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Taghiakbari M, Coman DE, Takla M, Barkun A, Bouin M, Bouchard S, Deslandres E, Sidani S, von Renteln D. Measuring the observer (Hawthorne) effect on adenoma detection rates. Endosc Int Open 2023; 11:E908-E919. [PMID: 37810903 PMCID: PMC10558259 DOI: 10.1055/a-2131-4797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background and study aims An independent observer can improve procedural quality. We evaluated the impact of the observer (Hawthorne effect) on important quality metrics during colonoscopies. Patients and Methods In a single-center comparative study, consecutive patients undergoing routine screening or diagnostic colonoscopy were prospectively enrolled. In the index group, all procedural steps and quality metrics were observed and documented, and the procedure was video recorded by an independent research assistant. In the reference group, colonoscopies were performed without independent observation. Colonoscopy quality metrics such as polyp, adenoma, serrated lesions, and advanced adenoma detection rates (PDR, ADR, SLDR, AADR) were compared. The probabilities of increased quality metrics were evaluated through regression analyses weighted by the inversed probability of observation during the procedure. Results We included 327 index individuals and 360 referents in the final analyses. The index group had significantly higher PDRs (62.4% vs. 53.1%, P =0.02) and ADRs (39.4% vs. 28.3%, P =0.002) compared with the reference group. The SLDR and AADR were not significantly increased. After adjusting for potential confounders, the ADR and SLDR were 50% (relative risk [RR] 1.51; 95%, CI 1.05-2.17) and more than twofold (RR 2.17; 95%, CI 1.05-4.47) more likely to be higher in the index group than in the reference group. Conclusions The presence of an independent observer documenting colonoscopy quality metrics and video recording the colonoscopy resulted in a significant increase in ADR and other quality metrics. The Hawthorne effect should be considered an alternative strategy to advanced devices to improve colonoscopy quality in practice.
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Affiliation(s)
- Mahsa Taghiakbari
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Diana Elena Coman
- Internal Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Mark Takla
- Faculty of Medicine, University of Montreal Hospital Centre, Montreal, Canada
| | - Alan Barkun
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Mickael Bouin
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Simon Bouchard
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
- Gastroenterology, Centre de Recherche de l'Université de Montréal (CHUM), Montreal, Canada
| | - Eric Deslandres
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
- Gastroenterology, Centre de Recherche de l'Université de Montréal (CHUM), Montreal, Canada
| | - Sacha Sidani
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
- Gastroenterology, Centre de Recherche de l'Université de Montréal (CHUM), Montreal, Canada
| | - Daniel von Renteln
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
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Mouchli M, Bierle L, Reddy S, Walsh C, Mir A, Yeaton P, Chitnavis V. Does completing advanced endoscopy fellowship improve outcomes after endoscopic mucosal resection? Minerva Gastroenterol (Torino) 2023; 69:344-350. [PMID: 33793165 DOI: 10.23736/s2724-5985.21.02782-3] [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: 11/08/2022]
Abstract
BACKGROUND It was reported that about 60% of the physicians in the USA believed that their Gastroenterology fellowship poorly prepared them for large polyp resection. The aim of this study was to compare endoscopic mucosal resection (EMR) efficacy and complication rates between skilled general gastroenterologists who perform high volume of EMR and advanced endoscopists. METHODS We identified 140 patients with documented large colonic polyps treated by 4 providers using EMR technique at Carilion Clinic, in Roanoke, Virginia, USA between 01/01/2014-12/31/2017, with follow-up through 10-2018. Information on demographics, clinical and pathological features of high-risk polyps (i.e., size, histology, site, and degree of dysplasia), timing of surveillance endoscopies, tools used during resection, and skills of performing endoscopist's were extracted. The cumulative risks of polyp recurrence after first resection using EMR technique were estimated using Kaplan-Meier curves. RESULTS One hundred and forty patients were identified (mean age, 64.1±11.2 years; 47.1% males). Fifty-five polyps (39.3%) were removed by 2 skilled gastroenterologists and 85 (60.7%) were removed by advanced endoscopists. Most of the polyps resected were located in the right colon (63.6%) and roughly half of the polyps were removed in piecemeal fashion. At follow-up endoscopy, the advanced endoscopy group had lower polyp recurrence rates. The median recurrence after polypectomy was significantly different between the groups (0.88 and 1.03 years for skilled gastroenterologists who did not complete and completed EMR hands-on workshops; respectively vs. 3.99 years for the advanced endoscopist who did not complete EMR hands-on workshop, P=0.03). CONCLUSIONS There is a need for additional EMR training since polyp recurrence was significantly different between the groups despite high rates of piecemeal resection in the advanced endoscopy groups.
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Affiliation(s)
- Mohamad Mouchli
- Department of Hepatology and Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH, USA -
| | - Lindsey Bierle
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Shravani Reddy
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Christopher Walsh
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Adil Mir
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Paul Yeaton
- Department of Hepatology and Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Vikas Chitnavis
- Department of Hepatology and Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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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: 0.8] [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.
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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
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Facciorusso A, Buccino VR, Tonti P, Licinio R, Del Prete V, Neve V, Di Maso M, Muscatiello N. Impact of fellow participation on colon adenoma detection rates: a multicenter randomized trial. Gastrointest Endosc 2020; 92:1228-1235. [PMID: 32433915 DOI: 10.1016/j.gie.2020.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS There are limited and conflicting data on the impact of fellow participation in improving the colon adenoma detection rate. We performed a multicenter randomized controlled trial to evaluate whether fellow involvement might have a beneficial effect on adenoma detection rate. METHODS The trial was conducted at 4 tertiary hospitals between April and December 2019. Eight hundred twelve patients were randomized to undergo colonoscopy performed by a fellow under the supervision of a staff endoscopist or by an attending physician alone. RESULTS No significant differences in demographic or adenoma risk factors were detected between the 2 groups. The adenoma detection rate in the intervention group was 44.8% versus 37.1% in the control arm (P = .02). The mean number of adenomas per colonoscopy was significantly higher in the intervention group (0.65 ± 0.3 vs 0.53 ± 0.2 in the control arm, P < .001). The polyp detection rate was 69.7% in the intervention group and 62.5% in the control arm (P = .03), whereas rates of advanced and sessile/serrated adenoma detection were not different between the trial arms (P = .50 and .42, respectively). In the subgroup of more experienced fellows, the adenoma detection rate and polyp detection rate were 49.5% and 75.7%, respectively. No difference was observed between less-experienced fellows and attending physicians alone (P = .53 and 0.86, respectively). The level of bowel preparation and fellow involvement were significant predictors of increased adenoma detection rate in a multivariate analysis. CONCLUSIONS Our multicenter trial represents the first prospective validation of the beneficial role of fellow involvement in colonoscopy procedures. (Clinical trial registration number: NCT03908229.).
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | | | - Paolo Tonti
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Viviana Neve
- Endoscopy Unit, Ospedale A. Perrino, Brindisi, Italy
| | - Marianna Di Maso
- Endoscopy Unit, Ospedale Teresa Masselli Mascia, San Severo, Italy
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
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Kumar NL, Saltzman JR. Want to improve your adenoma detection rate? Work with a fellow! Gastrointest Endosc 2020; 92:1236-1238. [PMID: 33236995 DOI: 10.1016/j.gie.2020.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Navin L Kumar
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - John R Saltzman
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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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: 10] [Impact Index Per Article: 2.5] [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).
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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.
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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: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [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%.
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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.
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Gkolfakis P, Tziatzios G, Triantafyllou K. Oldie but goodie? Do attending endoscopists really need their fellows? Gastrointest Endosc 2019; 89:446. [PMID: 30665541 DOI: 10.1016/j.gie.2018.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022]
Affiliation(s)
- 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
| | - 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
| | - 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
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9
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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: 1.7] [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=.
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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.
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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: 0.5] [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.
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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
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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: 12] [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.
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12
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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: 1.2] [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.
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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
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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: 1.9] [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.
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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.
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Lasa J, Moore R, Peralta A, Dima G, Zubiaurre I, Arguello M, Senderovsky M, Moretti L, Avagnina A, Soifer L. Impact of the endoscopic teaching process on colonic adenoma detection. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2014.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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If you have a low adenoma detection rate, don't blame your fellows. Dig Dis Sci 2013; 58:3382-3. [PMID: 24114041 DOI: 10.1007/s10620-013-2817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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