Volume and yield of screening colonoscopy at a tertiary medical center after change in medicare reimbursement

Prajapati, Devang; Saeian, Kia; Binion, David G.; Staff, David; Kim, Joseph P.; Massey, Benson T.; Hogan, Walter J.

doi:10.1111/j.1572-0241.2003.07172.x

Cited by 65 publications

(25 citation statements)

References 21 publications

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“…7). Effective July 1, 2001, Medicare does provide coverage for screening colonoscopy for all individuals, not just those at increased risk of colorectal cancer (8). Previous evidence suggests that there is the potential for a 75% to 90% reduction in colorectal cancer mortality with the use of colonoscopy and clearing polypectomy, substantially higher than the 60% to 70% estimated for sigmoidoscopy and 20% to 60% estimated for fecal occult blood test (6,(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 82%

Surveillance Patterns and Polyp Recurrence following Diagnosis and Excision of Colorectal Polyps in a Medicare Population

Amonkar

Hunt²,

Zhou³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Objective: Study objectives were to determine surveillance and polyp recurrence rates among older, increased-risk patients who have been diagnosed and excised of colorectal polyps. The high incidence of colorectal cancers in the Medicare-eligible population, the strong evidence linking reductions in mortality from colorectal cancer by removal of colorectal polyps, and the paucity of postpolypectomy surveillance data in this population all supported the need for this study. Methods: This retrospective study used Medicare claims data to identify a cohort of 19,895 beneficiaries ages z65 years diagnosed and excised of colorectal polyps in 1994. Survival analysis was used to compute surveillance and polyp recurrence rates over 5 years. Log-rank test was used for all statistical comparisons. Results: Median time to first surveillance was 2.6 years. Surveillance rates for 1, 3, and 5 years were 17.6%, 55.8%, and 74.5%, respectively. Twenty-six percent had no surveillance event. Polyp recurrence rates for 1, 3, and 5 years were 10.9%, 38.2%, and 52.6%, respectively. Males and younger patients were more likely to undergo surveillance and showed higher polyp recurrence rates.

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Section: Introductionmentioning

confidence: 82%

Surveillance Patterns and Polyp Recurrence following Diagnosis and Excision of Colorectal Polyps in a Medicare Population

Amonkar

Hunt²,

Zhou³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Since that time, there has been a dramatic increase in the performance of screening colonoscopies. 8,9 Despite its utility, colonoscopy has inherent limitations, some of which are operator-dependent. Several published studies have reported colonoscopy adenoma miss rates ranging from 6% to 27%.…”

Section: Introductionmentioning

confidence: 99%

Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time

Simmons

Harewood

Baron

et al. 2006

Aliment Pharmacol Ther

209

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SummaryBackgroundIn 2002, a U.S. Multi‐Society Task Force on Colorectal Cancer recommended that the withdrawal phase for colonoscopy should average at least 6–10 min. This was based on 10 consecutive colonoscopies by two endoscopists with different adenoma miss rates.AimsTo characterize the relationship between endoscopist withdrawal time and polyp detection at colonoscopy, and to determine the withdrawal time that corresponds to the median polyp detection rate.DesignProcedural data from out‐patient colonoscopies performed at the Mayo Clinic, Rochester during 2003 were reviewed. Endoscopists were characterized by their mean withdrawal time for a negative procedure and individual polyp detection rate.ResultsA total of 10 955 colonoscopies performed by 43 endoscopists were analysed. Median withdrawal time was 6.3 min (range: 4.2–11.9); polyp detection rate was 44.0% (all polyps), 29.8% (≤5 mm), 5.9% (6–9 mm), 6.7% (10–19 mm), 2.1% (≥20 mm). Longer withdrawal time was associated with higher polyp detection rate (r = 0.76; P < 0.0001); this relationship weakened for larger polyps (r = 0.19 for polyps 6–9 mm, r = 0.28 for polyps 10–19 mm, r = 0.02 for polyps ≥20 mm). Overall median polyp detection rate corresponded to a withdrawal time of 6.7 min.ConclusionOur findings support a colonoscopy withdrawal time of at least 7 min, which correlates with higher colon polyp detection rates.

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“…In recent years, the quantity of routine endoscopic examinations has grown considerably because of an aging population and an increased subject awareness of the benefits of cancer screening (1,2). Upper and lower gastrointestinal (GI) endoscopic examinations have been recommended for first-line screening of cancer because of increasing safety.…”

Section: Introductionmentioning

confidence: 99%

Sedation for gastrointestinal endoscopy with the application of target-controlled infusion

Chang

Tsai²,

Hsu³

et al. 2015

Turk J Gastroenterol

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Background/Aims: A majority of esophagogastroduodenoscopy (EGD) and colonoscopy procedures are performed under sedation, with the intravenous administration of a hypnotic agent combined with an opioid analgesic agent. The goal of our study was to establish the quality and plausibility of target-controlled infusion (TCI) as a sedation mechanism for upper and lower gastrointestinal (GI) endoscopies. Materials and Methods: A randomized, single-blinded, controlled clinical trial was arranged in a local community hospital. In total, 100 adult outpatients scheduled for upper and lower GI endoscopies were included and randomly allocated to a control group (n=50) and a TCI group (n=50). The sedation quality was assessed using the simplified quality of an anesthesia scoring system. Categorical parameters were compared using Pearson's chi-square test. Continuous parameters that were normally distributed were further compared using Student's t-test, and the others were compared using the Mann-Whitney test. Results: The significantly lower anesthesia quality score in the TCI group (12.2 vs. 12.7) indicated that the anesthesia quality was better in this group. Conclusion: This study showed that sedation using TCI for GI endoscopy provided safe and effective sedation and was associated with a better sedation quality. We believe that TCI can be used to provide routine sedation for patients receiving GI endoscopy.

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Volume and yield of screening colonoscopy at a tertiary medical center after change in medicare reimbursement

Cited by 65 publications

References 21 publications

Surveillance Patterns and Polyp Recurrence following Diagnosis and Excision of Colorectal Polyps in a Medicare Population

Surveillance Patterns and Polyp Recurrence following Diagnosis and Excision of Colorectal Polyps in a Medicare Population

Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time

Sedation for gastrointestinal endoscopy with the application of target-controlled infusion

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