|
1
|
Cheloff AZ, Lee B, Kim L, Karnik N, Lin E, Lee M, Dikman A, Poles M, Williams R, Vignesh S, Popov V. Multicenter evaluation of the impact of COVID-19 on the uptake of endoscopic skills by gastroenterology trainees. Surg Endosc 2025; 39:2551-2557. [PMID: 40029382 DOI: 10.1007/s00464-025-11633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 02/18/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic significantly decreased procedural volume in 2020, thus limiting training opportunities. First-year fellows (1YF) are particularly susceptible to reduction in endoscopic volume as they build foundational endoscopic skills. We used an objective validated tool, the Assessment of Competency in Endoscopy (ACE), to determine the effect of the pandemic on endoscopy competency in gastroenterology fellows. METHODS This was a prospective cohort study conducted across two fellowship programs in New York City. Our primary outcome was the comparison of ACE scores of fellows starting gastroenterology fellowships in 2020 to the scores of those starting in 2016-2018. Our secondary outcome was to compare colonoscopy quality metrics and endoscopy volume between these cohorts. RESULTS ACE scores were available from 11 pandemic and 10 pre-pandemic 1YFs, and five pandemic and 19 pre-pandemic second (2YF) and third-year fellows (3YF). ACE scores for 1YFs showed significantly higher rating in the pre-pandemic cohort for 4 domains including knowledge of indications and medical issues (p = 0.03), effective and efficient use of air, water, and suction (p = 0.04), pathology identification (p = 0.001), and overall hands-on skills (p = 0.004). 2YFs showed no significant differences. 3YFs showed significantly lower scores in the pandemic cohort in the effective and efficient use of air, water, and suction (p = 0.03), fellows' knowledge of therapeutic tools (p = 0.05), and fellows overall cognitive skills (p = 0.05). There were no significant differences in quality metrics between the cohorts, except longer procedure time for the pandemic cohort (p < 0.01). CONCLUSION Following the COVID-19 pandemic, there was a decline in multiple aspects of endoscopic competency both at the beginning and the end of fellowship training. These trends are likely the result of a decrease in overall procedure volume early in training and highlight the need for supplementing trainee education with other modalities.
Collapse
Affiliation(s)
| | | | - Leah Kim
- NYU Langone Health, New York, NY, USA
| | - Nihaal Karnik
- SUNY Downstate Health Sciences University, New York City, NY, USA
| | | | | | | | - Michael Poles
- NYU Langone Health, New York, NY, USA
- VA New York Harbor Health Care, 423 East 23 Street, New York, NY, USA
| | | | | | - Violeta Popov
- NYU Langone Health, New York, NY, USA.
- VA New York Harbor Health Care, 423 East 23 Street, New York, NY, USA.
| |
Collapse
|
|
2
|
Gangwani MK, Haghbin H, Ishtiaq R, Hasan F, Dillard J, Jaber F, Dahiya DS, Ali H, Salim S, Lee-Smith W, Sohail AH, Inamdar S, Aziz M, Hart B. Single Versus Second Observer vs Artificial Intelligence to Increase the ADENOMA Detection Rate of Colonoscopy-A Network Analysis. Dig Dis Sci 2024; 69:1380-1388. [PMID: 38436866 PMCID: PMC11026252 DOI: 10.1007/s10620-024-08341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND AIMS Screening colonoscopy has significantly contributed to the reduction of the incidence of colorectal cancer (CRC) and its associated mortality, with adenoma detection rate (ADR) as the quality marker. To increase the ADR, various solutions have been proposed including the utilization of Artificial Intelligence (AI) and employing second observers during colonoscopies. In the interest of AI improving ADR independently, without a second observer, and the operational similarity between AI and second observer, this network meta-analysis aims at evaluating the effectiveness of AI, second observer, and a single observer in improving ADR. METHODS We searched the Medline, Embase, Cochrane, Web of Science Core Collection, Korean Citation Index, SciELO, Global Index Medicus, and Cochrane. A direct head-to-head comparator analysis and network meta-analysis were performed using the random-effects model. The odds ratio (OR) was calculated with a 95% confidence interval (CI) and p-value < 0.05 was considered statistically significant. RESULTS We analyzed 26 studies, involving 22,560 subjects. In the direct comparative analysis, AI demonstrated higher ADR (OR: 0.668, 95% CI 0.595-0.749, p < 0.001) than single observer. Dual observer demonstrated a higher ADR (OR: 0.771, 95% CI 0.688-0.865, p < 0.001) than single operator. In network meta-analysis, results were consistent on the network meta-analysis, maintaining consistency. No statistical difference was noted when comparing AI to second observer. (RR 1.1 (0.9-1.2, p = 0.3). Results were consistent when evaluating only RCTs. Net ranking provided higher score to AI followed by second observer followed by single observer. CONCLUSION Artificial Intelligence and second-observer colonoscopy showed superior success in Adenoma Detection Rate when compared to single-observer colonoscopy. Although not statistically significant, net ranking model favors the superiority of AI to the second observer.
Collapse
Affiliation(s)
| | - Hossein Haghbin
- Department of Gastroenterology and Hepatology, Ascension Providence Hospital, Southfield, MI, USA
| | - Rizwan Ishtiaq
- Department of Medicine, St Francis Hospital and Medical Center, Hartford, CT, USA
| | - Fariha Hasan
- Department of Internal Medicine, Cooper University Hospital, Camden, NJ, USA
| | - Julia Dillard
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Dushyant Singh Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Hassam Ali
- Department of Gastroenterology and Hepatology, East Carolina University Health, Greenville, NC, USA
| | - Shaharyar Salim
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Amir Humza Sohail
- Department of General Surgery, New York University Langone Health, Long Island, NY, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Benjamin Hart
- Depertment of Hepatology and Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
|
3
|
Xu J, Kuai Y, Chen Q, Wang X, Zhao Y, Sun B. Spatio-Temporal Feature Transformation Based Polyp Recognition for Automatic Detection: Higher Accuracy than Novice Endoscopists in Colorectal Polyp Detection and Diagnosis. Dig Dis Sci 2024; 69:911-921. [PMID: 38244123 PMCID: PMC10960915 DOI: 10.1007/s10620-024-08277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Artificial intelligence represents an emerging area with promising potential for improving colonoscopy quality. AIMS To develop a colon polyp detection model using STFT and evaluate its performance through a randomized sample experiment. METHODS Colonoscopy videos from the Digestive Endoscopy Center of the First Affiliated Hospital of Anhui Medical University, recorded between January 2018 and November 2022, were selected and divided into two datasets. To verify the model's practical application in clinical settings, 1500 colonoscopy images and 1200 polyp images of various sizes were randomly selected from the test set and compared with the STFT model's and endoscopists' recognition results with different years of experience. RESULTS In the randomized sample trial involving 1500 colonoscopy images, the STFT model demonstrated significantly higher accuracy and specificity compared to endoscopists with low years of experience (0.902 vs. 0.809, 0.898 vs. 0.826, respectively). Moreover, the model's sensitivity was 0.904, which was higher than that of endoscopists with low, medium, or high years of experience (0.80, 0.896, 0.895, respectively), with statistical significance (P < 0.05). In the randomized sample experiment of 1200 polyp images of different sizes, the accuracy of the STFT model was significantly higher than that of endoscopists with low years of experience when the polyp size was ≤ 0.5 cm and 0.6-1.0 cm (0.902 vs. 0.70, 0.953 vs. 0.865, respectively). CONCLUSIONS The STFT-based colon polyp detection model exhibits high accuracy in detecting polyps in colonoscopy videos, with a particular efficiency in detecting small polyps (≤ 0.5 cm)(0.902 vs. 0.70, P < 0.001).
Collapse
Affiliation(s)
- Jianhua Xu
- Anhui Medical University, Hefei, Anhui, 230032, China
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
| | - Yaxian Kuai
- Anhui Medical University, Hefei, Anhui, 230032, China
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
| | - Qianqian Chen
- Anhui Medical University, Hefei, Anhui, 230032, China
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
| | - Xu Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
- Anhui Provincial Key Laboratory of Digestive Disease, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
| | - Yihang Zhao
- Anhui Medical University, Hefei, Anhui, 230032, China
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
| | - Bin Sun
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China.
- Anhui Provincial Key Laboratory of Digestive Disease, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China.
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, Anhui, 230022, China.
| |
Collapse
|
|
4
|
Mizukami K, Fushimi E, Sagami R, Abe T, Sato T, Terashi S, Fukuda M, Nishikiori H, Nagai T, Kodama M, Murakami K. Usefulness of AI-Equipped Endoscopy for Detecting Colorectal Adenoma during Colonoscopy Screening: Confirm That Colon Neoplasm Finely Can Be Identified by AI without Overlooking Study (Confidential Study). J Clin Med 2023; 12:6332. [PMID: 37834976 PMCID: PMC10573595 DOI: 10.3390/jcm12196332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
In the present prospective case series study, we investigated the lesion-detection ability of an AI-equipped colonoscopy as an addition to colonoscopy (CS) screening. Participants were 100 patients aged ≥20 years who had not undergone CS at the study site in the last 3 years and passed the exclusion criteria. CS procedures were conducted using conventional white light imaging and computer-aided detection (CADe). Adenoma detection rate (ADR; number of individuals with at least one adenoma detected) was compared between the conventional group and the CADe group. Of the 170 lesions identified, the ADR of the CADe group was significantly higher than the ADR of the conventional group (69% vs. 61%, p = 0.008). For the expert endoscopists, although ADR did not differ significantly, the mean number of detected adenomas per procedure (MAP) was significantly higher in the CADe group than in the conventional group (1.7 vs. 1.45, p = 0.034). For non-expert endoscopists, ADR and MAP were significantly higher in the CADe group than in the conventional group (ADR 69.5% vs. 56.6%, p = 0.016; MAP 1.66 vs. 1.11, p < 0.001). These results indicate that the CADe function in CS screening has a positive effect on adenoma detection, especially for non-experts.
Collapse
Affiliation(s)
- Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Erina Fushimi
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Ryota Sagami
- Department of Gastroenterology, Oita San-ai Medical Center, 1213 Ichi, Oita 870-1151, Japan
| | - Takashi Abe
- Department of Gastroenterology, Oita Koseiren Tsurumi Hospital, 4333, Tsurumi, Beppu, Oita 874-8585, Japan
| | - Takao Sato
- Department of Gastroenterology, Oita San-ai Medical Center, 1213 Ichi, Oita 870-1151, Japan
| | - Shohei Terashi
- Department of Gastroenterology, Oita Koseiren Tsurumi Hospital, 4333, Tsurumi, Beppu, Oita 874-8585, Japan
| | - Masahide Fukuda
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Hidefumi Nishikiori
- Department of Gastroenterology, Oita San-ai Medical Center, 1213 Ichi, Oita 870-1151, Japan
| | - Takayuki Nagai
- Department of Gastroenterology, Oita Koseiren Tsurumi Hospital, 4333, Tsurumi, Beppu, Oita 874-8585, Japan
| | - Masaaki Kodama
- Department of Advanced Medical Sciences, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita 879-5593, Japan
| |
Collapse
|
|
5
|
Sun C, Chen Y, Ma S, Liu M, Yau V, Kim NH, Kailas S, Lowe S, Bentley R, Chen S, Liu J, Meng M, Huang Y, Zhou Q, Wu Y. You are not lab rats at teaching hospitals: A systematic review of resident and fellow participation leads to improved colonoscopy. J Evid Based Med 2023; 16:332-341. [PMID: 37735811 DOI: 10.1111/jebm.12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Participation in colonoscopies is an essential aspect of endoscopic training. The purpose of this study was to explore the impact of fellow/trainee participation on colonoscopy outcomes. METHODS This meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). From database inception to July 2022, studies investigating fellow involvement and colonoscopy outcomes were searched across Cochrane library, PubMed, and other databases. The random-effects model was applied to generate more conservative estimates. Sensitive analysis was conducted to explore whether the result would depend on a particular study. Egger's test and Begg's test were used to estimate the potential for publication bias. RESULTS Seventeen studies including 30,062 participants were included. We found that fellow/trainee involvement enhanced the overall rates of adenoma detection and polyp detection (OR = 1.26, 95% CI = 1.14-1.40, p < 0.001; OR = 1.29, 95% CI = 1.02-1.63, p = 0.020, respectively). The mean number of adenoma/polyps per colonoscopy was also higher with fellow/trainee participation (MD = 0.12, 95% CI = 0.08-0.17, p < 0.001; MD = 0.15, 95% CI = 0.02-0.28, p = 0.020, respectively). CONCLUSION In addition to its educational purpose, fellow or trainee involvement is associated with beneficial effects on colonoscopy outcomes.
Collapse
Affiliation(s)
- Chenyu Sun
- Department of Thyroid and Breast Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of clinic medicine, University of IIIinois College of Medicine, Chicago, Illinois, United States
| | - Yue Chen
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei, China
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, Hefei, China
| | - Mengqing Liu
- Department of Clinical Medicine, School of the Chaohu Clinical Medicine, Anhui Medical University, Hefei, China
| | - Vicky Yau
- Department of Dentistry and Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, New York
| | - Na Hyun Kim
- Department of clinic medicine, University of IIIinois College of Medicine, Chicago, Illinois, United States
| | - Sujatha Kailas
- Department of clinic medicine, University of IIIinois College of Medicine, Chicago, Illinois, United States
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri
| | - Rachel Bentley
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri
| | | | - Jie Liu
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Muzi Meng
- UK Program Site, American University of the Caribbean School of Medicine, Sint Maarten, UK
- Bronxcare Health System, The Bronx, New York
| | - Yuting Huang
- Department of Gastroenterology & Hepatology, Mayo Clinic Florida, Jacksonville, Florida
| | - Qin Zhou
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yuyan Wu
- Department of Pediatrics, The first people's Hospital of Hefei, Hefei, China
| |
Collapse
|
|
6
|
Gong Y, Zheng Y, Wu R, Liu M, Li H, Zeng Q. Detection rates of adenomas, advanced adenomas, and colorectal cancers among the opportunistic colonoscopy screening population: a single-center, retrospective study. Chin Med J (Engl) 2023; 136:159-166. [PMID: 36692899 PMCID: PMC10106243 DOI: 10.1097/cm9.0000000000002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders. METHODS This was a retrospective study performed at the Institute of Health Management, Chinese People's Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test. RESULTS The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs . 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74-17.53% vs . 9.44% [1692/17,926], 95% CI 8.94-9.79%, P < 0.001), AAs (3.72% [1309], 95% CI 3.47-3.87% vs . 1.85% [332], 95% CI 1.61-2.00%, P < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43-1.69% vs . 0.59% [105], 95% CI 0.47-0.70%, P < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80-3.55%) in men and 1.69% (69/4091, 95% CI 1.12-1.86%) in women, and their NNS was 31.55 (95% CI 28.17-35.71) in men and 67.11 (95% CI 53.76-89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05-46.73]). CONCLUSIONS The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.
Collapse
Affiliation(s)
- Yan Gong
- Department of Health Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yansong Zheng
- Health Examination Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Rilige Wu
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Miao Liu
- Graduate School of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hong Li
- Department of Health Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qiang Zeng
- Health Management Institute, The Second Medical Center and National Clinical Research Center for Geriatric Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| |
Collapse
|
|
7
|
Edwardson N, Adsul P, Gonzalez Z, Pankratz VS, Parasher G, English K, Mishra S. Sessile serrated lesion detection rates continue to increase: 2008-2020. Endosc Int Open 2023; 11:E107-E116. [PMID: 36712908 PMCID: PMC9879655 DOI: 10.1055/a-1990-0509] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/17/2022] [Indexed: 01/28/2023] Open
Abstract
Background and study aims We assessed sessile serrated lesion detection rate (SSLDR) at a large academic medical center from 2008 to 2020 and modeled a local, aspirational target SSLDR. We also assessed SSLDRs among all gastroenterology fellows to better understand the relationship between SSLDRs and total colonoscopies performed. Patients and methods SSL-positive pathology results were flagged from a dataset composed of all screening colonoscopies for average-risk patients from 2008 to 2020. Unadjusted SSLDRs were calculated for individual endoscopists by year. A mixed effects logistic regression was used to estimate the log odds of SSL detection, with one model estimating division-wide predictors of SSL detection and a second model focused exclusively on colonoscopies performed by fellows. Model-adjusted SSLDRs were estimated for all 13 years and across both categories of all endoscopists and fellows only. Results Adjusted SSLDRs showed a consistent improvement in SSLDR from a low of 0.37 % (95 % confidence interval [CI]: 0.10-0.63) in 2008 to a high of 7.94 % (95 % CI: 6.34-9.54) in 2020. Among fellows only, the odds of SSL detection were significantly lower during their first year compared to their second year (OR: 0.80, 95 % CI: 0.66-0.98) but not significantly higher in their third year compared to their second year (OR: 1.09, 95 % CI: 0.85-1.4). Conclusions SSLDR increased steadily and significantly throughout our study period but variance among endoscopists persists. The peak SSLDR from 2020 of 7.94 % should serve as the local aspirational target for this division's attendings and fellows but should be continuously reevaluated.
Collapse
Affiliation(s)
- Nicholas Edwardson
- University of New Mexico, School of Public Administration, Albuquerque, New Mexico, United States
| | - Prajakta Adsul
- University of New Mexico, Department of Internal Medicine, Albuquerque, New Mexico, United States
- University of New Mexico, Comprehensive Cancer Center, Cancer Control and Population Sciences, Albuquerque, New Mexico, United States
| | - Zorisadday Gonzalez
- University of New Mexico, Department of Internal Medicine, Albuquerque, New Mexico, United States
| | - V. Shane Pankratz
- University of New Mexico, Department of Internal Medicine, Albuquerque, New Mexico, United States
- University of New Mexico, Comprehensive Cancer Center, Cancer Control and Population Sciences, Albuquerque, New Mexico, United States
| | - Gulshan Parasher
- University of New Mexico, Department of Internal Medicine, Albuquerque, New Mexico, United States
- University of New Mexico, Department of Gastroenterology, Albuquerque, New Mexico, United States
| | - Kevin English
- Albuquerque Area Indian Health Board Inc., Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, New Mexico, United States
| | - Shiraz Mishra
- University of New Mexico, Comprehensive Cancer Center, Cancer Control and Population Sciences, Albuquerque, New Mexico, United States
- University of New Mexico, Department of Pediatrics, Albuquerque, New Mexico, United States
| |
Collapse
|
|
8
|
Muething L, Quach B, Smith DE, Gao D, Smith JA, Simril RT, Tompkins A, Espinoza J, Cowan ML, Hammad H, Wani S, Patel SG. Adoption of Optimal Small (6-9 mm) Colorectal Polyp Resection Technique Over Time. Dig Dis Sci 2023; 68:240-251. [PMID: 35624328 DOI: 10.1007/s10620-022-07554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cold snare polypectomy (CSP) is the preferred resection technique for small (6-9 mm) polyps due to lower rate of incomplete resection compared to cold forceps polypectomy (CFP) and improved safety profile over hot snare polypectomy (HSP). AIMS To describe resection techniques for small (6-9 mm) polyps and determine factors associated with sub-optimal technique. METHODS This was retrospective cohort study of colonoscopies performed by gastroenterological and surgical endoscopists from 2012 to 2019 where at least one 6-9 mm polyp was removed. Patient, provider, and procedure characteristics were collected. Univariate and multivariate regression analyses were performed to determine factors associated with sub-optimal technique. RESULTS In total, 773 colonoscopies where 1,360 6-9 mm polyps removed by 21 endoscopists were included. CSP was used for 1,122 (82.5%), CFP for 61 (4.5%), and HSP for 177 (13.0%). Surgeon specialty was associated with CFP use (aOR 7.81; 95% CI 3.02-20.16). Polyp location in left colon (aOR 1.65; 95% CI 1.17-2.33) and pedunculated morphology (aOR 12.76; 95% CI 7.24-22.50) were associated with HSP. There was a significant increase in overall CSP use from 30.4% in 2012 to 96.8% in 2019. CONCLUSIONS 82.5% of all 6-9 mm polyps removed from 2012 to 2019 were removed using a cold snare with significant increase in CSP from 2012 to 2019. Differences in how optimal technique was adopted over time based on specialty highlight the need for standardized practice guidelines and quality monitoring.
Collapse
Affiliation(s)
- Larissa Muething
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Bill Quach
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Derek E Smith
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dexiang Gao
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joshua A Smith
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert T Simril
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Amanda Tompkins
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeannine Espinoza
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Michelle L Cowan
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Hazem Hammad
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Sachin Wani
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Swati G Patel
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
| |
Collapse
|
|
9
|
Sey M, Cocco S, McDonald C, Hindi Z, Rahman H, Chakraborty D, French K, Alsager M, Siddiqi O, Blier MA, Markandey B, Al Obaid S, Wong A, Siebring V, Brahmania M, Gregor J, Khanna N, Ott M, Qumosani K, Wilson A, Guizzetti L, Yan B, Jairath V. Association of Trainee Participation in Colonoscopy Procedures With Quality Metrics. JAMA Netw Open 2022; 5:e2229538. [PMID: 36044211 PMCID: PMC9434358 DOI: 10.1001/jamanetworkopen.2022.29538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Trainees routinely participate in colonoscopy procedures, yet whether their involvement is positively or negatively associated with procedural quality is unknown because prior studies involved small number of trainees and/or supervisors, lacked generalizability, and/or failed to adjust for potential confounders. OBJECTIVE To assess the association between trainee participation and colonoscopy quality metrics. DESIGN, SETTING, AND PARTICIPANTS This multicenter population-based cohort study was conducted at 21 academic and community hospitals between April 1, 2017, and October 31, 2018, among consecutive adult patients undergoing colonoscopy. Procedures performed by endoscopists who did not supervise trainees were excluded. Statistical analysis was performed from April 3, 2017, to October 31, 2018. EXPOSURE Participation by a trainee, defined as a resident or fellow enrolled in a gastroenterology or general surgery training program. MAIN OUTCOMES AND MEASURES The primary outcome was the adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate. RESULTS A total of 35 499 colonoscopies (18 989 women [53.5%]; mean [SD] patient age, 60.0 [14.1] years) were performed by 71 physicians (mean [SD] time in practice, 14.0 [9.3] years); 5941 colonoscopies (16.7%) involved trainees. There were no significant differences in the ADR (26.4% vs 27.3%; P = .19), CIR (96.7% vs 97.2%; P = .07), and perforation rate (0.05% vs 0.06%; P = .82) when trainees participated vs when they did not participate, whereas the the ssPDR (4.4% vs 5.2%; P = .009) and PDR (39.2% vs 42.0%; P < .001) were significantly lower when trainees participated vs when they did not. After adjustment for potential confounders, the ADR (risk ratio [RR], 0.97; 95% CI, 0.91-1.03; P = .30), PDR (RR, 0.98; 95% CI, 0.93-1.04; P = .47), and CIR (RR, 0.93; 95% CI, 0.78-1.10; P = .38) were not associated with trainee participation, although the ssPDR remained significantly lower (RR, 0.79; 95% CI, 0.64-0.98; P = .03). CONCLUSIONS AND RELEVANCE This study suggests that trainee involvement during colonoscopy was associated with reduced ssPDR but not other colonoscopy outcome measures. Extra care should be exercised when examining the right colon when trainees are involved.
Collapse
Affiliation(s)
- Michael Sey
- Division of Gastroenterology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, Western University, London, Ontario, Canada
- South West Ontario Regional Cancer Program, Ontario Health, London, Ontario, Canada
| | - Sarah Cocco
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Cassandra McDonald
- Lawson Health Research Institute, Western University, London, Ontario, Canada
| | - Zaid Hindi
- Department of Medicine, Western University, London, Ontario, Canada
| | - Hasibur Rahman
- Department of Medicine, Western University, London, Ontario, Canada
| | | | - Karissa French
- Department of Pathology, Western University, London, Ontario, Canada
| | - Mohammed Alsager
- Department of Medicine, Western University, London, Ontario, Canada
| | - Omar Siddiqi
- The Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya, Bahrain
| | - Marc-Andre Blier
- Department of Medicine, Western University, London, Ontario, Canada
| | - Bharat Markandey
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| | - Sarah Al Obaid
- Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony Wong
- Department of Medicine, Western University, London, Ontario, Canada
| | - Victoria Siebring
- South West Ontario Regional Cancer Program, Ontario Health, London, Ontario, Canada
| | - Mayur Brahmania
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Jamie Gregor
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Nitin Khanna
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Michael Ott
- Department of Surgery, Western University, London, Ontario, Canada
| | - Karim Qumosani
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Aze Wilson
- Division of Gastroenterology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, Western University, London, Ontario, Canada
- Division of Clinical Pharmacology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | | | - Brian Yan
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, Western University, London, Ontario, Canada
| |
Collapse
|
|
10
|
Wong YT, Tai TF, Wong KF, Leung SK, Lam SM, Wong SY, Lo YY, Yan KM, Tam SK, Wong MF, Chan HL. The Study on Artificial Intelligence (AI) Colonoscopy in Affecting the Rate of Polyp Detection in Colonoscopy – A Single Center Retrospective Study. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y. T. Wong
- Dept. of Surgery New Territories West Cluster, Hospital Authority
| | - T. F. Tai
- Dept. of Surgery New Territories West Cluster, Hospital Authority
| | - K. F. Wong
- Dept. of Surgery New Territories West Cluster, Hospital Authority
| | - S. K. Leung
- Dept. of Surgery New Territories West Cluster, Hospital Authority
| | - S. M. Lam
- Combined Endoscopy Unit, Tin Shui Wai Hospital
| | - S. Y. Wong
- Combined Endoscopy Unit, Tin Shui Wai Hospital
| | - Y. Y. Lo
- Combined Endoscopy Unit, Tin Shui Wai Hospital
| | - K. M. Yan
- Combined Endoscopy Unit, Tin Shui Wai Hospital
| | - S. K. Tam
- Combined Endoscopy Unit, Tin Shui Wai Hospital
| | - M. F. Wong
- Combined Endoscopy Unit, Tin Shui Wai Hospital
| | - H. L. Chan
- Combined Endoscopy Unit, Tin Shui Wai Hospital
| |
Collapse
|
|
11
|
Petros V, Tsambikos E, Madhoun M, Tierney WM. Impact of Community Referral on Colonoscopy Quality Metrics in a Veterans Affairs Medical Center. Clin Transl Gastroenterol 2022; 13:e00460. [PMID: 35081542 PMCID: PMC8963833 DOI: 10.14309/ctg.0000000000000460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION The Veterans Access, Choice, and Accountability Act of 2014 expands the number of options veterans have to ensure timely access to high-quality care. There are minimal data currently available analyzing the impact and quality of colonoscopy metrics in veterans receiving procedures within the Department of Veterans' Affairs (VA) vs community settings. METHODS All patients at our academic VA medical center who were referred to a community care colonoscopy (CCC) for positive fecal immunochemical testing, colorectal cancer screening, and adenoma surveillance from 2015 to 2018 were identified and matched for sex, age, and year of procedure to patients referred for a VA-based colonoscopy (VAC). Metrics measured included time to procedure measured in days, adenoma detection rate (ADR), advanced ADR (AADR), adenomas per colonoscopy, sessile serrated polyp detection rate, cecal intubation rate, bowel preparation quality, and compliance with guideline recommendations for surveillance. Patient comorbidities were also recorded. Variable associations with adenoma detection and compliance with surveillance guidelines were analyzed with univariate and multivariate logistic regression. RESULTS In total, 235 veterans (mean age, 64.6 years, and 95.7% male) underwent a CCC and had an appropriately matched VAC. ADR in the community was 36.9% compared with 62.6% for the VAC group (P < 0.0001). The mean number of adenomas per procedure in the community was 0.77 compared with 1.83 per VAC (P < 0.0001). CCC AADR was 8.9% compared with 18.3% for VAC (P = 0.003). The cecal intubation rate for community colonoscopies was 90.6% compared with 95.3% for VA colonoscopies (P = 0.047). Community care compliance with surveillance guidelines was 74.9% compared with 93.3% for VA (P < 0.0001). This nonconformity was primarily due to recommending a shorter interval follow-up in the CCC group (15.3%) compared with the VAC group (5.5%) (P = 0.0012). The mean time to procedure was 58.4 days (±33.7) for CCC compared with 83.8 days (±38.6) for VAC (P < 0.0001). In multivariate regression, CCC was associated with lower ADR (odds ratio 0.39; 95% confidence interval, 0.20-0.63) and lower compliance with surveillance guidelines (odds ratio 0.21; 95% confidence interval, 0.09-0.45) (P < 0.0001 for both). DISCUSSION Time to colonoscopy was significantly shorter for CCC compared with VAC. However, compared with VA colonoscopies, there was significantly lower ADR, AADR, and surveillance guideline compliance for services rendered by community providers. This impact on quality of care should be further studied to ensure that colonoscopy quality standards for veterans are not compromised by the process of care and site of care.
Collapse
Affiliation(s)
- Vincent Petros
- Digestive Diseases and Nutrition Section, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
- Oklahoma City VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Erin Tsambikos
- Internal Medicine Section, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mohammad Madhoun
- Digestive Diseases and Nutrition Section, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
- Oklahoma City VA Medical Center, Oklahoma City, Oklahoma, USA
| | - William M. Tierney
- Digestive Diseases and Nutrition Section, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
- Oklahoma City VA Medical Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
|
12
|
Araujo JL, Jaiswal P, Ragunathan K, Arroyo-Mercado FM, Chawla GS, Li C, Kazmi W, Le A, Gupta N, Chokshi T, Klinger CA, Salim S, Mirza RM, Grossman E, Vignesh S. Impact of Fellow Participation During Colonoscopy on Adenoma Detection Rates. Dig Dis Sci 2022; 67:85-92. [PMID: 33611689 DOI: 10.1007/s10620-021-06887-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND An endoscopist's adenoma detection rate (ADR) is inversely related to interval colorectal cancer risk and cancer mortality. Previous studies evaluating the impact of gastroenterology fellow participation in colonoscopy on ADR have generated conflicting results. AIMS We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR). METHODS We retrospectively analyzed average-risk patients undergoing screening colonoscopy at Veterans Affairs New York Harbor Healthcare System Brooklyn Campus and Kings County Hospital Center. Review of colonoscopy and pathology reports were performed to obtain adenoma-specific details, including the presence of advanced adenoma and adenoma location (right vs. left colon). RESULTS There were 893 colonoscopies performed by attending only and 502 performed with fellow participation. Fellow participation improved overall ADR (44.6% vs. 35.4%, p < 0.001), right-sided ADR (34.1% vs. 25.2%, p < 0.001), and AADR (15.3% vs. 8.3%, p < 0.001); however, these findings were institution-specific. Year of fellowship training did not impact overall ADR or overall AADR, but did significantly improve right-sided AADR (p-value for trend 0.03). Female attending physicians were associated with increased ADR (47.1% vs. 37.0%, p = 0.0037). Fellow sex did not impact ADR. CONCLUSIONS Fellow participation in colonoscopy improved overall ADR and AADR, and female attending physicians were associated with improved ADR. Year of fellowship training did not impact overall ADR or AADR.
Collapse
Affiliation(s)
- James L Araujo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Veterans Affairs, New York Harbor Healthcare System, Brooklyn Campus, 800 Poly Place, Brooklyn, NY, 11209, USA.
| | - Palashkumar Jaiswal
- Division of Gastroenterology and Hepatology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Karthik Ragunathan
- Division of Gastroenterology and Hepatology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Gurasees S Chawla
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Canny Li
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Wajiha Kazmi
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Alexander Le
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Nikita Gupta
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Tanuj Chokshi
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Sabrin Salim
- Translational Research Program, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Raza M Mirza
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Evan Grossman
- Division of Gastroenterology and Hepatology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Division of Gastroenterology, Department of Medicine, NYC Health and Hospitals/Kings County, Brooklyn, NY, USA
| | - Shivakumar Vignesh
- Division of Gastroenterology and Hepatology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
|
13
|
Xu L, He X, Zhou J, Zhang J, Mao X, Ye G, Chen Q, Xu F, Sang J, Wang J, Ding Y, Li Y, Yu C. Artificial intelligence-assisted colonoscopy: A prospective, multicenter, randomized controlled trial of polyp detection. Cancer Med 2021; 10:7184-7193. [PMID: 34477306 PMCID: PMC8525182 DOI: 10.1002/cam4.4261] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Artificial intelligence (AI) assistance has been considered as a promising way to improve colonoscopic polyp detection, but there are limited prospective studies on real-time use of AI systems. METHODS We conducted a prospective, multicenter, randomized controlled trial of patients undergoing colonoscopy at six centers. Eligible patients were randomly assigned to conventional colonoscopy (control group) or AI-assisted colonoscopy (AI group). AI assistance was our newly developed AI system for real-time colonoscopic polyp detection. Primary outcome is polyp detection rate (PDR). Secondary outcomes include polyps per positive patient (PPP), polyps per colonoscopy (PPC), and non-first polyps per colonoscopy (PPC-Plus). RESULTS A total of 2352 patients were included in the final analysis. Compared with the control, AI group did not show significant increment in PDR (38.8% vs. 36.2%, p = 0.183), but its PPC-Plus was significantly higher (0.5 vs. 0.4, p < 0.05). In addition, AI group detected more diminutive polyps (76.0% vs. 68.8%, p < 0.01) and flat polyps (5.9% vs. 3.3%, p < 0.05). The effects varied somewhat between centers. In further logistic regression analysis, AI assistance independently contributed to the increment of PDR, and the impact was more pronounced for male endoscopists, shorter insertion time but longer withdrawal time, and elderly patients with larger waist circumference. CONCLUSION The intervention of AI plays a limited role in overall polyp detection, but increases detection of easily missed polyps; ChiCTR.org.cn number, ChiCTR1800015607.
Collapse
Affiliation(s)
- Lei Xu
- Department of GastroenterologyNingbo Hospital of Zhejiang UniversityNingboChina
| | - Xinjue He
- Department of GastroenterologyThe First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Jianbo Zhou
- Department of GastroenterologyYuyao People’s Hospital of Zhejiang ProvinceYuyaoChina
| | - Jie Zhang
- Department of GastroenterologyThe First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Xinli Mao
- Department of GastroenterologyTaizhou Hospital of Zhejiang ProvinceLinhaiChina
| | - Guoliang Ye
- Department of GastroenterologyThe Affiliated Hospital of Medical School of Ningbo UniversityNingboChina
| | - Qiang Chen
- Department of GastroenterologySanmen People’s HospitalTaizhouChina
| | - Feng Xu
- Department of GastroenterologyNingbo Yinzhou People’s HospitalNingboChina
| | - Jianzhong Sang
- Department of GastroenterologyYuyao People’s Hospital of Zhejiang ProvinceYuyaoChina
| | - Jun Wang
- Department of GastroenterologyTaizhou Hospital of Zhejiang ProvinceLinhaiChina
| | - Yong Ding
- Department of GastroenterologyThe Affiliated Hospital of Medical School of Ningbo UniversityNingboChina
| | - Youming Li
- Department of GastroenterologyThe First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| | - Chaohui Yu
- Department of GastroenterologyThe First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhouChina
| |
Collapse
|
|
14
|
Computer-Aided Colon Polyp Detection on High Resolution Colonoscopy Using Transfer Learning Techniques. SENSORS 2021; 21:s21165315. [PMID: 34450756 PMCID: PMC8402119 DOI: 10.3390/s21165315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 01/10/2023]
Abstract
Colonoscopies reduce the incidence of colorectal cancer through early recognition and resecting of the colon polyps. However, the colon polyp miss detection rate is as high as 26% in conventional colonoscopy. The search for methods to decrease the polyp miss rate is nowadays a paramount task. A number of algorithms or systems have been developed to enhance polyp detection, but few are suitable for real-time detection or classification due to their limited computational ability. Recent studies indicate that the automated colon polyp detection system is developing at an astonishing speed. Real-time detection with classification is still a yet to be explored field. Newer image pattern recognition algorithms with convolutional neuro-network (CNN) transfer learning has shed light on this topic. We proposed a study using real-time colonoscopies with the CNN transfer learning approach. Several multi-class classifiers were trained and mAP ranged from 38% to 49%. Based on an Inception v2 model, a detector adopting a Faster R-CNN was trained. The mAP of the detector was 77%, which was an improvement of 35% compared to the same type of multi-class classifier. Therefore, our results indicated that the polyp detection model could attain a high accuracy, but the polyp type classification still leaves room for improvement.
Collapse
|
|
15
|
Tang CP, Shao PP, Hsieh YH, Leung FW. A review of water exchange and artificial intelligence in improving adenoma detection. Tzu Chi Med J 2021; 33:108-114. [PMID: 33912406 PMCID: PMC8059458 DOI: 10.4103/tcmj.tcmj_88_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/22/2020] [Accepted: 06/06/2020] [Indexed: 12/21/2022] Open
Abstract
Water exchange (WE) and artificial intelligence (AI) have made critical advances during the past decade. WE significantly increases adenoma detection and AI holds the potential to help endoscopists detect more polyps and adenomas. We performed an electronic literature search on PubMed using the following keywords: water-assisted and water exchange colonoscopy, adenoma and polyp detection, artificial intelligence, deep learning, neural networks, and computer-aided colonoscopy. We reviewed relevant articles published in English from 2010 to May 2020. Additional articles were searched manually from the reference lists of the publications reviewed. We discussed recent advances in both WE and AI, including their advantages and limitations. AI may mitigate operator-dependent factors that limit the potential of WE. By increasing bowel cleanliness and improving visualization, WE may provide the platform to optimize the performance of AI for colonoscopies. The strengths of WE and AI may complement each other in spite of their weaknesses to maximize adenoma detection.
Collapse
Affiliation(s)
- Chia-Pei Tang
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Paul P. Shao
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| | - Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Felix W. Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
|
16
|
Marella HK, Saleem N, Tombazzi C. Impact of Moderate versus Deep Sedation and Trainee Participation on Adenoma Detection Rate-Analysis of a Veteran Population. Clin Endosc 2020; 54:250-255. [PMID: 33317225 PMCID: PMC8039744 DOI: 10.5946/ce.2020.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS The adenoma detection rate (ADR) is used as a quality indicator for screening and surveillance colonoscopy. The study aimed to determine if moderate versus deep sedation affects the outcomes of the ADR and other quality metrics in the veteran population. METHODS A retrospective review of colonoscopies performed at Memphis Veterans Affairs Medical Center over a one-year period was conducted. A total of 900 colonoscopy reports were reviewed. After exclusion criteria, a total of 229 index, average-risk screening colonoscopies were identified. Data were collected to determine the impact of moderate (benzodiazepine plus opioids) versus deep (propofol) sedation on the ADR, polyp detection rate (PDR), and withdrawal time. RESULTS Among 229 screening colonoscopies, 103 (44.9%) used moderate sedation while 126 (55%) were done under deep sedation. The ADR and PDR were not significantly different between moderate versus deep sedation at 35.9% vs. 37.3% (p=0.82) and 58.2% vs. 48.4% (p=0.13), respectively. Similarly, there was no significant difference in withdrawal time between moderate and deep sedation (13.4 min vs. 14 min, p=0.56) during screening colonoscopies. CONCLUSION In veterans undergoing index, average-risk screening colonoscopies, the quality metrics of the ADR, PDR, and withdrawal time are not influenced by deep sedation compared with moderate sedation.
Collapse
Affiliation(s)
- Hemnishil K Marella
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nasir Saleem
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Claudio Tombazzi
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
|
17
|
Eckardt AJ, Kheder J, Basil A, Silverstein T, Patel K, Mahmoud M, Al-Azzawi Y, Ellis D, Gillespie W, Carrasquillo Vega Y, Person SD, Levey JM. Trainee participation during screening colonoscopy does not affect ADR at subsequent surveillance, but may result in early follow-up. Endosc Int Open 2020; 8:E1732-E1740. [PMID: 33269304 PMCID: PMC7676994 DOI: 10.1055/a-1244-1859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Training future endoscopists is essential to meet rising demands for screening and surveillance colonoscopies. Studies have shown conflicting results regarding the influence of trainees on adenoma detection rates (ADR). It is unclear whether trainee participation during screening adversely affects ADR at subsequent surveillance and whether it alters surveillance recommendations. Patients and methods A retrospective analysis of average-risk screening colonoscopies and surveillance exams over a subsequent 10-year period was performed. The initial inclusion criteria were met by 5208 screening and 2285 surveillance exams. Patients with poor preparation were excluded. The final analysis included 7106 procedures, including 4922 screening colonoscopies and 2184 surveillance exams. Data were collected from pathology and endoscopy electronic databases. The primary outcome was the ADR with and without trainee participation. Surveillance recommendations were analyzed as a secondary outcome. Results Trainees participated in 1131 (23 %) screening and in 232 (11 %) surveillance exams. ADR did not significantly differ ( P = 0.19) for screening exams with trainee participation (19.5 %) or those without (21.4 %). ADRs were higher at surveillance exams with (22.4 %) and without (27.5 %) trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous colonoscopy. Shorter surveillance intervals were given more frequently if trainees participated during the initial screening procedure ( P = 0.0001). Conclusions ADR did not significantly differ in screening or surveillance colonoscopies with or without trainee participation. ADR at surveillance was not adversely affected by trainee participation during the previous screening exam. However, trainee participation may result in shorter surveillance recommendations.
Collapse
Affiliation(s)
- Alexander J. Eckardt
- Department of Gastroenterology and Hepatology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - Joan Kheder
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | - Anjali Basil
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | - Taryn Silverstein
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | - Krunal Patel
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | - Mohamed Mahmoud
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | - Yasir Al-Azzawi
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | - Daniel Ellis
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | | | - Yoel Carrasquillo Vega
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| | - Sharina D. Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - John M. Levey
- Division of Gastroenterology and Hepatology, UMass Memorial Medical Center, Worcester, Massachusetts, United States
| |
Collapse
|
|
18
|
Ng S, Sreenivasan AK, Pecoriello J, Liang PS. Polyp Detection Rate Correlates Strongly with Adenoma Detection Rate in Trainee Endoscopists. Dig Dis Sci 2020; 65:2229-2233. [PMID: 31927766 PMCID: PMC7881441 DOI: 10.1007/s10620-020-06049-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The adenoma detection rate (ADR) is a widely accepted quality benchmark for screening colonoscopy but can be burdensome to calculate. Previous studies have shown good correlation between polyp detection rate (PDR) and ADR, but this has not been validated in trainees. Additionally, the correlation between PDR and detection rates for sessile serrated polyps (SSPDR) and advanced neoplasia (ANDR) is not well studied. AIMS We investigated the relationship between PDR and ADR, SSPDR, and ANDR in trainees. METHODS We examined 1600 outpatient colonoscopies performed by 24 trainees at a VA hospital from 2014 to 2017. Variables collected included patient demographics, year of fellowship, colonoscopy indication, and endoscopic and histologic findings. We calculated the overall ratios of PDR to ADR, SSPDR, and ANDR to assess the correlation between measured and calculated ADR, SSPDR, and ANDR, which is equivalent to the correlation between PDR and measured ADR, SSPDR, and ANDR. RESULTS The overall PDR, ADR, SSPDR, and ANDR were 72%, 52%, 2%, and 14%. PDR (48%) was highest in the left colon, while ADR (32%) and ANDR (7%) were highest in the right colon (p < 0.001 for all). The overall ADR/PDR, SSPDR/PDR, and ANDR/PDR ratios were 0.73, 0.03, and 0.20. Correlation between PDR and ADR was highly positive overall (r = 0.87, p < 0.0001) and stronger in the right (r = 0.91) and transverse (r = 0.94) colon than the left colon (r = 0.80). Correlation between PDR and overall SSPDR and ANDR were not statistically significant. CONCLUSIONS PDR can serve as a surrogate measure of ADR to monitor colonoscopy quality in gastroenterology fellowship.
Collapse
Affiliation(s)
- Sandy Ng
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Aditya K. Sreenivasan
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Jillian Pecoriello
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Peter S. Liang
- Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA,Department of Medicine, VA New York Harbor Health Care System, 423 E 23rd St, 11N GI, New York, NY 10010, USA
| |
Collapse
|
|
19
|
Aziz M, Weissman S, Khan Z, Fatima R, Lee-Smith W, Nawras A, Adler DG. Use of 2 Observers Increases Adenoma Detection Rate During Colonoscopy: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2020; 18:1240-1242.e3. [PMID: 31589976 DOI: 10.1016/j.cgh.2019.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
Current efforts are directed toward improving quality metrics such as adenoma/polyp detection rates during colonoscopy to decrease the incidence of colorectal cancer.1 Previous studies have reported variable detection rates for adenomas/polyps during colonoscopy for active participation/observation by nurses, trainees, and/or technician (dual observer [DO] group) with an endoscopist.2,3 We performed a systematic review and meta-analysis to evaluate the detection rate of adenomas/polyps during colonoscopy via DO versus single observers (ie, endoscopist alone).
Collapse
Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Simcha Weissman
- Department of Medicine, Hackensack University, Palisades Medical Center, North Bergen, New Jersey
| | - Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Ali Nawras
- Department of Gastroenterology, University of Toledo, Toledo, Ohio
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah.
| |
Collapse
|
|
20
|
Zachariah R, Ninh A, Karnes W. Artificial intelligence for colon polyp detection: Why should we embrace this? ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.tgie.2019.150631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
|
21
|
Arimoto J, Chiba H, Higurashi T, Fukui R, Tachikawa J, Misawa N, Ashikari K, Niikura T, Kuwabara H, Nakaoka M, Goto T, Nakajima A. Risk factors for incomplete polyp resection after cold snare polypectomy. Int J Colorectal Dis 2019; 34:1563-1569. [PMID: 31312890 DOI: 10.1007/s00384-019-03347-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incomplete polyp resection (IPR) is recognized as a risk factor for interval colorectal cancer (ICC), and is, therefore, an important issue in polypectomy. Cold snare polypectomy (CSP) is a procedure that does not involve electrocautery and has no burn effect. Therefore, there is the possibility that the risk of ICC associated with IPR is higher in cases undergoing CSP than in those undergoing hot polypectomy. However, little is known about the risk factors for IPR after CSP. PURPOSE Precise identification of the risk factors can lead to prevention of IPR after CSP. Therefore, we performed this observational study for accurate identification of the risk factors for IPR after CSP. METHODS Medical records of a total of 501 patients with 1177 colorectal polyps that were resected at Omori Red Cross Hospital between October 2017 and March 2018 were retrospectively reviewed. The lateral and deep margins of the resected polyps were evaluated to check for the resection completeness. RESULTS Among the 1177 polyp resections, 1163 were included in the final analysis. IPR was detected in 206 (17.7%) cases. Performance of the resection by a trainee (OR (95% CI) 1.87 (1.328-2.632); P < 0.001) was identified as an independent risk factor for IPR in patients undergoing CSP. CONCLUSIONS Performance of the polypectomy by a trainee was identified as a significant risk factor for IPR in patients undergoing CSP. Prospective, randomized studies are necessary in the future to develop effective methods for the prevention/control of IPR after CSP.
Collapse
Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ryo Fukui
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Noboru Misawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Toshihiro Niikura
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Tohru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| |
Collapse
|
|
22
|
Zhan Q, Xiang L, Zhao X, An S, Zhou Y, Xu Y, Li A, Liu S. Determination of withdrawal times in individualized opportunistic screening colonoscopies. Medicine (Baltimore) 2019; 98:e16819. [PMID: 31393413 PMCID: PMC6708899 DOI: 10.1097/md.0000000000016819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 05/22/2019] [Accepted: 07/20/2019] [Indexed: 01/10/2023] Open
Abstract
To investigate effects of bowel preparation, experience level of colonoscopists, and colonoscopy withdrawal time (CWT) on the quality of an individual opportunistic screening colonoscopy, according to adenoma detection rate (ADR).Data were retrospectively analyzed from opportunistic screening colonoscopies (n = 16,951) at 4 hospitals of various care levels in China.The ADR positively correlated with the experience level of the colonoscopist. The individualized CWT varied, depending on the quality of bowel preparation and the number of colonoscopies performed previously by the colonoscopist. In a setting of adequate bowel preparation, the mean CWT decreased with the increased experience of the colonoscopist. With poor and inadequate bowel preparation, no colonoscopist at any level of experience could obtain a satisfactory ADR.For adequately prepared colonoscopies, minimum CWTs have been determined. Repeat colonoscopy is strongly recommended for patients with poor bowel preparation, regardless of the colonoscopist's experience.
Collapse
Affiliation(s)
- Qiang Zhan
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu Province
| | - Li Xiang
- Department of Gastroenterology, Longgang District People's Hospital, Shenzhen, Guangdong Province
| | - Xinhua Zhao
- Department of Gastroenterology, Mianyang Central Hospital, Mianyang, Sichuan Province
| | - Shengli An
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province
| | - Yongbai Zhou
- Department of Gastroenterology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong Province
| | - Yangzhi Xu
- Guangdong Provincial Key Laboratory of Gastroenterology & Department of Gastroenterology, Nanfang Hospital Affiliated to the Southern Medical University, Guangzhou, Guangdong Province, China
| | - Aimin Li
- Guangdong Provincial Key Laboratory of Gastroenterology & Department of Gastroenterology, Nanfang Hospital Affiliated to the Southern Medical University, Guangzhou, Guangdong Province, China
| | - Side Liu
- Guangdong Provincial Key Laboratory of Gastroenterology & Department of Gastroenterology, Nanfang Hospital Affiliated to the Southern Medical University, Guangzhou, Guangdong Province, China
| |
Collapse
|
|
23
|
Tziatzios G, Gkolfakis P, Triantafyllou K. Effect of fellow involvement on colonoscopy outcomes: A systematic review and meta-analysis. Dig Liver Dis 2019; 51:1079-1085. [PMID: 31272937 DOI: 10.1016/j.dld.2019.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The effect of fellow involvement on colonoscopy outcomes is controversial. Thus, we evaluated this effect on adenoma detection rate (ADR) and on other colonoscopy quality indicators. METHODS MEDLINE and Cochrane central register of controlled trials were searched up to September 2018 for studies evaluating fellow-involved colonoscopies vs. attending physicians-only examinations in terms of colonoscopy outcomes. Primary outcome was ADR, while advanced ADR (AADR), mean number of adenomas per colonoscopy (MAC), cecum intubation rate (CIR) and adverse events rate comprised the secondary outcomes. The effect size on study outcomes was calculated using random-effects model and it is presented as Odds Ratio (OR) or Mean Difference (MD) with 95% confidence interval (CI). RESULTS Nineteen observational studies involving 34,059 patients (fellow-involved 16,875, attending physician-only 17,184) were included. Compared to the attending physician-only group, fellow involvement marginally increased ADR [OR (95%CI) = 1.12 (1.00-1.26); p = 0.06, I2 = 76%]. Attending physicians with low-to-moderate ADR (<35%) benefited most from fellow's participation [OR (95%CI): 1.26 (1.13-1.40) vs. 1.12 (1.00-1.26); p = 0.03 when ADR < 35% and OR (95%CI): 1.29 (1.13-1.46) vs. 0.95 (0.78-1.16); p = 0.01 when ADR < 30%, respectively]. Moreover, fellow-involved group had higher MAC compared to attending-only group [MD (95%CI) = 0.12 (0.04-0.20); p = 0.002, I2 = 53%]. No benefit from fellow involvement was detected either for AADR, CIR or adverse events rate. CONCLUSIONS Fellow involvement during colonoscopy is associated with more adenomas detected per procedure and with higher ADR when the attending physician-only group ADR is less than 35%.
Collapse
Affiliation(s)
- Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece.
| |
Collapse
|
|
24
|
Bitar H, Zia H, Bashir M, Parava P, Hanafi M, Tierney W, Madhoun M. Impact of fellowship training level on colonoscopy quality and efficiency metrics. Gastrointest Endosc 2018; 88:378-387. [PMID: 29679692 DOI: 10.1016/j.gie.2018.04.2338] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Previous studies have described variable effects of fellow involvement on the adenoma detection rate (ADR), but few have stratified this effect by level of training. We aimed to evaluate the "fellow effect" on multiple procedural metrics including a newly defined adenoma management efficiency index, which may have a role in documenting colonoscopy proficiency for trainees. We also describe the impact of level of training on moderate sedation use. METHODS We performed a retrospective review of 2024 patients (mean age, 60.9 ± 10 years; 94% men) who underwent outpatient colonoscopy between June 2012 and December 2014 at our Veterans Affairs Medical Center. Colonoscopies were divided into 5 groups. The first 2 groups were first-year fellows in the first 6 months and last 6 months of the training year. Second- and third-year fellows and attending-only procedures accounted for 1 group each. We collected data on doses of sedatives used, frequency of adjunctive agent use, procedural times, and location, size, and histology of polyps. We defined the adenoma management efficiency index as average time required per adenoma resected during withdrawal. RESULTS Of the colonoscopies performed, 1675 involved a fellow and 349 were performed by the attending alone. There was no difference in ADR between fellows according to level of training (P = .8) or between fellows compared with attending-only procedures (P = .67). Procedural times decreased consistently during training and declined further for attending-only procedures. This translated into improvement in the adenoma management efficiency index (fellow groups by ascending level of training: 23.5 minutes vs 18.3 minutes vs 13.7 minutes vs 13.4 minutes vs attending group 11.7 minutes; P < .001). There was no difference in the average doses of midazolam and fentanyl used among fellow groups (P = .16 and P = .1, respectively). Compared with attending-only procedures, fellow involvement was associated with higher doses of fentanyl and midazolam and more frequent use of diphenhydramine and glucagon (P < .0001, P = .0002, P < .0001, and P = .01, respectively). CONCLUSIONS ADR was similar at different stages of fellowship training and comparable with the attending group. Efficiency of detecting and resecting polyps improved throughout training without reaching the attending level. Fellow involvement led to a greater use of moderate sedation, which may relate to a longer procedure duration and an evolving experience in endoscopic technique.
Collapse
Affiliation(s)
- Hussein Bitar
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Hassaan Zia
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Muhammad Bashir
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Pratyusha Parava
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Muhammad Hanafi
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - William Tierney
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Mohammad Madhoun
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
|
25
|
Wu J, Zhao SB, Wang SL, Fang J, Xia T, Su XJ, Xu C, Li ZS, Bai Y. Comparison of efficacy of colonoscopy between the morning and afternoon: A systematic review and meta-analysis. Dig Liver Dis 2018; 50:661-667. [PMID: 29776746 DOI: 10.1016/j.dld.2018.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Colonoscopy performed in the afternoon, rather than morning, has been reported to be associated with lower rates of adenoma and polyp detection (ADR and PDR) and cecal intubation (CIR). This meta-analysis evaluated the efficacy of afternoon colonoscopy relative to morning colonoscopy. METHODS The databases MEDLINE, Web of Science, EMBASE, and the Cochrane Library were searched to identify potential relevant studies. The primary outcome was ADR and the secondary outcomes were CIR and PDR. The outcomes were estimated by relative risk (RR) and 95% confidence interval (CI) with a random effects model. RESULTS Sixteen studies with 38,063 participants met the inclusion criteria. The pooled analyses indicated that ADR (RR: 1.08, 95% CI: 1.00-1.17) and CIR (RR: 1.01, 95% CI: 1.00-1.02) were stable during the whole day. In subgroup analyses, the effect of full-day block or inferior bowel preparation were more prominent, reflected by a significant reduction of ADR (RR: 1.18, 95% CI: 1.09-1.28; RR: 1.12, 95% CI: 1.01-1.24) and CIR (RR: 1.08, 95% CI: 1.02-1.13; RR: 1.02, 95% CI: 1.01-1.03) in the afternoon, respectively. CONCLUSIONS Colonoscopy quality, as indicated by the ADR and CIR, is not affected by the time of day for procedures performed in block shifts. However, endoscopists' working full-day blocks and inferior bowel preparation are associated with a significant decrease in ADR and CIR in the afternoon.
Collapse
Affiliation(s)
- Junqi Wu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China; Student Brigade, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Sheng-Bing Zhao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Shu-Ling Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Jun Fang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Tian Xia
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Xiao-Ju Su
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Can Xu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
| |
Collapse
|
|
26
|
Wang W, Xu L, Bao Z, Sun L, Hu C, Zhou F, Xu L, Shi D. Differences with experienced nurse assistance during colonoscopy in detecting polyp and adenoma: a randomized clinical trial. Int J Colorectal Dis 2018. [PMID: 29541895 DOI: 10.1007/s00384-018-3003-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aims to evaluate whether the participation of an experienced endoscopy nurse in colonoscopy increases the polyp detection rate (PDR) and adenoma detection rate (ADR) of experienced colonoscopists. METHODS This study was a randomized controlled trial. Patients were randomly assigned to the experienced colonoscopist alone (single observer) group, or experienced nurse participation (dual observer) group. The primary outcome was the PDR and ADR. The advanced lesion detection rate was also recorded. RESULTS A total of 587 patients were included in the analysis. Among these patients, 291 patients were assigned to the single observer group, while 296 patients were assigned to the dual observer group. The PDR was 33% in the single observer group and 41.9% in the dual observer group (P = 0.026), while the ADR was 23.0% in the single observer group and 30.4% in the dual observer group (P = 0.043). No significant difference was found for advanced lesions between groups. CONCLUSIONS The present data demonstrated that experienced nurse observation during colonoscopy can improve polyp and adenoma detection rates, even if the colonoscopist is experienced. TRIAL REGISTRATION Clinicaltrials.gov No. NCT02292563. https://clinicaltrials.gov/ct2/results?cond=&term=NCT02292563&cntry=&state=&city=&dist=.
Collapse
Affiliation(s)
- Weihong Wang
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Lu Xu
- College of Medicine, Ningbo University, Ningbo, China
| | - Zhenfei Bao
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Linyin Sun
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Chunyan Hu
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Feng Zhou
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Dingmei Shi
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China.
| |
Collapse
|
|
27
|
Menees SB, Kim HM, Schoenfeld P. Split-dose bowel preparation improves adequacy of bowel preparation and gastroenterologists' adherence to National Colorectal Cancer Screening and Surveillance Guidelines. World J Gastroenterol 2018; 24:716-724. [PMID: 29456410 PMCID: PMC5807674 DOI: 10.3748/wjg.v24.i6.716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/29/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To quantify the impact of split-dose regimen on endoscopists' compliance with guideline recommendations for timing of repeat colonoscopy in patients with normal colonoscopy or 1-2 small polyps (< 10 mm). METHODS A retrospective chart review of all endoscopy reports was undertaken in average-risk individuals > 50 years old with a normal screening colonoscopy and 1-2 small polyps. Data were abstracted from two time periods, pre and post-split-dose bowel preparation institution. Main outcome measurements were recommendation for timing of repeat colonoscopy and bowel preparation quality. Bivariate analysis by χ2 tests and Student's t-tests were performed to assess differences between the two cohorts. Multivariable logistic regression was used with guideline consistent recommendations as the dependent variables and an indicator for 2011 cohort as the primary predictor. RESULTS Four thousand two hundred and twenty-five patients were included in the study; 47.0% (1987) prior to the institution of split dose bowel preparation, and 53.0% (2238) after the institution of split dose bowel preparation. Overall, 82.2% (n = 3472) of the colonoscopies were compliant with guideline recommendations, with a small but significantly increased compliance rate in year 2011 (83.7%) compared to year 2009 (80.4%, P = 0.005), corresponding to an unadjusted odds ratio of 1.25 (95%CI: 1.07-1.47; P = 0.005). Colonoscopies with either "Adequate" or "Excellent" had increased from 30.6% in year 2009 to 39.6% in year 2011 (P < 0.001). However, there was no significant difference in poor/inadequate category of bowel preparation as there was a mild increase from 4.6% in year 2009 to 5.1% in year 2011 (P = 0.50). CONCLUSION Split-dose bowel regimen increases endoscopists' compliance to guidelines in average-risk patients with normal colonoscopy or 1-2 small polyps.
Collapse
Affiliation(s)
- Stacy Bartnik Menees
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI 48105, United States
- Division of Gastroenterology, Ann Arbor Veterans’ Administration Hospital, Ann Arbor, MI 48105, United States
| | - H Myra Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI 48105, United States
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48105, United States
| | - Philip Schoenfeld
- Division of Gastroenterology, John D. Dingell VA Medical Center, Detroit, MI 48201, United States
| |
Collapse
|
|
28
|
El-Halabi MM, Barrett PR, Martinez Mateo M, Fayad NF. Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training? Gastroenterology Res 2018; 11:290-294. [PMID: 30116428 PMCID: PMC6089585 DOI: 10.14740/gr1043w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/29/2018] [Indexed: 02/06/2023] Open
Abstract
Background Adenoma detection rate (ADR) is a proven quality metric for colonoscopy. The value of ADR for the evaluation of gastroenterology fellows is not well established. The aim of this study is to calculate and evaluate the utility of ADR as a measure of competency for gastroenterology fellows. Methods Colonoscopies for the purposes of screening and surveillance, on which gastroenterology fellows participated at the Richard L. Roudebush VAMC (one of the primary training sites at Indiana University), during a 9-month period, were included. ADR, cecal intubation rate, and indirect withdrawal time were measured. These metrics were compared between the levels of training. Results A total of 591 screening and surveillance colonoscopies were performed by 14 fellows. This included six, four and four fellows, in the first, second and third year of clinical training, respectively. Fellows were on rotation at the VAMC for a mean of 1.9 months (range 1 to 3 months) during the study period. The average ADR was 68.8% (95% CI 65.37 - 72.24). The average withdrawal time was 27.59 min (95% CI 23.45 - 31.73). The average cecal intubation rate was 99% (95% CI 98-100%). There was no significant difference between ADRs, cecal intubation rates, and withdrawal times at different levels of training; however, a trend toward swifter withdrawal times with advancing training was noted. Conclusions ADR appears not to be a useful measure of competency for gastroenterology fellows. Consideration should be given to alternative metrics that could avoid bias and confounders.
Collapse
Affiliation(s)
- Mustapha M El-Halabi
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick R Barrett
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa Martinez Mateo
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nabil F Fayad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.,Section of Gastroenterology and Hepatology, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| |
Collapse
|
|
29
|
Position change during colonoscopy improves caecal intubation rate, mucosal visibility, and adenoma detection in patients with suboptimal caecal preparation. GASTROENTEROLOGY REVIEW 2018; 12:296-302. [PMID: 29359000 PMCID: PMC5771455 DOI: 10.5114/pg.2017.72106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023]
Abstract
Introduction Most colonoscopies are completed in the left lateral (LL) position but in cases of suboptimal caecal preparation, changing the patient's position to supine (S) and, if needed, to right lateral (RL) improves caecal intubation rate, mucosal visibility, and adenoma detection. Aim To determine if position change during colonoscopy facilitates optimal visualisation of the caecum. Material and methods A total of 359 patients were grouped into three categories based on the initial caecal intubation position. After caecal intubation, caecal visibility was scored on a four-point scale depending on the number of imaginary quadrants of the caecum completely visualized - Arya Caecal Prep Score. A score of 1 or 2 was unsatisfactory, while 3 or 4 was considered satisfactory. In patients with unsatisfactory score, position was changed from LL to S and then RL and visibility was scored again. Results The initial caecal intubation in the LL position was achieved in 66.8% of patients, S in 28.5%, and RL in 4.8% of patients. 84.5% (300/355) of patients had an acceptable visualisation score at the initial caecal intubation position. Of the 55 patients with unsatisfactory caecum visualisation scores in the initial intubation position, 30 (8.5%) had satisfactory scores after the first position change (95% CI: 5.77-11.84). Twenty-five (7.04%) subjects required two position changes (95% CI: 4.61-10.22%). An additional 9.3% (11/118) of adenomas were detected in caecum and ascending colon following position change. Conclusions Changing patient position improves caecal intubation rate, mucosal visibility, and adenoma detection.
Collapse
|
|
30
|
Parikh MP, Muthukuru S, Jobanputra Y, Naha K, Gupta NM, Wadhwa V, Lopez R, Thota PN, Sanaka MR. Proximal Sessile Serrated Adenomas Are More Prevalent in Caucasians, and Gastroenterologists Are Better Than Nongastroenterologists at Their Detection. Gastroenterol Res Pract 2017; 2017:6710931. [PMID: 29403530 PMCID: PMC5748307 DOI: 10.1155/2017/6710931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/04/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIM Proximal sessile serrated adenomas (PSSA) leading to colorectal cancer (CRC) represent an alternate pathway for CRC development. In this study, we aim to determine the prevalence of PSSAs and the impact of patient, colonoscopy, and endoscopist-related factors on PSSA detection. METHODS Patients ≥ 50 years of age undergoing a screening colonoscopy between 2012 and 2014 were included. Detection rates based on patient gender, race, colonoscopy timing, fellow participation, bowel preparation quality, and specialty of the endoscopist were calculated. t-tests were used to compare detection rates and a multivariate-adjusted analysis was performed. RESULTS 140 PSSAs were detected from 4151 colonoscopies, with a prevalence of 3.4%. Detection rate was higher in Caucasians compared to African-Americans (AA) (3.7 ± 4.1 versus 0.96 ± 3.5; p < 0.001). Gastroenterologists detected more PSSAs compared to nongastroenterologists (3.9 ± 3.5 versus 2.2 ± 3.0; p = 0.028). These findings were still significant after adjusted multivariate analysis. The rest of the factors did not make significant difference in PSSA detection rate. CONCLUSIONS PSSAs are more prevalent in Caucasians compared to AAs. Racial difference in prevalence of PSSAs is intriguing and warrants further investigation. Gastroenterologists have a significantly higher PSSADR compared to nongastroenterologists. Educational measures should be implemented in nongastroenterologists to improve their PSSA detection rates.
Collapse
Affiliation(s)
- Malav P. Parikh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sujit Muthukuru
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Yash Jobanputra
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Kushal Naha
- Department of Internal Medicine, Presence Saint Francis Hospital, 355 Ridge Ave, Evanston, IL 60202, USA
| | - Niyati M. Gupta
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Vaibhav Wadhwa
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rocio Lopez
- Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Prashanthi N. Thota
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Madhusudhan R. Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| |
Collapse
|
|
31
|
Maratt JK, Dickens J, Schoenfeld PS, Elta GH, Jackson K, Rizk D, Erickson C, Menees SB. Factors Associated with Surveillance Adenoma and Sessile Serrated Polyp Detection Rates. Dig Dis Sci 2017; 62:3579-3585. [PMID: 29043592 PMCID: PMC5818715 DOI: 10.1007/s10620-017-4792-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/05/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Adenoma detection rate (ADR) and sessile serrated polyp detection rate (SSPDR) data in surveillance colonoscopy are limited. AIMS Our aim was to determine surveillance ADR and SSPDR and identify associated predictors. METHODS A retrospective review of subjects who underwent surveillance colonoscopy for adenoma and/or SSP at an academic center was performed. The following exclusion criteria were applied: prior colonoscopy ≤ 3 years, incomplete examination, or another indication for colonoscopy. Patient, endoscopist, and procedure characteristics were collected. Predictors were identified using multivariable logistic regression. RESULTS Of 3807 colonoscopies, 2416 met inclusion criteria. Surveillance ADR was 49% and, SSPDR was 8%. Higher ADR was associated with: age per year (OR 1.03; 95% CI 1.02-1.04), male gender (OR 1.55; 95% CI 1.29-1.88), BMI per kg/m2 (OR 1.02; 95% CI 1.01-1.04), withdrawal time per minute (OR 1.09; 95% CI 1.07-1.10), and endoscopists' screening ADR (OR 1.01; 95% CI 1.00-1.03). Years since training (OR 0.99; 95% CI 0.98-0.99) was associated with lower ADR. Family history of CRC (OR 1.58; 95% CI 1.02-2.27) and endoscopists' screening ADR (OR 1.40; 95% CI 1.15-1.74) were associated with higher SSPDR. African-American race (OR 0.36; 95% CI 0.10-0.75) and diabetes (OR 0.41; 95% CI 0.21-0.76) were associated with lower SSPDR. CONCLUSIONS For surveillance colonoscopy, nearly half of patients had an adenoma and one in twelve had an SSP. In addition to established factors, BMI, endoscopists' screening ADR, and years since training were associated with ADR, whereas African-American race and diabetes were inversely associated with SSPDR. Further studies are needed prior to integrating surveillance ADR and SSPDR into quality metrics.
Collapse
Affiliation(s)
- Jennifer K. Maratt
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, 3912 Taubman Center, SPC 5362, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | | | - Grace H. Elta
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, 3912 Taubman Center, SPC 5362, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA
| | - Kenya Jackson
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, 3912 Taubman Center, SPC 5362, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA
| | | | - Christine Erickson
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, 3912 Taubman Center, SPC 5362, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA
| | - Stacy B. Menees
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, 3912 Taubman Center, SPC 5362, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
| |
Collapse
|
|
32
|
Chan BP, Hussey A, Rubinger N, Hookey LC. Patient comfort scores do not affect endoscopist behavior during colonoscopy, while trainee involvement has negative effects on patient comfort. Endosc Int Open 2017; 5:E1259-E1267. [PMID: 29218318 PMCID: PMC5718911 DOI: 10.1055/s-0043-120828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 05/02/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Patient comfort is an important part of endoscopy and reflects procedure quality and endoscopist technique. Using the validated, Nurse Assisted Patient Comfort Score (NAPCOMS), this study aimed to determine whether the introduction of NAPCOMS would affect sedation use by endoscopists. PATIENTS AND METHODS The study was conducted over 3 phases. Phase One and Two consisted of 8 weeks of endoscopist blinded and aware data collection, respectively. Data in Phase Three was collected over a 5-month period and scores fed back to individual endoscopists on a monthly basis. RESULTS NAPCOMS consists of 3 domains - pain, sedation, and global tolerability. Comparison of Phase One and Two, showed no significant differences in sedative use or NAPCOMS. Phase Three data showed a decline in fentanyl use between individual months ( P = 0.035), but no change in overall NAPCOMS. Procedures involving trainees were found to use more midazolam ( P = 0.01) and fentanyl ( P = 0.01), have worse NAPCOMS scores, and resulted in longer procedure duration ( P < 0.001). Data comparing gastroenterologists and general surgeons showed increased fentanyl use ( P = 0.037), decreased midazolam use ( P = 0.001), and more position changes ( P = 0.002) among gastroenterologists. CONCLUSIONS The introduction of a patient comfort scoring system resulted in a decrease in fentanyl use, although with minimal clinical significance. Additional studies are required to determine the role of patient comfort scores in quality control in endoscopy. Procedures completed with trainees used more sedation, were longer, and had worse NAPCOMS scores, the implications of which, for teaching hospitals and training programs, will need to be further considered.
Collapse
Affiliation(s)
- Brian P.H. Chan
- Queen's University, Department of Medicine, Kingston Ontario, Canada
| | - Amanda Hussey
- Queen's University, Department of Medicine, Kingston Ontario, Canada
| | - Natalie Rubinger
- Queen's University, Department of Medicine, Kingston Ontario, Canada
| | - Lawrence C. Hookey
- Queen’s University, Gastrointestinal Diseases Research Unit, GI Division Hotel Dieu Hospital, Kingston Ontario, Canada
| |
Collapse
|
|
33
|
Qayed E, Vora R, Levy S, Bostick RM. Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees. World J Gastrointest Endosc 2017; 9:540-551. [PMID: 29184610 PMCID: PMC5696606 DOI: 10.4253/wjge.v9.i11.540] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/20/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate (ADRs) and polyp detection rate (PDRs) of attending gastroenterologists.
METHODS We reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows’ procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural volume.
RESULTS During the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume (1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies (P = 0.0001), while there was no significant change in advanced ADR (0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings’ ADR and PDR after 265 and 292 colonoscopies, respectively.
CONCLUSION We found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.
Collapse
Affiliation(s)
- Emad Qayed
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
- Grady Memorial Hospital, Atlanta, GA 30303, United States
| | - Ravi Vora
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Sara Levy
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Roberd M Bostick
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA 30303, United States
- Emory University, Winship Cancer Institute Atlanta, GA 30303, United States
| |
Collapse
|
|
34
|
Qayed E, Shea L, Goebel S, Bostick RM. Association of trainee participation with adenoma and polyp detection rates. World J Gastrointest Endosc 2017; 9:204-210. [PMID: 28572874 PMCID: PMC5437386 DOI: 10.4253/wjge.v9.i5.204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/12/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether adenoma and polyp detection rates (ADR and PDR, respectively) in screening colonoscopies performed in the presence of fellows differ from those performed by attending physicians alone.
METHODS We performed a retrospective review of all patients who underwent a screening colonoscopy at Grady Memorial Hospital between July 1, 2009 and June 30, 2015. Patients with a history of colon polyps or cancer and those with poor colon preparation or failed cecal intubation were excluded from the analysis. Associations of fellowship training level with the ADR and PDR relative to attendings alone were assessed using unconditional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparation quality.
RESULTS A total of 7503 colonoscopies met the inclusion criteria and were included in the analysis. The mean age of the study patients was 58.2 years; 63.1% were women and 88.2% were African American. The ADR was higher in the fellow participation group overall compared to that in the attending group: 34.5% vs 30.7% (P = 0.001), and for third year fellows it was 35.4% vs 30.7% (aOR = 1.23, 95%CI: 1.09-1.39). The higher ADR in the fellow participation group was evident for both the right and left side of the colon. For the PDR the corresponding figures were 44.5% vs 40.1% (P = 0.0003) and 45.7% vs 40.1% (aOR = 1.25, 95%CI: 1.12-1.41). The ADR and PDR increased with increasing fellow training level (P for trend < 0.05).
CONCLUSION There is a stepwise increase in ADR and PDR across the years of gastroenterology training. Fellow participation is associated with higher adenoma and polyp detection.
Collapse
|
|
35
|
Gianotti RJ, Oza SS, Tapper EB, Kothari D, Sheth SG. A Longitudinal Study of Adenoma Detection Rate in Gastroenterology Fellowship Training. Dig Dis Sci 2016; 61:2831-2837. [PMID: 27405989 DOI: 10.1007/s10620-016-4228-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/09/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Current guidelines suggest that a gastroenterology fellow in training needs to perform 140 colonoscopies to achieve competency. Data are limited regarding adenoma detection rate (ADR) in fellowship. AIMS To assess how fellow ADR correlates with number of colonoscopies performed. METHODS We performed a retrospective study examining consecutive colonoscopies performed by gastroenterology fellows. Fellow ADR before and after the 140 procedure benchmark was compared to colonoscopies performed by attending only with whom these fellows trained. A threshold for ideal procedure count was performed using ROC analysis. RESULTS We analyzed 2021 average-risk colonoscopies performed by 10 gastroenterology fellows under the supervision of an attending physician. When fellows had performed <140 colonoscopies, the ADR was 27 % compared with an ADR of 36 % when fellows had performed >140 colonoscopies under attending supervision (p = 0.02). The ADR of fellows who had performed >140 colonoscopies under attending supervision was greater than that of attending-only colonoscopies (36 vs. 25 %, p < 0.0001). A threshold of >325 (male patients) and 539 (female patients) colonoscopies was determined to be ideal for achieving adequate ADR based on ROC analysis. CONCLUSIONS Our data suggest that ADR increases after fellows perform >140 colonoscopies under attending supervision, and thereafter surpasses the ADR of attending-only colonoscopies. Some of the differences may be driven by detection of small adenomas. The findings of this study suggest that a higher threshold for number of colonoscopies performed under attending supervision may be needed to achieve adequate ADR during fellowship prior to independent practice.
Collapse
Affiliation(s)
- Robert J Gianotti
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Sveta Shah Oza
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Elliot B Tapper
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Darshan Kothari
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Sunil G Sheth
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| |
Collapse
|
|
36
|
Jung DK, Kim TO, Kang MS, Kim MS, Kim MS, Moon YS. The Colonoscopist's Expertise Affects the Characteristics of Detected Polyps. Clin Endosc 2016; 49:61-8. [PMID: 26855926 PMCID: PMC4743734 DOI: 10.5946/ce.2016.49.1.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 12/31/2022] Open
Abstract
Background/Aims: The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist. Methods: We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist. Results: No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies. Conclusions: Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.
Collapse
Affiliation(s)
- Da Kyoung Jung
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Mi Seon Kang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Mo Se Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Min Sik Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Soo Moon
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
|
37
|
Nurse Participation in Colonoscopy Observation versus the Colonoscopist Alone for Polyp and Adenoma Detection: A Meta-Analysis of Randomized, Controlled Trials. Gastroenterol Res Pract 2015; 2016:7631981. [PMID: 26839543 PMCID: PMC4709663 DOI: 10.1155/2016/7631981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/08/2015] [Indexed: 12/22/2022] Open
Abstract
The role of nurse participation (NP) in colonoscopy observation for polyp and adenoma detection is unclear. This study aimed to evaluate whether nurse participation can improve polyp and adenoma detection. Patients and Methods. The PUBMED, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) published in English. The outcome measurements included (1) the polyp and adenoma detection rate (PDR and ADR); (2) the advanced lesions detection rate; and (3) the mean polyp and adenoma detection rate per colonoscopy. Results. Three RCTs with a total of 1676 patients were included. The pooled data showed a significantly higher ADR in the NP group than colonoscopist alone (CA) (45.7% versus 39.3%; RR 1.16; 95% CI, 1.04–1.30). And it showed no significant difference in the PDR and advanced lesions detection rate between the two groups (RR: 1.14, 95% CI: 0.95–1.37; RR: 1.35, 95% CI: 0.91–2.00; resp.). Conclusions. Nurse participation during a colonoscopy can improve the ADR, whereas no benefit for the PDR and advanced lesions detection rate was observed. All RCTs included in the meta-analysis had high risk of bias. Thus, there is a need for new research that uses sound methodology to definitively address the research question under study.
Collapse
|
|
38
|
Ratuapli SK, Ruff KC, Ramirez FC, Wu Q, Mohankumar D, Santello M, Fleischer DE. Kinematic analysis of wrist motion during simulated colonoscopy in first-year gastroenterology fellows. Endosc Int Open 2015; 3:E621-6. [PMID: 26716123 PMCID: PMC4683126 DOI: 10.1055/s-0034-1393061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Gastroenterology trainees acquire skill and proficiency in performing colonoscopies at different rates. The cause for heterogeneous competency among the trainees is unclear. Kinematic analysis of the wrist joint while performing colonoscopy can objectively assess the variation in wrist motion. Our objective was to test the hypothesis that the time spent by the trainees in extreme ranges of wrist motion will decrease as the trainees advance through the fellowship year. SUBJECTS AND METHODS Five first-year gastroenterology fellows were prospectively studied at four intervals while performing simulated colonoscopies. The setting was an endoscopy simulation laboratory at a tertiary care center. Kinematic assessment of wrist motion was done using a magnetic position/orientation tracker held in place by a custom-made arm sleeve and hand glove. The main outcome measure was time spent performing each of four ranges of wrist motion (mid, center, extreme, and out) for each wrist degree of freedom (pronation/supination, flexion/extension, and adduction/abduction). RESULTS There were no statistically significant differences in the time spent for wrist movements across the three degrees of freedom throughout the study period. However, fellows spent significantly less time in extreme range (1.47 ± 0.34 min vs. 2.44 ± 0.34 min, P = 0.004) and center range (1.02 ± 0.34 min vs 1.9 ± 0.34 min, P = 0.01) at the end of the study compared to the baseline evaluation. The study was limited by the small number of subjects and performance of colonoscopies on a simulator rather than live patients. CONCLUSIONS Gastroenterology trainees alter the time spent at the extreme range of wrist motion as they advance through training. Endoscopy training during the first 10 months of fellowship may have beneficial effects on learning ergonomically correct motion patterns.
Collapse
Affiliation(s)
| | - Kevin C Ruff
- Division of Gastroenterology, Mayo Clinic Arizona,Corresponding Author: Kevin C Ruff MD Division of Gastroenterology 13400 East Shea BoulevardScottsdale, AZ 85259480-301-6990480-301-6737
| | | | - Qing Wu
- Division of Health Sciences and Research, Mayo Clinic Arizona
| | - Deepika Mohankumar
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
| | - Marco Santello
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
| | | |
Collapse
|
|
39
|
Subramanian S, Psarelli EE, Collins P, Haslam N, O’Toole P, Lombard M, Sarkar S. Colonoscopy performance is stable during the course of an extended three-session working day. Endosc Int Open 2015; 3:E494-500. [PMID: 26528507 PMCID: PMC4612239 DOI: 10.1055/s-0034-1392523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/06/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Three-session days were introduced in our endoscopy unit to accommodate the increased demand resulting from the introduction of the National Health Service Bowel Cancer Screening Programme (BCSP). Cecal intubation rate (CIR) and adenoma detection rate (ADR) may decline with time during a standard working day, but data are lacking for an extended three-session day. We assessed colonoscopy performance in an extended three-session day. METHODS Colonoscopies performed during the year 2011 were retrospectively analyzed. The CIR and ADR were analyzed according to the time of day when procedures were done: morning (AM), afternoon (PM), or evening (EVE). Because of an expected higher incidence of adenomas in the BCSP patients, ADR was analyzed according to indication (BCSP or non-BCSP). RESULTS Of the 2574 colonoscopies, 1328 (51.7 %) were in male patients and 1239 (48.3 %) in female patients with a median age of 63 years (interquartile range [IQR], 51 - 70). Of the 2574 colonoscopies, 1091 (42.4 %) were performed in AM lists, 994 (38.6 %) in PM lists, and 489 (19 %) in EVE lists. Time of day did not affect the CIRs for the AM, PM, and EVE lists (90.5 %, 90.1 %, and 89.9 %, respectively; χ (2) [2, N = 2540] = 0.15, P = 0.927). The CIR was reduced in female patients and those with poor bowel preparation (P < 0.05). After exclusion of the BCSP patients, the ADR was lower in the EVE lists than in the AM and PM lists on univariate analysis, but on multivariate analysis, this difference was not significant (P > 0.05). The ADR was significantly higher in patients older than 60 years and in men (P < 0.001). Queue position did not independently influence the CIR or ADR. CONCLUSIONS Colonoscopy quality does not appear to depend on time of day or queue position in an extended three-session day.
Collapse
Affiliation(s)
- Sreedhar Subramanian
- Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom,Corresponding author Sreedhar Subramanian, MD, MRCP Department of GastroenterologyRoyal Liverpool University HospitalPrescot StreetLiverpool L7 8XPUnited Kingdom+44-151-7065832
| | | | - Paul Collins
- Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom
| | - Neil Haslam
- Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom
| | - Paul O’Toole
- Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom
| | - Martin Lombard
- Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom
| | - Sanchoy Sarkar
- Department of Gastroenterology, Royal Liverpool University Hospital, United Kingdom
| |
Collapse
|
|
40
|
Brenner H, Altenhofen L, Kretschmann J, Rösch T, Pox C, Stock C, Hoffmeister M. Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program. Gastroenterology 2015; 149:356-66.e1. [PMID: 25911510 DOI: 10.1053/j.gastro.2015.04.012] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/05/2015] [Accepted: 04/14/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program. METHODS We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry. RESULTS We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3% to 22.3% among men and from 8.4% to 14.9% among women. This increase was mostly due to an increase in detection rates of adenomas <0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4% to 9.0% among men, and from 4.4% to 5.2% among women) and colorectal cancer. In 2012, overall ADR reached 31.3% and 20.1% in men and women, respectively. CONCLUSIONS We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas <0.5 cm). Further research should address potential implications for defining screening and surveillance intervals.
Collapse
Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Lutz Altenhofen
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Jens Kretschmann
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Thomas Rösch
- Interdisciplinary Endoscopy Department and Clinic, University Clinic Hamburg, Hamburg, Germany
| | - Christian Pox
- Department of Medicine, Ruhr University Bochum, Knappschaftskrankenhaus, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
|
41
|
Pace D, Borgaonkar M, Hickey N, Evans B, Lougheed M, Marcoux C, McGrath J, Boone D, O’Leary M, Smith C. Does the hands-on, technical training of residents in colonoscopy affect quality outcomes? Surg Endosc 2015; 30:1352-5. [DOI: 10.1007/s00464-015-4397-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/27/2015] [Indexed: 01/28/2023]
|
|
42
|
Abstract
GOALS To assess whether endoscopist fatigue adversely affects the adenoma detection rate (ADR) during screening colonoscopy. BACKGROUND Endoscopist fatigue may affect the ADR during colonoscopy; however, this association has not been directly studied. STUDY A prospective, multi-center study was performed on screening colonoscopies performed for asymptomatic subjects between March 2012 and December 2012 in Korea. Endoscopist fatigue was defined and measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. The ADR was compared between fatigued endoscopists and nonfatigued endoscopists, and a multivariate regression analysis was performed to identify independent factors related to the detection of colorectal adenoma. RESULTS During the study period, a total of 457 subjects underwent screening colonoscopy. After excluding 62 subjects, outcomes of 395 subjects were analyzed. The overall ADR of the study population was 39.7%. The mean score of FACIT-F was 36.4±10.8, and a cutoff score of 25 was chosen to define fatigue. The ADR was lower in fatigued endoscopists than nonfatigued endoscopists (25.0% vs. 42.6%, P=0.008). Using multivariate regression analysis, endoscopist fatigue measured with FACIT-F (odds ratio=3.585; 95% confidence interval, 1.663-7.728; P=0.001) was found to be an independent factor for the ADR. CONCLUSIONS FACIT-F score may be a novel measure for endoscopist fatigue, and ADR was adversely influenced by endoscopist fatigue measured by FACIT-F. Our results suggest that endoscopist fatigue may contribute to a decline in the effectiveness of screening colonoscopy.
Collapse
|
|
43
|
van Doorn SC, Klanderman RB, Hazewinkel Y, Fockens P, Dekker E. Adenoma detection rate varies greatly during colonoscopy training. Gastrointest Endosc 2015; 82:122-9. [PMID: 25817896 DOI: 10.1016/j.gie.2014.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/07/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The adenoma detection rate (ADR) is considered the most important quality indicator for colonoscopy and varies widely among colonoscopists. It is unknown whether the ADR of gastroenterology consultants can already be predicted during their colonoscopy training. OBJECTIVE To evaluate the ADR of fellows in gastroenterology and evaluate whether this predicts their ADR as gastroenterology consultants. DESIGN Retrospective observational study. SETTING Academic and regional centers. PATIENTS Symptomatic patients undergoing colonoscopy. MAIN OUTCOME MEASUREMENTS The variance in ADR among 7 gastroenterology fellows during their training (between May 2004 and March 2012) and of the same fellows after they registered as consultants (between October 2011 and April 2014) was evaluated. Multivariate logistic regression was performed to compare the highest detector (endoscopist with highest ADR) with the individual fellows and to evaluate whether an ADR of 20% or higher during the training was predictive of a high ADR as a consultant. RESULTS During training, ADRs ranged from 14% to 36% (P < .001). Compared with the highest detector, the OR for detecting an adenoma ranged from 0.64 (95% CI, 0.40-1.03) to 0.29 (95% CI, 0.17-0.48). After registration, ADR ranged from 19.8% to 40.2% (P = .066). Compared with the highest detector during consultancy, the OR ranged from 0.64 (95% CI, 0.34-1.21) to 0.26 (95% CI, 0.13-0.52). Only 2 fellows significantly improved their ADR after completing their training. An ADR lower than 20% during training was associated with a lower ADR as a consultant (OR 0.51; 95% CI, 0.30-0.87). LIMITATIONS Retrospective study. CONCLUSIONS Variance in ADR is already present during the endoscopy training of gastroenterology fellows. Most fellows do not improve their ADR after completing their training. These findings suggest that the ADR can be predicted during colonoscopy training, and we suggest that feedback and benchmarking should be implemented early during training of fellows in an effort to improve ADR in future daily practice as a consultant.
Collapse
Affiliation(s)
- Sascha C van Doorn
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert B Klanderman
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
|
44
|
Complete resection of colorectal adenomas: what are the important factors in fellow training? Dig Dis Sci 2015; 60:1579-88. [PMID: 25540087 DOI: 10.1007/s10620-014-3500-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND The complete removal of adenomatous polyps is important for reducing interval cancer after colonoscopy. AIMS To identify factors affecting the completeness of colonoscopic polypectomies and to evaluate the experience level of fellows who achieve competence compared with that of experts. METHODS Medical records of 1,860 patients who underwent at least one polypectomy for an adenomatous polyp at Seoul National University Hospital between March 2011 and February 2013 were retrospectively reviewed. A total of 3,469 adenomatous polyps were included. The lateral and deep margins of the resected polyps were evaluated to check the resection completeness. RESULTS Of the 3,469 adenomatous polyps, 1,389 (40.0 %) were removed by two experts and 2,080 (60.0 %) were removed by seven fellows. In the expert-treated group, larger size [odds ratio (OR) 2.81 for ≥20 mm, 95 % confidence interval (CI) 1.64-4.84, P < 0.001] and right-sided location (OR 1.31, 95 % CI 1.05-1.63, P = 0.019) were associated with incomplete resection. In the fellow-treated group, not only polyp characteristics [right-sided location (OR 1.41, 95 % CI 1.18-1.69, P < 0.001)], but also the cumulative number of procedures was also related to resection completeness. After 300 polypectomies, the complete resection rate of the fellows was comparable to that of the experts. CONCLUSIONS In the fellow-treated group, the level of procedure experience was closely associated with the polypectomy outcomes. Meticulous attention is critical to ensure the completeness of polypectomies performed by trainee endoscopists during the training program.
Collapse
|
|
45
|
Ussui V, Coe S, Rizk C, Crook JE, Diehl NN, Wallace MB. Stability of increased adenoma detection at colonoscopy. Follow-up of an endoscopic quality improvement program-EQUIP-II. Am J Gastroenterol 2015; 110:489-96. [PMID: 25267326 DOI: 10.1038/ajg.2014.314] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/01/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We recently completed a randomized controlled trial of an endoscopic quality improvement program (EQUIP) that demonstrated an improved adenoma detection rate (ADR) through simple educational interventions. The aim of this study (phase III) is to examine whether the improvement in ADR in the trained endoscopists remained stable with further follow-up. METHODS We prospectively followed up 15 staff endoscopists who had previously been randomized to a quality improvement intervention. In the current study, we examined an additional 1,200 colonoscopy procedures conducted over a 5-month time period following the original study, referred to as phase III. During this time, all physicians received quarterly ADR and other quality metric feedback, and the previous control group was offered the educational intervention voluntarily. ADRs and adenoma per patient (APP) rates were estimated in the endoscopists who were and were not randomized to EQUIP training and compared with those obtained in phases I and II of the original study. The study was conducted in a tertiary care Academic Medical Center. The study sample comprised 1200 patients undergoing routine colonoscopy. The main outcome measurement was adenoma detection rate. RESULTS The previously observed increase in ADR in the trained group from 36% in phase I to 47% in phase II was maintained into phase III (46%). The ADR of the untrained group remained unchanged from phase I (36%) to phase II (35%); it was increased only marginally in phase III to 39%, which was still lower than the 46% ADR in the trained group. The trained group had an increase in APP, from 0.72 in Phase I to 0.87 in Phase II and 0.98 in Phase III. For the previously untrained group, there was no change in APP from phase I (0.68) to phase II (0.68), but there was possibly a small increase (to 0.74) in Phase III. CONCLUSIONS This study provides evidence that improvements in ADR obtained through the endoscopic quality-training program can persist for at least 5 months after completion of the program. It further suggests that a focus on ADR does not lead to a "one and done" phenomenon. The limitations of this study were as follows: single-center setting, and lack of sessile polyp information/standardization.
Collapse
Affiliation(s)
- Vivian Ussui
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Susan Coe
- 1] Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA [2] Atlanta Gastroenterology Associates, Snellville, Georgia, USA
| | - Cynthia Rizk
- 1] Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA [2] Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Julia E Crook
- Division of Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Nancy N Diehl
- Division of Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
|
46
|
Triantafyllou K, Sioulas AD, Kalli T, Misailidis N, Polymeros D, Papanikolaou IS, Karamanolis G, Ladas SD. Optimized sedation improves colonoscopy quality long-term. Gastroenterol Res Pract 2015; 2015:195093. [PMID: 25648556 PMCID: PMC4306400 DOI: 10.1155/2015/195093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/23/2014] [Indexed: 12/24/2022] Open
Abstract
Background. Quality monitoring and improvement is prerequisite for efficient colonoscopy. Aim. To assess the effects of increased sedation administration on colonoscopy performance. Materials and Methods. During Era 1 we prospectively measured four colonoscopy quality indicators: sedation administration, colonoscopy completion rate, adenoma detection rate, and early complications rate in three cohorts: cohort A: intention for total colonoscopy cases; cohort B: cohort A excluding bowel obstruction cases; cohort C: CRC screening-surveillance cases within cohort B. We identified deficiencies and implemented our plan to optimize sedation. We prospectively evaluated its effects in both short- (Era 2) and long-term period (Era 3). Results. We identified that sedation administration and colonoscopy completion rates were below recommended standards. After sedation optimization its use rate increased significantly (38.1% to 55.8% to 69.5%) and colonoscopy completion rate increased from 88.3% to 90.6% to 96.4% in cohort B and from 93.2% to 95.3% to 98.3% in cohort C, in Eras 1, 2, and 3, respectively. Adenoma detection rate increased in cohort C (25.9% to 30.6% to 35%) and early complications rate decreased from 3.4% to 1.9% to 0.3%. Most endoscopists increased significantly their completion rate and this was preserved long-term. Conclusion. Increased sedation administration results in long-lasting improvement of colonoscopy quality indicators.
Collapse
Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece
| | - Athanasios D. Sioulas
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece
| | - Theodora Kalli
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece
| | - Nikolaos Misailidis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece
| | - Dimitrios Polymeros
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece
| | - George Karamanolis
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School, Athens University, 11527 Athens, Greece
| | - Spiros D. Ladas
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School, Athens University, 11527 Athens, Greece
| |
Collapse
|
|
47
|
Adenoma detection rates decline with increasing procedural hours in an endoscopist's workload. Can J Gastroenterol Hepatol 2015; 29:304-8. [PMID: 25996612 PMCID: PMC4578453 DOI: 10.1155/2015/789038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Operator fatigue may negatively influence adenoma detection (AD) during screening colonoscopy. OBJECTIVE To better characterize factors affecting AD, including the number of hours worked, and the number and type of procedures performed before an index screening colonoscopy. METHODS A retrospective cohort study was conducted involving individuals undergoing a screening colonoscopy at a major tertiary care hospital in Montreal, Quebec. Individuals were identified using an endoscopic reporting database; AD was identified by an electronic chart review. A hierarchical logistic regression analysis was performed to determine the association between patient- and endoscopist-related variables and AD. RESULTS A total of 430 consecutive colonoscopies performed by 10 gastroenterologists and two surgeons were included. Patient mean (± SD) age was 63.4±10.9 years, 56.3% were males, 27.7% had undergone a previous colonoscopy and the cecal intubation rate was 95.7%. The overall AD rate was 25.7%. Age was associated with AD (OR 1.06 [95% CI 1.03 to 1.08]), while female sex (OR 0.44 [95% CI 0.25 to 0.75]), an indication for average-risk screening (OR 0.47 [95% CI 0.27 to 0.80]) and an increase in the number of hours during which endoscopies were performed before the index colonoscopy (OR 0.87 [95% CI 0.76 to 0.99]) were associated with lower AD rates. On exploratory univariable analysis, a threshold of 3 h of endoscopy time performed before the index colonoscopy was associated with decreased AD. CONCLUSION The number of hours devoted to endoscopies before the index colonoscopy was inversely associated with AD rate, with decreased performance possibly as early as within 3 h. This metric should be confirmed in future studies and considered when optimizing scheduling practices.
Collapse
|
|
48
|
Zhang Q, Chen ZY, Chen CD, Liu T, Tang XW, Ren YT, Huang SL, Cui XB, An SL, Xiao B, Bai Y, Liu SD, Jiang B, Zhi FC, Gong W. Training in early gastric cancer diagnosis improves the detection rate of early gastric cancer: an observational study in China. Medicine (Baltimore) 2015; 94:e384. [PMID: 25590840 PMCID: PMC4602560 DOI: 10.1097/md.0000000000000384] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/22/2014] [Accepted: 11/24/2014] [Indexed: 12/14/2022] Open
Abstract
Few studies have analyzed the training of endoscopists in the diagnosis of early gastric cancer (EGC). This study assessed whether specific training of endoscopists improves the detection rate of EGC. The rates of detection of EGC by endoscopists at the Digestive Endoscopy Center of the Affiliated Nanfang Hospital of China Southern Medical University between January 2013 and May 2014 were retrospectively analyzed. Because some endoscopists received training in the diagnosis of EGC, beginning in September 2013, the study was divided into 3 time periods: January to September 2013 (period 1), September 2013 to January 2014 (period 2), and January to May 2014 (period 3). The rates of EGC detection during these 3 periods were analyzed. From January 2013 to May 2014, a total of 25,314 gastroscopy examinations were performed at our center, with 48 of these examinations (0.2%) detecting EGCs, accounting for 12.1% (48/396) of the total number of gastric cancers detected. The EGC detection rates by trained endoscopists during periods 1, 2, and 3 were 0.3%, 0.6%, and 1.5%, respectively, accounting for 22.0%, 39.0%, and 60.0%, respectively, of the gastric cancers detected during these time periods. In comparison, the EGC detection rates by untrained endoscopists during periods 1, 2, and 3 were 0.05%, 0.08%, and 0.10%, respectively, accounting for 3.1%, 6.0%, and 5.7%, respectively, of the gastric cancers detected during these times. After training, the detection rate by some trained endoscopists markedly increased from 0.2% during period 1 to 2.3% during period 3. Further, the use of magnifying endoscopy with narrow-band imaging (M-NBI) (odds ratio = 3.1, 95% confidence interval 2.4-4.1, P < 0.001) contributed to the diagnosis of EGC. In conclusion, specific training could improve the endoscopic detection rate of EGC. M-NBI contributed to the diagnosis of EGC.
Collapse
Affiliation(s)
- Qiang Zhang
- From the Department of Gastroenterology (QZ, Z-yC, C-dC, TL, X-wT, Y-tR, S-lH, X-bC, BX, YB, S-dL, BJ, F-cZ, WG), Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province; and Department of Bio-Statistics (S-lA), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
49
|
Xirasagar S, Li YJ, Hurley TG, Tsai MH, Hardin JW, Hurley DM, Hebert JR, de Groen PC. Colorectal cancer prevention by an optimized colonoscopy protocol in routine practice. Int J Cancer 2014; 136:E731-42. [PMID: 25242510 DOI: 10.1002/ijc.29228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/05/2014] [Accepted: 09/12/2014] [Indexed: 12/22/2022]
Abstract
We conducted a retrospective cohort study to investigate the colorectal cancer (CRC) incidence and mortality prevention achievable in clinical practice with an optimized colonoscopy protocol targeting near-complete polyp clearance. The protocol consisted of: (i) telephonic reinforcement of bowel preparation instructions; (ii) active inspection for polyps throughout insertion and circumferential withdrawal; and (iii) timely updating of the protocol and documentation to incorporate the latest guidelines. Of 17,312 patients provided screening colonoscopies by 59 endoscopists in South Carolina, USA from September 2001 through December 2008, 997 were excluded using accepted exclusion criteria. Data on 16,315 patients were merged with the South Carolina Central Cancer Registry and Vital Records Registry data from January 1996 to December 2009 to identify incident CRC cases and deaths, incident lung cancers and brain cancer deaths (comparison control cancers). The standardized incidence ratios (SIR) and standardized mortality ratios (SMR) relative to South Carolina and US SEER-18 population rates were calculated. Over 78,375 person-years of observation, 18 patients developed CRC versus 104.11 expected for an SIR of 0.17, or 83% CRC protection, the rates being 68% and 91%, respectively among the adenoma- and adenoma-free subgroups (all p < 0.001). Restricting the cohort to ensure minimum 5-year follow-up (mean follow-up 6.64 years) did not change the results. The CRC mortality reduction was 89% (p < 0.001; four CRC deaths vs. 35.95 expected). The lung cancer SIR was 0.96 (p = 0.67), and brain cancer SMR was 0.92 (p = 0.35). Over 80% reduction in CRC incidence and mortality is achievable in routine practice by implementing key colonoscopy principles targeting near-complete polyp clearance.
Collapse
Affiliation(s)
- Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | | | | | | | | | | | | | | |
Collapse
|
|
50
|
Impact of the endoscopic teaching process on colonic adenoma detection. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:155-8. [PMID: 24878220 DOI: 10.1016/j.rgmx.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND There has been little reported experience in the Latin American hospital setting in relation to the impact of the endoscopic training process on colonoscopy quality. AIMS To determine the effect that training in the technique of colonoscopy has on adenoma detection in an Argentinian teaching hospital. MATERIAL AND METHOD Within the time frame of July 2012 and July 2013, 3 physicians received training in colonoscopy from 4 experienced endoscopists. The colonoscopies performed by the supervised trainees were compared with those carried out by the experienced endoscopists. RESULTS A total of 318 colonoscopies performed by any one of the 3 supervised trainees and 367 carried out by any one of the experienced endoscopists were included. The univariate analysis showed a non-significant difference in the detection rate of adenomas (30.4 vs. 24.7%, P=.09). In the multivariate analysis, the detection rate of adenomas was significantly higher in the colonoscopies performed by one of the 3 trainees (odds ratio = 1.72 [1.19-2.48]). CONCLUSIONS The supervised involvement of endoscopic trainees has a positive effect on adenoma detection.
Collapse
|