese adults to those without these risks are limited. Study We calculated ADR, SDR and 95% confidence intervals for screening colonoscopies in participants ≥ 50 years. Sex and sex-age specific rates were compared by smoking exposure (never versus < 20 pack-years versus ≥ 20 pack-years) and body mass index (BMI < 30 versus BMI ≥ 30). Results 21,539 screening colonoscopies were performed by 77 endoscopists at 20 facilities (4/2009 -9/2013). The difference in ADR between non-smokers and smokers with ≥ 20 pack-years was 8.8% (p < 0.0001) and between obesity groups 5.0% (p<0.0001). Significant sex specific and sex-age specific increases in ADR and SDR were found among smokers and obese participants. Conclusions ADR and SDR for smokers and obese adults were significantly higher than their counterparts without those risks. Endoscopists should consider the prevalence of these risks within their screening population when comparing their rates to established benchmarks. Calculating sex or sex-age specific ADR and SDR based on smoking and obesity may provide optimal protection for populations with a particularly high prevalence of smokers and obese adults.

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The impact of exclusion criteria on a physician’s adenoma detection rate

Cited by 26 publications

References 39 publications

ADR evaluation of screening colonoscopies during 2016 – 2017 in a private health clinic in Peru

ADR evaluation of screening colonoscopies during 2016 – 2017 in a private health clinic in Peru

Development and validation of a prediction model for adenoma detection during screening and surveillance colonoscopy with comparison to actual adenoma detection rates

Adenoma Detection Rates for Screening Colonoscopies in Smokers and Obese Adults

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