Variation in Colonoscopic Technique and Adenoma Detection Rates at an Academic Gastroenterology Unit

Abstract

The purpose of this research is to evaluate the quality of colonoscopy at an academic institution with a focus on factors influencing withdrawal times and adenoma detection rates. Procedural data and pathologic results of 550 consecutive screening colonoscopies in average risks patients (mean [+/-SD] age, 57 +/- 7.6, 44% male) completed by ten academic gastroenterologists were reviewed. Per individual gastroenterologist, the adenoma detection rates ranged widely from 0.09 to 0.82 adenomas per patient with a mean of 0.46 for the group. The mean withdrawal time was 7.0 min for the group and ranged from 3.4 to 9.6 min. There was a significant positive relationship between the number of adenomas detected and the withdrawal time (P = 0.006). Endoscopists with cecal intubation time to withdrawal time ratios of less than 1 detected significantly more adenomas compared to endoscopists with ratios greater than 1 (P = 0.001). (1) Significant variation in academic gastroenterologists' abilities to detect adenomas during screening colonoscopies exists. (2) Colonoscopic withdrawal time and the cecal intubation to withdrawal time ratio are important factors associated with increased adenoma detection rates.

Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule

“…However, shift of day is a less significant predictive factor for PDR than mean endoscopist WT, patient age, and patient gender. Withdrawal time has been associated with PDR in multiple studies, [12][13][14][15] and our study again confirms a strong linear relationship between the 2 variables. It remains unclear why PDR is higher in the midday shift than in the morning or afternoon shifts.…”

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

“…First, no information about physicians' experience, specialization, and setting (hospital or private practice) was available, which might be important factors in the detection of CRC and its precancerous lesions (Adler et al, 2012). Second, examination or withdrawal times of screening colonoscopies were not known, which have been shown to be associated with neoplasm detection rates (Barclay et al, 2006;Simmons et al, 2006;Barclay et al, 2008;Benson et al, 2010;Lee et al, 2013). Therefore, it was not possible to assess the impact of these specific determinants of the colorectal neoplasm detection rate identified in previous studies.…”

“…The adenoma detection rate has been suggested as an indicator of the quality of screening colonoscopy (Kaminski et al, 2010). Reported adenoma detection rates have varied widely across populations (Barclay et al, 2006;Church, 2008;Millan et al, 2008;Benson et al, 2010;Kaminski et al, 2010;Ferlitsch et al, 2011;Adler et al, 2012;Coriat et al, 2012;Pox et al, 2012;Barret et al, 2013;Greenspan et al, 2013;Corley et al, 2014), but this variation might partly reflect differences in neoplasm prevalences between those populations. A few studies specifically focused on interphysician variation in detection rates within the same study population, showing a wide range of adenoma detection rates among colonoscopists (Millan et al, 2008;Adler et al, 2012;Greenspan et al, 2013;Corley et al, 2014).…”

Quality evaluation of colonoscopy reporting and colonoscopy performance in daily clinical practice

“…Finally, the quality of colonoscopy varies greatly among individual endoscopists. 22,30,31,35 Thus, reasons for variance can lie in individual endoscopist characteristics or techniques. Feedback, education, and training programs should thus be tailored to improve specific factors.…”