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Lorenzo-Zúñiga García V, Sábado Martí F, Pantaleón Sánchez MÁ, Machlab Mashlab S, Carral Martínez D, Gómez Rodríguez BJ, López Cano A, Rodríguez Muñoz S, Pérez Arellano E, Turbi Disla C, Esteban López-Jamar JM. Effectiveness and safety of a 1L polyethylene glycol and ascorbic acid preparation for colonoscopy in routine clinical practice in Spain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116. [PMID: 39087668 DOI: 10.17235/reed.2024.10426/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND AND AIMS Large clinical trials and small real-world studies show that a 1L polyethylene glycol and ascorbic acid solution (1L PEG-ASC) is an effective and safe bowel preparation for colonoscopy. Here, the effectiveness and safety of 1L PEG-ASC was evaluated in a large cohort of patients in routine clinical practice in Spain. METHODS A sub-analysis was performed in an observational, multicenter, retrospective study assessing the effectiveness and safety of 1L PEG-ASC in adult patients undergoing a colonoscopy at 10 centers in Spain. Cleansing quality was assessed with the Boston Bowel Preparation Scale, scores ≥6 with all segmental scores ≥2 was considered adequate colon cleansing, high-quality was considered as cleansing ≥8 or =3 in the right colon. Polyp and adenoma detection rates, and adverse events were also assessed. RESULTS Data was collected from 7160 patients: 48.3% males; mean age 58.0, 33.6% ≥65 years old. Adequate overall bowel cleansing was achieved in 95.6% of patients (95% CI 95.1%-96.0%), high quality cleansing in 74.4% (95% CI 73.4%-75.4%) and high-quality right colon cleansing in 66.0% (95% CI 64.9-67.1). The adequate overall cleansing rate was 97.0% with a split-dose and 94.0% with same-day regimen (P<0.0001), and high-quality right colon cleansing was 69.0% and 62.5% (P<0.0001), respectively. Colonoscopy was completed in 97.2% of cases. A multivariate regression analysis revealed that an overnight split-dose regimen and age <65 years were independent predictors of adequate bowel cleansing of the overall colon, age <65 years and female gender were independent predictors of HQ cleansing of the overall colon, and the three covariates were independent predictors of HQ cleansing of the right colon. At least one adverse event was experienced by 3.3% of participants, with nausea (1.5%) and vomiting (1.2%) being the most frequent. CONCLUSION This sub-analysis confirmed 1L PEG-ASC to be an effective and safe bowel cleansing preparation in a real world setting in Spain.
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Song JH, Kim ER. Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer. Korean J Intern Med 2024; 39:547-554. [PMID: 38247125 PMCID: PMC11236814 DOI: 10.3904/kjim.2023.334] [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: 08/11/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 01/23/2024] Open
Abstract
The incidence and mortality of colorectal cancer (CRC) have decreased through regular screening colonoscopy, surveillance, and endoscopic treatment. However, CRC can still be diagnosed after negative colonoscopy. Such CRC is called interval CRC and accounts for 1.8-9.0% of all CRC cases. Most cases of interval CRC originate from missed lesions and incompletely resected lesions. Interval CRC can be minimized by improving the quality of colonoscopy. This has led to a growing interest in and demand for high-quality colonoscopy. It is important to reduce the risk of CRC and its associated mortality by improving the quality of colonoscopy. In this review article, we provide an overview of colonoscopy quality indicators, including bowel preparation adequacy, the cecal intubation rate, the adenoma detection rate, the colonoscopy withdrawal time, appropriate polypectomy, and complication of the procedure. Because colonoscopy is a highly endoscopist-dependent procedure, colonoscopists should be well-acquainted with quality indicators and strive to apply them in daily clinical practice for the prevention of CRC.
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Affiliation(s)
- Joo Hye Song
- Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tiankanon K, Karuehardsuwan J, Aniwan S, Mekaroonkamol P, Sunthornwechapong P, Navadurong H, Tantitanawat K, Mekritthikrai K, Samutrangsi S, Vateekul P, Rerknimitr R. Performance comparison between two computer-aided detection colonoscopy models by trainees using different false positive thresholds: a cross-sectional study in Thailand. Clin Endosc 2024; 57:217-225. [PMID: 38556473 PMCID: PMC10984740 DOI: 10.5946/ce.2023.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND/AIMS This study aims to compare polyp detection performance of "Deep-GI," a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model. METHODS Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen. RESULTS In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p<0.01) and the lowest PMR (0.6% vs. 14.6% vs. 33.3%, p<0.01) when compared to CADe and trainees, respectively. Compared to CADe, Deep-GI demonstrated lower FPR at FP thresholds of ≥0.5 (12.1 vs. 22.4) and ≥1 second (4.4 vs. 6.8) (both p<0.05). However, when the threshold was raised to ≥1.5 seconds, the FPR became comparable (2 vs. 2.4, p=0.3), while the PMR increased from 2% to 10%. CONCLUSION Compared to CADe, Deep-GI demonstrated a higher PDS with significantly lower FPR at ≥0.5- and ≥1-second thresholds. At the ≥1.5-second threshold, both systems showed comparable FPR with increased PMR.
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Affiliation(s)
- Kasenee Tiankanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Julalak Karuehardsuwan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Satimai Aniwan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Parit Mekaroonkamol
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | | | - Huttakan Navadurong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Kittithat Tantitanawat
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Krittaya Mekritthikrai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Salin Samutrangsi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
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Jiao TX, Hu Y, Guo SB. Clinical value of sigmoid colon water exchange colonoscopy: a prospective randomized clinical trial. Sci Rep 2023; 13:13704. [PMID: 37608083 PMCID: PMC10444785 DOI: 10.1038/s41598-023-40706-4] [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: 10/20/2022] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
This prospective randomized controlled trial investigated the clinical value of sigmoid colon water exchange (SWE) colonoscopy by comparing it with air insufflation (AI) colonoscopy in terms of the patient's pain score, insertion time, and screening quality. Consecutive patients who underwent colonoscopy without sedation were randomized into an AI group (n = 267) or an SWE group (n = 255). Patient characteristics, history of abdominal or pelvic surgery, maximum pain score, insertion time, cecal intubation rate, polyp detection rate, and the need for maneuvers were recorded. There was no significant between-group difference in insertion time, cecal intubation rate, assisted maneuvers (abdominal pressure, changing patients' position), or polyp detection rate (P > 0.05). The mean maximum pain score was significantly lower in the SWE group than in the AI group. (3.57 ± 2.01 vs. 4.69 ± 1.83, P < 0.001). For patients with a history of abdominal or pelvic surgery and those who were overweight (body mass index > 24), the maximum pain scores were lower in the SWE group than in the AI group (3.67 ± 1.95 vs. 4.88 ± 1.80, P < 0.001; 3.40 ± 1.96 vs. 4.79 ± 1.97, P < 0.001, respectively). SWE colonoscopy can significantly reduce abdominal pain with non-inferior screening quality and does not increase insertion time.Trial registration number: ChiCTR2200059057 (date April 23, 2022).
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Affiliation(s)
- Tian-Xiao Jiao
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116011, Liaoning Province, People's Republic of China
- Department of Gastroenterology, Dalian Friendship Hospital, Dalian, 116011, Liaoning, People's Republic of China
| | - Yang Hu
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116011, Liaoning Province, People's Republic of China
| | - Shi-Bin Guo
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116011, Liaoning Province, People's Republic of China.
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Kuga R, Facanali MR, Artifon ELDA. Quality indicators in colonoscopy: observational study in a supplementary health system. Acta Cir Bras 2023; 37:e371106. [PMID: 36629532 PMCID: PMC9829243 DOI: 10.1590/acb371106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/21/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Colorectal cancer is responsible for 9.4% of cancer deaths, and low polyp detection rate and cecal intubation rate increase the risks of interval colorectal cancer. Despite several population studies that address colonoscopy quality measures, there is still a shortage of these studies in Latin America. The aim of this study was to assess quality indicators in colonoscopy, enabling future strategies to improve colorectal cancer prevention. METHODS An observational retrospective study, in which all colonoscopies performed in 11 hospitals were evaluated through a review of medical records. Information such as procedure indication, colorectal polyp detection rate, cecal intubation rate, quality of colonic preparation, and immediate adverse events were collected and analyzed. RESULTS In 17,448 colonoscopies performed by 86 endoscopists, 57.9% were in patients aged 50 to 74 years old. Colon preparation was adequate in 94.4% procedures, with rates of cecal intubation and polyp detection of 94 and 36.6%, respectively. Acute adverse events occurred in 0.2%. In 53.9%, high-definition imaging equipment was used. The procedure location, colon preparation and high-definition equipment influenced polyp detection rates (p < 0.001). CONCLUSIONS The extraction and analysis of electronic medical records showed that there are opportunities for improvement in colonoscopy quality indicators in the participating hospitals.
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Affiliation(s)
- Rogerio Kuga
- MD, MSc. Universidade de São Paulo – Postgraduate Program in Anesthesiology, Surgical Sciences and Perioperative Medicine – School of Medicine – São Paulo (SP), Brazil; Hospital Samaritano de São Paulo , Americas Medical Services, UnitedHealth Group Brasil – São Paulo (SP), Brazil.,Corresponding author:
- (55 11) 998088119
| | - Marcio Roberto Facanali
- MD. Universidade de São Paulo – Gastroenterology Department – Hospital das Clínicas – School of Medicine – São Paulo (SP), Brazil
| | - Everson Luiz de Almeida Artifon
- MD, MSc, PhD. Universidade de São Paulo – Surgery Department – Hospital das Clínicas – School of Medicine – São Paulo (SP), Brazil
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Wieszczy P, Bugajski M, Januszewicz W, Rupinska M, Szlak J, Pisera M, Turkot MH, Rupinski M, Wojciechowska U, Didkowska J, Regula J, Kaminski MF. Comparison of Quality Measures for Detection of Neoplasia at Screening Colonoscopy. Clin Gastroenterol Hepatol 2023; 21:200-209.e6. [PMID: 35341951 DOI: 10.1016/j.cgh.2022.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The proportion of colonoscopies with at least one adenoma (adenoma detection rate [ADR]) is inversely associated with colorectal cancer (CRC) risk and death. The aim of this study was to examine whether such associations exist for colonoscopy quality measures other than ADR. METHODS We used data from the Polish Colorectal Cancer Screening Program collected in 2000-2011. For all endoscopists who performed ≥100 colonoscopies we calculated detection rates of adenomas (ADR), polyps (PDR), and advanced adenomas (≥10 mm/villous component/high-grade dysplasia [AADR]); and number of adenomas per colonoscopy (APC) and per colonoscopy with ≥1 adenoma (APPC). We followed patients until CRC diagnosed before recommended surveillance, death, or December 31, 2019. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazard models. We used Harrell's C statistic to compare the predictive power of the quality measures. RESULTS Data on 173,287 patients (median age, 56 years; 37.8% male) and 262 endoscopists were used. During a median follow-up of 10 years and 1,490,683 person-years, we identified 395 CRCs. All quality measures were significantly associated with CRC risk and death. The relative reductions in CRC risk were as follows: for ADR ≥24.9% (reference <12.1%; HR, 0.41; 95% CI, 0.25-0.66), PDR ≥42.7% (reference <19.9%; HR, 0.35; 95% CI, 0.24-0.51), AADR ≥9.1% (reference <4.1%; HR, 0.69; 95% CI, 0.49-0.96), APC ≥0.37 (reference <0.15; HR, 0.35; 95% CI, 0.21-0.58), and APPC ≥1.54 (reference <1.19; HR, 0.54; 95% CI, 0.35-0.83). AADR was the only quality measure with significantly lower predictive power than ADR (Harrell's C, 59.7 vs 63.4; P = .001). Similar relative reductions were observed for CRC death. CONCLUSIONS This large observational study confirmed the inverse association between ADR and CRC risk and death. The PDR and APC quality measures appear to be comparable with ADR.
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Affiliation(s)
- Paulina Wieszczy
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Marek Bugajski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Oncological Gastroenterology and Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Department of Oncological Gastroenterology and Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Rupinska
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Department of Oncological Gastroenterology and Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jakub Szlak
- Department of Oncological Gastroenterology and Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Malgorzata Pisera
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maryla H Turkot
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maciej Rupinski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Department of Oncological Gastroenterology and Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Urszula Wojciechowska
- National Cancer Registry of Poland, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joanna Didkowska
- National Cancer Registry of Poland, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Department of Oncological Gastroenterology and Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Oncological Gastroenterology and Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Afify S, Tag-Adeen M, Abu-Elfatth A, Eid A, Nageh A, Alzamzamy A, El-Raey F, Basiony AN, Abdelghani M, Abdeltawab D, Ahmed RM, Nasr H, Alkady MN, Ibrahim W, Elshaarawy O, Amer H, Thoufeeq M, Alboraie M. Quality indicators for colonoscopy in Egypt: A prospective multicenter study. Arab J Gastroenterol 2022; 23:253-258. [PMID: 35934640 DOI: 10.1016/j.ajg.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/18/2021] [Accepted: 06/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Despite its wide availability, we do not have sufficient data aboutthe quality of colonoscopy in Egypt. In this study, we proposed 13 indicators to assess the quality of colonoscopy procedures in the included study centers aiming to attain a representative image of the quality of CS in Egypt. PATIENTS AND METHODS A multicenter prospective study was conducted between July and December 2020, which included all patients who underwent colonoscopy in the participating centers. The following were the proposed quality indicators: indications for colonoscopy, preprocedure clinical assessment, obtaining written informed consent, adequate colon preparation, sedation, cecal intubation rate (CIR), withdrawal time, adenoma detection rate (ADR), complication rate, photographic documentation, automated sterilization, regular infection control check, and well-equipped postprocedure recovery room. RESULT A total of 1,006 colonoscopy procedures were performed during the study duration in the included centers. Our analysis showed the following four indicators that were fulfilled in all centers: appropriate indications for colonoscopy, preprocedure assessment, written informed consent, and automated sterilization. However, photographic documentation and postprocedure follow-up room were fulfilled only in 57 %. Furthermore, 71 % of the centers performed regular infection control checks. Adequate colon preparation was achieved in 61 % of the procedures, 81 % of the procedures were performed under sedation, 95.4 % CIR, 11-min mean withdrawal time, 15 % ADR, and 0.1 % overall complication rate. Statistically significant factors affecting CIR were age > 40 years, high-definition endoscope, previous colon intervention, and rectal bleeding, whereas those affecting ADR were age > 40 years, the use of image enhancement, previous colon intervention, rectal bleeding, the use of water pump, and a withdrawal time of > 9 min. CONCLUSION Our study revealed the bright aspects of colonoscopy practice in Egypt, including high CIRs and low complication rates; conversely, ADR, bowel cleansing quality, and infection control measures should be improved.
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Affiliation(s)
- Shimaa Afify
- Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo, Postal Code: 11796 Cairo, Egypt
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena, Postal Code: 83523 Qena, Egypt.
| | - Ahmed Abu-Elfatth
- Department of Tropical Medicine and Gastroenterology, Assuit University, Assiut, Postal Code: 71515 Assiut, Egypt
| | - Alshaimaa Eid
- Department of Hepatogastroenterology and Infectious Disease, Al-Azhar University, Cairo, Postal Code: 11615 Cairo, Egypt
| | - Ahmed Nageh
- Department of Gastroenterology and Endoscopy, Alexandria Hepatology, GIT and Fever Hospital, Alexandria, Postal Code: 21544 Alexandria, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Postal Code: 11711 Cairo, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious diseases, Al-Azhar University, Damietta, Postal Code: 34711 Damietta, Egypt
| | - Ahmed N Basiony
- Department of Tropical Medicine, Ain Shams University, Cairo, Postal Code: 11566 Cairo, Egypt
| | - Mohamed Abdelghani
- Department of Tropical Medicine and Gastroenterology, Assuit University, Assiut, Postal Code: 71515 Assiut, Egypt
| | - Doaa Abdeltawab
- Department of Tropical Medicine and Gastroenterology, Assuit University, Assiut, Postal Code: 71515 Assiut, Egypt
| | - Rasha M Ahmed
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Assuit University, Assiut, Postal Code: 71515 Assiut, Egypt
| | - Hayam Nasr
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Assuit University, Assiut, Postal Code: 71515 Assiut, Egypt
| | - Mohamed N Alkady
- Division of Gastro-intestinal Endoscopy, Department of Internal Medicine, Kasr Alaini Faculty of Medicine, Cairo University, Giza, Postal Code: 12613 Giza, Egypt
| | - Wael Ibrahim
- Department of Gastroenterology and Hepatology, Nasser Institute for Research and Treatment, Cairo, Postal Code: 11796 Cairo, Egypt
| | - Omar Elshaarawy
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Postal Code: 13829 Menoufia, Egypt
| | - Hossam Amer
- Department of General Medicine, Suad Kafafy University Hospital, Misr University for Science and Technology, Cairo, Postal Code: 12566 Cairo, Egypt
| | - Mo Thoufeeq
- Department of Endoscopy, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, Postal Code: S5 7AU Sheffield, United Kingdom
| | - Mohamed Alboraie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine , Al-Azhar University, Cairo, Postal Code: 11615 Cairo, Egypt
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Liang M, Zhang X, Xu C, Cao J, Zhang Z. Anesthesia Assistance in Colonoscopy: Impact on Quality Indicators. Front Med (Lausanne) 2022; 9:872231. [PMID: 35911411 PMCID: PMC9326494 DOI: 10.3389/fmed.2022.872231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAdenoma detection rate (ADR) and polyp detection rate (PDR) are both indicators for colonoscopy quality. Improving ADR or PDR is critical for reducing the incidence and mortality of colorectal cancer (CRC). Although several studies have focused on identifying the factors that may influence ADR or PDR, the evidence remains limited and inconclusive. We conducted a retrospective study to evaluate the effect of anesthesia assistance (AA) on ADR or PDR in patients undergoing colonoscopy screening and identify risk factors affecting ADR or PDR.MethodsWe reviewed electronic medical records of patients who underwent colonoscopy screening between May 2019 and August 2020. Patients were divided into two groups according to whether they received AA: patients in Group A underwent colonoscopy screening with AA, whereas patients in Group O underwent colonoscopy screening without AA. Propensity score matching (PSM) was utilized to account for differences in baseline characteristics. After, ADR and PDR were compared between the two groups. Binary logistic regression was employed to identify risk factors that affected ADR or PDR.ResultsOf 9432 patients who underwent colonoscopy examination during the study period, 7170 were included in the final analyses (Group A = 5756 and Group O = 1414). After PSM, 736 patients remained in each group for analyses. There was no significant difference between groups A and O (P > 0.05) in ADR or PDR. Binary logistic regression indicated that the endoscopic device version (Olympus HQ290), equipment image-based technique and number of images were independent risk factors that affected ADR, and the age (50–59 years and 60–69 years), gender (male), high-risk status, endoscopist seniority (senior endoscopist), equipment image-based technique and number of images were all independent risk factors that affected PDR.ConclusionsWe discovered that AA does not affect ADR or PDR. Despite improved patient satisfaction, using AA is unnecessary for improving colonoscopy quality. Endoscopists should consider all these factors as much as possible when performing colonoscopy screening.
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Affiliation(s)
- Min Liang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, China
| | - Xinyan Zhang
- Department of Pathology, Liaocheng People's Hospital, Liaocheng, China
| | - Chunhong Xu
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Junli Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zongwang Zhang
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, China
- *Correspondence: Zongwang Zhang
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Continuous ADR50 monitoring through automated linkage between endoscopy and pathology: a quality improvement initiative in a Brussels public hospital. Acta Gastroenterol Belg 2022; 85:259-266. [DOI: 10.51821/85.2.9706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background and study aim: Adenoma detection rate in patients aged 50 years or older (ADR50) is considered by the European Society of Gastrointestinal Endoscopy (ESGE) a key performance measures for lower gastrointestinal endoscopy. Technical and human resources constrain implementation of recording quality monitoring. The aim was to deploy an infrastructure for continuous monitoring of endoscopy quality indicators. And to evaluate its potential benefit on quality performance.
Methods: A company reporting system was adapted by adding a dedicated tab for quality monitoring, including: preparation, progression, number of resected polyps. Automated linkage with the pathology database resulted in continuous monitoring of inter alia: rate of adequate bowel preparation, cecal intubation rate and ADR50. Continuous monitoring was done for all nine endoscopists working at our center, with individual feedback after 4, 9 and 28 months.
Results: A total of 1434 colonoscopies were performed during the first 9 months of monitoring, 682 during the first 4 months, 752 during the following 5 months. Five months after feedback a global increase in ADR50 of 4.6% (22.9% to 27.5%) (P<0.05) was observed, compared to the first 4 months. Thus meeting the benchmark (≥25%) recommended by ESGE. A durable effect of monitoring and feedback was observed after 28 months (ADR50: 29.4%).
Conclusions: An easy to use infrastructure for registration of quality monitoring in daily endoscopy practice, automatically linking the pathology database, facilitates continuous monitoring of endoscopy quality indicators. A global and durable ADR50 increase was observed after feedback, considered a quality improvement in performance of lower gastrointestinal endoscopy at our center.
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10
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Han JH, Kim HG, Ahn EM, Park S, Jeon SR, Cha JM, Kwak MS, Jung Y, Shin JE, Shin HD, Cho YS. Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study. Gut Liver 2021; 16:716-725. [PMID: 34933279 PMCID: PMC9474487 DOI: 10.5009/gnl210287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/16/2021] [Accepted: 10/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background/Aims The adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested. This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy. Methods We performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR. Results A total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001). Conclusions The colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.
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Affiliation(s)
- Jae Hee Han
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eu Mi Ahn
- Department of Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Suyeon Park
- Department of Data Innovation, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Deok Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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11
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Watson MM, Maddern GJ, McCullough TK, Gunning T, Beukes E, Wichmann MW. Quality of rural colonoscopy-A prospective single-centre pilot study. Aust J Rural Health 2021; 30:103-107. [PMID: 34495569 DOI: 10.1111/ajr.12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/26/2021] [Accepted: 04/20/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Matthew M Watson
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia.,The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia
| | - Guy J Maddern
- The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia
| | - Timothy K McCullough
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia
| | - Thomas Gunning
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia
| | - Eben Beukes
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia
| | - Matthias W Wichmann
- Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia.,The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia.,Flinders University Rural Health South Australia, Flinders University, Adelaide, SA, Australia
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12
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Effect of Using Personal Protective Equipment during the COVID-19 Pandemic on the Quality Indicators of Screening Colonoscopies. Gastroenterol Res Pract 2021; 2021:8910004. [PMID: 34373691 PMCID: PMC8349272 DOI: 10.1155/2021/8910004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/11/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Aims Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as the cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT), and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT, and ADR from outpatient, nonemergent procedures conducted at 3 endoscopy suites of St. Luke's University Health Network. All inpatient and emergent procedures were excluded. Results Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 and 2020 (318 in 2019 vs. 157 in 2020, p = 0.005). CIT (320 ± 105 seconds in 2019 vs. 392 ± 107 seconds in 2020, p = 0.001) and SWT (706 ± 232 seconds in 2019 vs. 830 ± 241 seconds in 2020, p = 0.001) were increased while CIR (98.2% in 2019 vs. 96.6% in 2020, p = 0.04) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs. 38.18 (16.66-66.00) in 2020, p = 0.8). Conclusion Our study showed that quality indices for screening colonoscopies like CIR, CIT, and SWT were negatively impacted during the COVID-19 time period. ADR, however, was similar. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopy's clinical benefit.
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13
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Schmidt C, Bachmann O, Baumgart DC, Goetz M, Drvarov O, Kucharzik TF, Kühbacher T, Langhorst J, Maul J, Mohl W, Mudter J, Repp M, Sturm A, Witzemann D, Atreya R. [Position paper on endoscopic reporting in IBD]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1091-1109. [PMID: 34284522 DOI: 10.1055/a-1504-9782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The complete and reliable documentation of endoscopic findings make up the crucial foundation for the treatment of patients with inflammatory bowel diseases such as Crohn´s disease and ulcerative colitis. These findings are, on the one hand, a prerequisite for therapeutic decisions and, on the other hand, important as a tool for assessing the response to ongoing treatments. Endoscopic reports should, therefore, be recorded according to standardized criteria to ensure that the findings of different endoscopists can be adequately compared and that changes in the course of the disease can be traced back. In consideration of these necessities, fifteen members of the Imaging Working Group of the German Kompetenznetz Darmerkrankungen have created a position paper proposing a structure and specifications for the documentation of endoscopic exams. In addition to the formal report structure, the recommendations address a large number of attributes of acute and chronic inflammatory alterations as well as endoscopically detectable complications, which are explained in detail and illustrated using exemplary images. In addition, more frequently used endoscopic activity indices are presented and their use in everyday clinical practice is discussed.
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Affiliation(s)
- Carsten Schmidt
- Medizinische Klinik II, Klinikum Fulda gAG, Fulda, Germany.,Medizinische Fakultät der Friedrich-Schiller-Universität Jena, Germany
| | - Oliver Bachmann
- Klinik für Innere Medizin 1, Siloah St. Trudpert Klinikum, Pforzheim, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Martin Goetz
- Innere Medizin IV, Klinikverbund Südwest GmbH, Böblingen, Germany
| | | | | | - Tanja Kühbacher
- Klinik für Innere Medizin, Diabetologie, Gastroenterologie, Pulmonologie, Tumormedizin und Palliativmedizin, medius Klinik Nürtingen, Nürtingen, Germany
| | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Klinikum Bamberg, Bamberg, Germany.,Lehrstuhl für Integrative Medizin Schwerpunkt translationale Gastroenterologie, Universität Duisburg-Essen, Duisburg-Essen, Germany
| | - Jochen Maul
- Gastroenterology, Gastroenterologie am Bayerischen Platz, Berlin, Germany.,Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Mohl
- Zentrum für Gastroenterologie Saar MVZ GmbH Saarbrücken, Saarbrücken, Germany
| | - Jonas Mudter
- Klinik für Gastroenterologie und Infektiologie, HELIOS Kliniken Schwerin, Schwerin, Germany.,Medizinische Klinik 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Repp
- Zentrum für Innere Medizin, Klinik für Gastroenterologie/Hepatologie, Klinikum Altenburger Land GmbH, Altenburg, Germany
| | - Andreas Sturm
- Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Westend, Berlin, Germany
| | | | - Raja Atreya
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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14
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Vojtechova G, Ngo O, Grega T, Kmochova K, Voska M, Buckova B, Majek O, Zavoral M, Suchanek S. The conversion factor for predicting adenoma detection rate from polyp detection rate varies according to colonoscopy indication and patient sex. Eur J Cancer Prev 2021; 29:294-302. [PMID: 32543806 DOI: 10.1097/cej.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The adenoma detection rate (ADR) is the primary quality indicator for colonoscopies. The polyp detection rate (PDR) is available from administrative data and does not depend on histology verification. The correlation between PDR and ADR and the ADR/PDR conversion factor in preventive colonoscopies were evaluated. In the prospective study, asymptomatic individuals aged 45-75 years with preventive colonoscopy in 2012-2016 were included. Spearman's correlation coefficient was used to assess PDR/ADR for each endoscopist. Conversion factor predicting ADR from PDR was obtained by linear regression and subsequently compared with adenoma to polyp detection rate quotient. One thousand six hundred fourteen preventive colonoscopies performed by 16 endoscopists in 8 screening colonoscopy centres in the Czech Republic were analysed. Correlation between PDR and ADR in all preventive colonoscopies was high and statistically significant (Rs 0.82; P < 0.001). There was a strong correlation between PDR and ADR in men (Rs 0.74; P = 0.002) and in screening colonoscopies (Rs 0.85; P < 0.001). The conversion factor to convert ADR from PDR was 0.72 in all preventive colonoscopies, 0.76 in FOBT+ colonoscopies and 0.67 in screening colonoscopies. ADR may be replaced by PDR in the assessment of colonoscopy quality. The value of the conversion factor varies according to colonoscopy indication and gender of examined individuals; in this Czech study, it was 0.72 in all preventive colonoscopies. The minimum requested ADR of 25 % corresponds to a PDR of 35 %, when converted with the appropriate conversion factor.
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Affiliation(s)
- Gabriela Vojtechova
- Department of Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague
| | - Ondrej Ngo
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Grega
- Department of Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague
| | - Klara Kmochova
- Department of Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague
| | - Michal Voska
- Department of Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague
| | - Barbora Buckova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Majek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslav Zavoral
- Department of Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague
| | - Stepan Suchanek
- Department of Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague
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15
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Aguilar-Olivos NE, Balanzá R, Rojas-Mendoza F, Soto-Solis R, Ballesteros-Amozurrutia MA, González-Uribe N, Fernández-Rivero JA. Assessment of quality benchmarks in adenoma detection in Mexico. Endosc Int Open 2021; 9:E796-E801. [PMID: 34079860 PMCID: PMC8159590 DOI: 10.1055/a-1396-3718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Several Latin American countries, including Mexico, have reported an increase in colorectal cancer (CRC) mortality. The effectiveness of a colonoscopy in preventing CRC depends on the quality of the procedure, for which the adenoma detection rate (ADR) is one of the most trusted indicators. Awareness of ADR can improve the quality of colonoscopies through proper feedback and training of the specialists. The goal of this study was to estimate the ADR among Mexican endoscopists with experience in CRC screening and to compare it with previously reported data from this country. Methods We carried out a retrospective study to analyze ADR data in Mexico. The information was obtained from a group of certified endoscopists and compared with the former published data from Mexico. Results We found a current ADR of 24.6 % (95 %CI, 22.4 %-26.8 %) from 1,478 colonoscopies performed by eight endoscopists in two third-level private hospitals. The average ADR reported in previous publications was 15.2 % (95 %CI, 13.3 %-17.1 %). Statistical analysis showed differences between our results and those from previous studies (24.6 % vs. 15.2 %, P < 0.001). Conclusions The actual ADR in Mexico is higher than previously reported. Previous low ADR values could be explained by poorly performed colonoscopies rather than by low adenoma and CRC incidence in our country.
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Affiliation(s)
| | - Ricardo Balanzá
- Medica Sur Hospital, Gastroenterology and Endoscopy Unit, Mexico City, Mexico
| | | | - Rodrigo Soto-Solis
- Angeles Pedregral Hospital, Gastroenterology and Endoscopy Unit, Mexico City, Mexico
| | | | - Norma González-Uribe
- Angeles Pedregral Hospital, Gastroenterology and Endoscopy Unit, Mexico City, Mexico
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16
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Ouazzani S, Lemmers A, Martinez F, Kindt R, Le Moine O, Delhaye M, Arvanitakis M, Demetter P, Devière J, Eisendrath P. Implementation of colonoscopy quality monitoring in a Belgian university hospital with integrated computer-based extraction of adenoma detection rate. Endosc Int Open 2021; 9:E197-E202. [PMID: 33553581 PMCID: PMC7857963 DOI: 10.1055/a-1326-1179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/30/2019] [Indexed: 01/10/2023] Open
Abstract
Background and study aims Quality in colonoscopy has been promoted in last decade with definition of different quality indicators (QI) as benchmarks. Currently, automatized monitoring systems are lacking, especially for merging pathologic and endoscopic data, which limits quality monitoring implementation in daily practice. We describe an adapted endoscopy reporting system that allows continuous QI recording, with automatic pathological data inclusion. Material and methods We locally adapted a reporting system for colonoscopy by adding and structuring in a dedicated tab selected key QI. Endoscopic data from a reporting system and pathological results were extracted and merged in a separate database. During the initial period of use, performing physicians were encouraged to complete the dedicated tab on a voluntary basis. In a second stage, completing of the tab was made mandatory. The completeness of QI recording was evaluated across both periods. Performance measures for all endoscopists were compared to global results for the department and published targets. Results During the second semester of 2017, a total of 1827 colonoscopies were performed with a QI tab completed in 100 % of cases. Among key QI, the cecal intubation rate was 93.8 %, the rate of colonoscopies with adequate preparation was 90.7 %, and the adenoma detection rate was 29.8 % considering all colonoscopies, irrespective of indication; 28.8 % considering screening procedures; and 36.6 % in colonoscopies performed in people older than age 50 years. Conclusion This study shows that quality monitoring for colonoscopy can be easily implemented with limited human resources by adapting a reporting system and linking it to a pathology database.
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Affiliation(s)
- Sohaib Ouazzani
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Federico Martinez
- IT Department, Medicotechnical Team, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Raphael Kindt
- IT Department, Medicotechnical Team, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Olivier Le Moine
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Myriam Delhaye
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pieter Demetter
- Department of Pathology, Jules Bordet Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium,Department of Hepato-Gastroenterology, Saint-Pierre Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Chu Y, Zhang J, Wang P, Li T, Jiang S, Zhao Q, Liu F, Gao X, Qiao X, Wang X, Song Z, Liang H, Yue J, Linghu E. Will purposely seeking detect more colorectal polyps than routine performing during colonoscopy? Medicine (Baltimore) 2020; 99:e22738. [PMID: 33080734 PMCID: PMC7572006 DOI: 10.1097/md.0000000000022738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND & GOALS We observed that the number of colorectal polyps found intraoperatively was often higher than that encountered preoperatively during elective colonoscopic polypectomy. To evaluate whether more polyps can be detected when they are purposely sought than when they are routinely examined during colonoscopy. MATERIALS AND METHODS Patients undergoing colonoscopy were randomized into groups A and B. Before colonoscopy was performed, endoscopists were instructed to seek polyps for group A purposely but not for group B. Polypectomy was electively completed. In groups A and B, the cases of elective polypectomy were named groups AR and BR, including groups AR-1 and BR-1, during the first colonoscopy and groups AR-2 and BR-2 during the second colonoscopy for polypectomy, respectively. The following data were calculated: the number of polyps detected (NPD) and the polyp detection rate (PDR) in all cases and the number of polyps missed (NPM) and partial polyp miss rate (PPMR) in the cases of colorectal polyps. RESULTS A total of 419 cases were included in group A, 421 in group B, 43 in group AR, and 35 in group BR. No significant differences in PDR were found between groups A and B and in PPMR between groups AR-1 and BR-1 (P > .05), although PPMR in group AR-1 was higher than in group AR-2 (P < .05), similar results were found in PPMR between groups BR-1 and BR-2 (P < .05). CONCLUSION Purposely seeking for colorectal polyps did not result in more polyps detected compared with routine colonoscopy.
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Affiliation(s)
- Yanliu Chu
- Department of Hepatology and Gastroenterology, Chinese PLA General Hospital, Beijing
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Juan Zhang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Ping Wang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Tian Li
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Shuyi Jiang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Qinfu Zhao
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Feng Liu
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Xiaozhong Gao
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Xiuli Qiao
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Xiaofeng Wang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Zhenhe Song
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Heye Liang
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Jing Yue
- Department of Gastroenterology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, China
| | - Enqiang Linghu
- Department of Hepatology and Gastroenterology, Chinese PLA General Hospital, Beijing
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18
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Choi YI, Lee JJ, Chung JW, Kim KO, Kim YJ, Kim JH, Park DK, Kwon KA. Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial. J Clin Med 2020; 9:jcm9103286. [PMID: 33066237 PMCID: PMC7602042 DOI: 10.3390/jcm9103286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
Although adequate bowel preparation is essential in screening colonoscopy, patient intolerability to bowel cleansing agents is problematic. Recently, a probiotic mixture solution with bisacodyl emerged to improve patient tolerability. We investigated the efficacy, safety, and patient tolerability profiles of probiotics with bisacodyl versus conventional polyethylene glycol (PEG) solution for bowel preparation for screening colonoscopies in healthy patients in this prospective, randomized, case-control study. In total, 385 volunteers were randomly assigned to receive 2 L of water + 200 mL of probiotic solution (case group, n = 195) or 4 L of PEG solution (control group, n = 190). The efficacy of the bowel cleansing was evaluated using the Ottawa scale system, polyp detection rate, and adenoma detection rate, and the patient tolerability profiles were assessed using a questionnaire. The demographics were not significantly different between groups. When the Ottawa score for each bowel segment was stratified into an adequate vs. inadequate level (Ottawa score ≤ 3 vs. >3), there were no statistical differences between groups in each segment of the colon. There were no significant differences in the polyp and adenoma detection rates between groups (38.42% vs. 32.42, p = 0.30; 25.79% vs. 18.97%, p = 0.11). The case group showed significantly fewer events than the control group, especially nausea, vomiting, and abdominal bloating events. Regarding the overall satisfaction grade, the case group reported significantly more “average” scores (95% vs. 44%, p < 0.001) and were more willing to use the same agents again (90.26% vs. 61.85%, p < 0.001). As patient compliance with bowel preparation agents is associated with an adequate level of bowel cleansing, a probiotic solution with bisacodyl might be a new bowel preparation candidate, especially in patients who show a poor compliance with conventional bowel preparation agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Kwang An Kwon
- Correspondence: ; Tel.: +82-32-460-3778; Fax: +82-32-460-3408
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Wang W, Chen K, Xu Y, Zhou Y, Chen P. Routine ileal intubation in colonoscopy does not increase the polyp detection rate: a retrospective study. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:955-959. [PMID: 33036049 DOI: 10.1055/a-1213-6701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Colonoscopy is effective in the prevention and screening of colorectal cancer. Whether terminal ileal (TI) intubation is required during conventional colonoscopy and whether it offers clinical benefits with respect to polyp detection rate (PDR) remain unclear. This retrospective study included patients who underwent colonoscopy at our hospital between July 1, 2018 and April 20, 2019. The positive findings and time for TI intubation were recorded. Univariate and multivariate analyses were performed to identify factors associated with PDR. There were 1675 patients with cecal intubation colonoscopy, including 994 (59 %) with TI intubation and 8 (1 %) with intestinal disease. The mean time for TI intubation was 40 seconds (3-338), and the mean time from cecal intubation to arrival at the deep part of TI mucosa was 24 seconds (2-118). The overall PDR was 27 %. On multivariable analysis, age > 50 years [95 % confidence interval (CI) 2.837-4.590], male sex (95 %CI, 0.406-0.649), presence of symptoms (abdominal symptoms vs. asymptomatic, 95 % CI, 1.146-2.468; stool changes vs. asymptomatic, 95 % CI, 1.070-1.834), and non-TI intubation (95 % CI, 1.040-1.648) were independent predictors of higher PDR. Trend analysis indicated decreasing trend of PDR among non-TI intubation group, 0-5 cm TI intubation group, and > 5 cm TI intubation group (30 % vs. 27 % vs. 24 %, respectively; p < 0.05). TI intubation is necessary to identify small bowel disease among a designated population, but it was not suggested to be routinely performed as part of colonoscopy, owing to limited positive intestinal findings, extra time requirement, and possible PDR worsening.
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Affiliation(s)
- Weiyi Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Endoscopy, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ke Chen
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, PR China, Shanghai, China
| | - Ying Xu
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
| | - Yufen Zhou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
| | - Ping Chen
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
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Olivera P, Cernadas G, Fanjul I, Peralta D, Zubiaurre I, Lasa J, Moore R. Effect of successive endoscopic procedures in polyp and adenoma detection rates: Too early is not always too good. Indian J Gastroenterol 2020; 39:450-456. [PMID: 33150568 DOI: 10.1007/s12664-020-01060-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/21/2020] [Indexed: 02/04/2023]
Abstract
UNLABELLED BACKGROUND AND AIMS: There is conflicting evidence regarding the impact of hypothetical cumulative fatigue after performing too many endoscopic procedures on both polyp and adenoma detection rates (PDR, and ADR, respectively). The aim of this study is to evaluate the effect of successive endoscopic procedures on PDR and ADR. METHODS A retrospective cross-sectional study was undertaken among consecutive patients on whom colonoscopy and/or esophagogastroduodenoscopy were performed between January 2012 and August 2014. Data regarding polyp and adenoma detection, cecal intubation, and bowel cleansing quality as well as demographical data of subjects were extracted. Endoscopic procedures were classified according to the time slots of the procedures throughout the endoscopy session in three groups: from the 1st to 4th endoscopy study (round 1), from the 5th to the 8th study (round 2), above the 9th study (round 3). We compared PDR and ADR among rounds. RESULTS Overall, 3388 patients were enrolled. Median age was 50 years (range 18-95) and 52.39% were female. There was a significant difference in terms of PDR among rounds (36.83%, 41.24%, and 43.38%, respectively, p = 0.007) and a non-significant numerical difference when ADR was compared (23.2%, 25.71%, and 26.78%, p = 0.07). On multivariate analysis, ADR was significantly associated with age (odds ratio [OR] 1.02 [1.01-1.03]), and male sex (OR 1.64 [1.38-1.94]). CONCLUSION Theoretical endoscopist's fatigue due to cumulative performance of endoscopies does not diminish colonoscopy quality. Both PDR and ADR seem to improve after endoscopist's cumulative rounds of performed endoscopies. This could be due to a "warm-up" effect.
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Affiliation(s)
- P Olivera
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - G Cernadas
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina.
| | - I Fanjul
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - D Peralta
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - I Zubiaurre
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - J Lasa
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
| | - R Moore
- Gastroenterology Section, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica (CEMIC), Galván 4102 (ZIP code 1431), Buenos Aires, Argentina
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21
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Sastre Lozano VM, Morán Sánchez S, García Solano J, Conesa Zamora P, Ruiz Merino G. Relationship between the polyp detection rate and the post-colonoscopy colorectal cancer rate. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:598-602. [PMID: 31190550 DOI: 10.17235/reed.2019.5889/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM the adenoma detection rate is the quality indicator of colonoscopy that is most closely related to the development of interval colorectal cancer or post-colonoscopy colorectal cancer. However, the recording of this indicator in different units of gastrointestinal endoscopy is obstructed due to the large consumption of resources required for its calculation. Several alternatives have been proposed, such as the polyp detection rate. The objective of this study was to evaluate the relationship between the polyp detection rate and its influence on post-colonoscopy colorectal cancer rate. PATIENTS AND METHODS in this study, 12,482 colonoscopies conducted by 14 endoscopists were analyzed. The polyp detection rate was calculated for each endoscopist. Endoscopists were grouped into quartiles (Q1, Q2, Q3, and Q4), from lowest to highest polyp detection rate, in order to evaluate whether there were any differences in the development of post-colonoscopy colorectal cancer. RESULTS the lowest polyp detection rate was 20.66% and the highest was 52.16%, with a median of 32.78 and a standard deviation of ± 8.54. A strong and positive association between polyp endoscopy diagnosis and adenoma histopathology result was observed and a linear regression was performed. A significantly higher post-colonoscopy colorectal cancer rate was observed in the group of endoscopists with a lower polyp detection rate (p < 0.02). CONCLUSION polyp detection rate is a valuable quality indicator of colonoscopy and its calculation is much simpler than that of the adenoma detection rate. In our study, the prevalence of post-colonoscopy colorectal cancer was inversely and significantly related to the endoscopists' polyp detection rate.
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22
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Choi AJ, Mahadev S. Is Tissue Really the Issue? How the Polyp Detection Rate May Be a Good Enough Quality Measure Among Trainees. Dig Dis Sci 2020; 65:2151-2152. [PMID: 32086689 DOI: 10.1007/s10620-020-06151-3] [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: 12/09/2022]
Affiliation(s)
- Anthony J Choi
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York, NY, 10065, USA
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York, NY, 10065, USA.
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23
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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: 6] [Impact Index Per Article: 1.5] [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.
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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
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24
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Then EO, Brana C, Dadana S, Maddika S, Ofosu A, Brana S, Wexler T, Sunkara T, Culliford A, Gaduputi V. Implementing visual cues to improve the efficacy of screening colonoscopy: exploiting the Hawthorne effect. Ann Gastroenterol 2020; 33:374-378. [PMID: 32624657 PMCID: PMC7315716 DOI: 10.20524/aog.2020.0491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/27/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Colonoscopy is the gold standard for colon cancer screening. Adenoma detection rate and a withdrawal time of 6 min are quality metrics to measure the efficacy of colonoscopy in colon cancer screening. The aim of our study was to exploit the Hawthorne effect in an effort to ensure adherence to a minimum 6-min withdrawal time and subsequently increase adenoma detection rate. Methods: This was a retrospective single-center study where we reviewed the records of patients who underwent screening colonoscopy in 2015 and 2017. We divided our patient population into 2 groups. The first group of patients from 2015 underwent screening colonoscopy with no visual cues on the colonoscopy monitor. The second group of patients from 2017 had visual cues indicating withdrawal time on the colonoscopy monitor. Results: Screening colonoscopy had a statistically significantly higher adenoma detection rate when performed with visual cues compared to without visual cues (25.3% vs. 19.45, P=0.04). Polyp detection rate was also higher in the group where visual cueing was used (52.9% vs. 22.9%, P<0.001). There were no statistically significant differences in actual withdrawal time or cecal intubation rates. Conclusions: Visual cues indicating withdrawal time are a useful intervention that results in an increased adenoma detection rate. Given its practicality and cost effectiveness, we recommend universally implementing visual cues to ensure adherence to a minimum 6-min withdrawal time.
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Affiliation(s)
- Eric Omar Then
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
| | - Christopher Brana
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
| | - Sriharsha Dadana
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
| | - Srikanth Maddika
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY (Andrew Ofosu, Tagore Sunkara), USA
| | - Sabrina Brana
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
| | - Tina Wexler
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
| | - Tagore Sunkara
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY (Andrew Ofosu, Tagore Sunkara), USA
| | - Andrea Culliford
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
| | - Vinaya Gaduputi
- Division of Gastroenterology and Hepatology, SBH Health System, New York (Eric Omar Then, Christopher Brana, Sriharsha Dadana, Srikanth Maddika, Sabrina Brana, Tina Wexler, Andrea Culliford, Vinaya Gaduputi)
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25
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Fraser AG, Rose T, Wong P, Lane M, Frankish P. Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy. BMJ Open Gastroenterol 2020; 7:e000425. [PMID: 32675086 PMCID: PMC7368474 DOI: 10.1136/bmjgast-2020-000425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The audit process may help improve performance indicators for colonoscopy quality but it is unclear whether this is sustained over several years. METHODS 44138 procedures for 28 endoscopists from 2004 to 2019 were analysed for polyp detection rate and withdrawal time. From 2012, 14 endoscopists were analysed with additional data on polyp histology and number of polyps removed. RESULTS Polyp detection increased from 40.7% in 2004 to 62.2% in 2019; removal of polyps>1 cm remained constant (11%). Adenoma detection rate was 25.8% in 2012 and 28.3% in 2019. Sessile serrated polyp (SSP) detection rate increased from 4.5% to 14.7%; most of the increase was in the first 2 years of the histology part of the audit. There was a significant correlation of adenoma detection rate with mean number of adenomas (r=0.72, p=0.004) and a significant correlation of SSP detection with mean number of SSPs (r=0.85, p=0.0001). CONCLUSION The audit process appears to encourage a higher rate of polyp detection. This was due to increased detection of smaller polyps and increased detection of SSPs.
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Affiliation(s)
- Alan Gordon Fraser
- Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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26
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de Neree Tot Babberich MPM, Ledeboer M, van Leerdam ME, Spaander MCW, van Esch AAJ, Ouwendijk RJ, van der Schaar PJ, van der Beek S, Lacle MM, Seegers PA, Wouters MWJM, Fockens P, Dekker E. Dutch Gastrointestinal Endoscopy Audit: automated extraction of colonoscopy data for quality assessment and improvement. Gastrointest Endosc 2020; 92:154-162.e1. [PMID: 32057727 DOI: 10.1016/j.gie.2020.01.052] [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: 07/14/2019] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The importance of having quality assessment, assurance, and improvement tools in health care is increasingly recognized. However, the additional associated administration burden progressively interferes with the structural implementation and adoption of such tools, especially when it concerns high-volume procedures such as colonoscopies. The development of the Dutch Gastrointestinal Endoscopy Audit (DGEA), a registry with automated extraction of colonoscopy quality data, and its first results are described. METHODS In close cooperation with commercial endoscopy reporting systems and a national histopathology database, healthcare professionals performing colonoscopies initiated a quality registry that extracts data from its core hospital resource or histology database without manual interference of the healthcare providers. Data extracted consisted of patient age, gender, indication of the colonoscopy, American Society of Anesthesiologists score, Boston Bowel Preparation Score, and cecal intubation; for the colonoscopy after a positive fecal immunochemical test in the colorectal cancer screening program, other data were polyp detection rate, which was available for all 48 hospitals or endoscopy centers, and adenoma detection rate, which was available for 26 hospitals or endoscopy centers. RESULTS Between January 1, 2016 and March 31, 2019, 48 hospitals or endoscopy centers voluntarily participated in the DGEA, and 275,017 unique patients with 313,511 colonoscopies were registered. Overall missing values were limited to <1%. CONCLUSIONS The results of this study demonstrate that it is feasible to deploy a quality registry collecting uniform data without additional administration burden for healthcare professionals.
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Affiliation(s)
| | - Michiel Ledeboer
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology & Hepatology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aura A J van Esch
- Department of Gastroenterology & Hepatology, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Rob J Ouwendijk
- Department of Gastroenterology & Hepatology, Bravis Hospital, Roosendaal, the Netherlands
| | - Peter J van der Schaar
- Department of Gastroenterology & Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Sander van der Beek
- Department of Internal Medicine, Rivierenland Hospital, Tiel, the Netherlands
| | - Miangela M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Michel W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Buerger M, Kasper P, Scheller I, Hofer JH, Toermer H, Stelzer A, Stenschke F, Stollenwerk M, Allo G, Goeser T, Steffen HM, Schramm C. Detection rates for adenomas, serrated polyps and clinically relevant serrated polyps can be easily estimated by individually calculated detection rate ratios. Scand J Gastroenterol 2020; 55:745-751. [PMID: 32524866 DOI: 10.1080/00365521.2020.1774643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Adenoma detection rate (ADR) is a key quality indicator for colonoscopy; however, it is cumbersome to obtain. We investigated if detection rates (DRs) for adenomas, serrated polyps (SPs) and clinically relevant SP (crSPDR) can be accurately estimated by individualized DR ratios (DRRs) in a multicenter primary colonoscopy screening cohort of average-risk individuals.Methods: DRRs were calculated by dividing DRs for a certain polyp entity by polyp detection rate (PDR) for each endoscopist individually on the basis of his/her first 50 (DRR50) and 100 (DRR100) consecutive colonoscopies. DRs were estimated for each endoscopist by multiplying his/her DRR for a certain polyp entity with his/her PDR of subsequent colonoscopies in groups of 50 (DRR50) and 100 (DRR100) consecutive colonoscopies. Estimated and actual DRs were compared.Results: Estimated DRs showed a strong correlation with actual DRs for adenomas (r = 0.86 and 0.87; each p < .001), SPs (r = 0.85 and 0.91; each p < .001) and crSPs (r = 0.82 and 0.86; each p < .001) using DRRs derived from first 50 and 100 consecutive colonoscopies. Corresponding root mean square error (RMSE) between individual estimated and actual DRs using DRR50 and DRR100 was 5.3(±4.6)% and 4.5(±4.8)% for adenomas, 5.2(±4.1)% and 3.9(±2.8)% for SP, 3.1(±3.1)% and 2.8(±2.5)% for crSP, respectively. RMSE was not significantly different between DRR50 and DRR100 for ADR (p = .445), SPDR (p = .178) and crSP (p = .544).Conclusions: DR for all relevant polyp entities can be accurately estimated by using individual DRRs. This approach may enable endoscopists to easily track their performance measures in daily routine.
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Affiliation(s)
- Martin Buerger
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Philipp Kasper
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | | | | | | | | | | | - Gabriel Allo
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tobias Goeser
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Schramm
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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28
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Abstract
Adenoma detection rate (ADR) is a quality marker of colonoscopy and operator performance. Prior studies evaluating the effect of an extended workday on the ADR reported variable outcomes that remain controversial. Given the variable results of prior studies and the potential legal implications of reduced ADR in the afternoon, we aimed to further evaluate this parameter and its effect on ADR. We performed a systematic review of the PubMed, CINAHL and Scopus electronic databases. Studies were included if they reported ADR in patients undergoing colonoscopy in the morning session and the afternoon session. Afternoon sessions included both sessions following a morning shift and half-day block shifts. Subgroup analyses were performed for ADR comparing morning and afternoon colonoscopies in a continuous workday, advanced ADRs (AADRs) and polyp detection rates (PDRs) were also compared. Thirteen articles with 17 341 (61.2%) performed in the morning session and 10 994 (38.8%) performed in the afternoon session were included in this study. There was no statistical significance in the ADR or AADR between morning and afternoon sessions, respectively [relative risk (RR) 1.06, 95% confidence interval (CI) 0.99-1.14] and (RR 1.19, 95% CI 0.95-1.5). Afternoon procedures had a significantly higher PDR than morning procedures (RR 0.93, 95% CI 0.88-0.98). ADR was not significantly influenced in the afternoon session when operators continued to perform procedures throughout the day or on a half-day block schedule.
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29
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Zeng L, Chua EG, Xiong Y, Ding S, Ai H, Hou Z, Loke MF, Goh KL, Tay CY, Marshall BJ, Zhu F, Sun D. Actual and estimated adenoma detection rates: a 2-year monocentric colonoscopic screening outcome in Shenzhen, China. JGH OPEN 2020; 4:707-712. [PMID: 32782960 PMCID: PMC7411544 DOI: 10.1002/jgh3.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/26/2020] [Indexed: 11/20/2022]
Abstract
Background and Aim While adenoma detection rate (ADR) is an important quality metric for screening colonoscopy, it remains difficult to be accessed due to the lack of integrated endoscopy and pathology databases. Hence, the use of an adenoma‐to‐polyp detection rate quotient and polyp detection rate (PDR) has been proposed to predict ADR. This study aimed to examine the usefulness of estimated ADR across different colonic segments in two age groups for Shenzhen people in China. Methods We retrospectively analyzed 7329 colonoscopy procedures performed by 12 endoscopists between January 2012 and February 2014. The PDR, actual ADR, and estimated ADR of the entire, proximal, and distal colon, and within each colonic segment, in two patient age groups: <50 and ≥50 years, were calculated for each endoscopist. Results The overall polyp and adenoma prevalence rates were 19.1 and 9.3%, respectively. The average age of adenoma‐positive patients was significantly higher than that of adenoma‐negative patients (54 ± 12.6 years vs 42.9 ± 13.2 years, respectively). A total of 1739 polyps were removed, among which 826 were adenomas. More adenomatous polyps were found in the proximal colon (60.4%, 341/565) than in the distal colon (40.9%, 472/1154). Overall, both actual and estimated ADR correlated strongly at the entire colon level and within most colonic segments, except for the cecum and rectum. In both age groups, these parameters correlated strongly within the traverse colon and descending colon. Conclusion Caution should be exercised when predicting ADR within the sigmoid colon and rectum.
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Affiliation(s)
- Li Zeng
- Department of Gastroenterology The First Affiliated Hospital of Shenzhen University, The Second People's Hospital of Shenzhen Shenzhen China
| | - Eng G Chua
- The Marshall Centre for Infectious Disease Research and Training University of Western Australia Perth Australia
| | - Ying Xiong
- Department of Gastroenterology Shenzhen Longhua District Central Hospital Shenzhen China
| | - Shihua Ding
- Department of Gastroenterology The First Affiliated Hospital of Shenzhen University, The Second People's Hospital of Shenzhen Shenzhen China
| | - Hui Ai
- Department of Laboratory Medicine The First Affiliated Hospital of Shenzhen University, The Second People's Hospital of Shenzhen Shenzhen China
| | - Zhibo Hou
- Department of Gastroenterology The First Affiliated Hospital of Shenzhen University, The Second People's Hospital of Shenzhen Shenzhen China.,Kuichong People's Hospital Shenzhen China
| | - Mun F Loke
- School of Life Sciences and Chemical Technology Ngee Ann Polytechnic Singapore Singapore
| | - Khean L Goh
- Department of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Chin Y Tay
- The Marshall Centre for Infectious Disease Research and Training University of Western Australia Perth Australia
| | - Barry J Marshall
- The Marshall Centre for Infectious Disease Research and Training University of Western Australia Perth Australia
| | - Fuqiang Zhu
- Department of Pathology The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital Shenzhen China
| | - Dayong Sun
- Department of Gastroenterology The First Affiliated Hospital of Shenzhen University, The Second People's Hospital of Shenzhen Shenzhen China.,Kuichong People's Hospital Shenzhen China
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Zorron Cheng Tao Pu L, Singh G, Rana K, Nakamura M, Yamamura T, Krishnamurthi S, Ovenden A, Edwards S, Ruszkiewicz A, Hirooka Y, Fujishiro M, Burt AD, Singh R. Polyp Detection Rate as a Surrogate for Adenoma and Sessile Serrated Adenoma/Polyp Detection Rates. Gastrointest Tumors 2020; 7:74-82. [PMID: 32903839 DOI: 10.1159/000505622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/25/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Quality measures for colonoscopy such as adenoma detection rate (ADR) have been proposed to be surveilled for ensuring minimum standards. However, its direct measurement is time consuming and often neglected. Extrapolating ADR and other quality measures from polyp detection rate (PDR) can be a pragmatic alternative. Objective To determine quotients for estimating ADR and sessile serrated adenoma/polyp detection rate (SSA/P-DR) from PDR in an Australian cohort. Methods Consecutive adult patient colonoscopies during a 1-year period were retrospectively assessed in a single Australian tertiary endoscopy center. Adenoma detection quotient (ADQ) and SSA/P detection quotient (SSA/P-DQ) were defined as the division of ADR and SSA/P-DR by PDR, respectively. The primary outcome was the number of procedures to achieve a stable cumulative ADQ and SSA/P-DQ. Secondary outcomes included evaluation of ADQ and SSA/P-DQ in different subsets. Results In total, 2,657 colonoscopies were performed by 15 endoscopists in 2016. The ADR, SSA/P-DR, and PDR found were 32.2, 6.7, and 47.3%, respectively. The ADQ and SSA/P-DQ values found were 0.68 and 0.14, respectively. After approximately 500 procedures, both ADQ and SSA/P-DQ became stable. Interclass correlation coefficient (ICC) for the prediction of ADR from ADQ was excellent for all endoscopists that performed >177 procedures in that year (ICC 0.84). Conclusions ADQ and SSA/P-DQ values were consistent when over 500 procedures were analyzed. ADQ had an excellent correlation with ADR when >177 procedures per endoscopist were evaluated.
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Affiliation(s)
- Leonardo Zorron Cheng Tao Pu
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology and Hepatology, Nagoya University, Nagoya, Japan
| | - Gurfarmaan Singh
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Khizar Rana
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | | | - Amanda Ovenden
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew Ruszkiewicz
- Department of Pathology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Yoshiki Hirooka
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Toyoake, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University, Nagoya, Japan
| | - Alastair D Burt
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Rajvinder Singh
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
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Correlation between adenoma detection rate and polyp detection rate at endoscopy in a non-screening population. Sci Rep 2020; 10:2295. [PMID: 32041974 PMCID: PMC7010832 DOI: 10.1038/s41598-020-58963-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
It is understood that colorectal adenomas progress to colonic adenocarcinoma. Adenoma detection rate (ADR) at endoscopy has been used as a key performance indicator at endoscopy and is inversely associated with diagnosis of interval colorectal cancer. As most endoscopy reporting systems do not routinely incorporate histological assessment, ADR reporting is a cumbersome task. Polyp Detection Rate (PDR) has therefore been adopted as a surrogate marker for ADR. A prospectively maintained database of colonoscopies performed between July 2015 and July 2017 was analysed. This was cross referenced with a histological database. Statistical analysis was performed using IBM SPSS, version 24. Inferential procedures employed included the Pearson’s correlation coefficient (r) and Binomial logistic regression. Of 2964 procedures performed by 8 endoscopists, overall PDR was 27% and ADR was 19%. The PDR, ADR, adenoma to polyp detection rate quotient (APDRQ) and estimated ADR (PDR x APDRQ group average = 0.72) was calculated for each individual. There was a strong positive linear correlation between PDR and ADR,r(8) = 0.734, p = 0.038 and between PDR and estimated ADR, r(8) = 0.998, p < 0.001. Adenoma detection rate strongly correlated with estimated ADR, r(8) = 0.720, p = 0.044. With the exclusion of a moderate outlier, these correlations increased in both strength and significance. There was a stronger correlation between PDR and ADR,r(7) = 0.921, p = 0.003 and between ADR and estimated ADR, r(7) = 0.928, p = 0.003.
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Sohn DK, Shin IW, Yeon J, Yoo J, Kim BC, Kim B, Hong CW, Han KS. Validation of an automated adenoma detection rate calculating system for quality improvement of colonoscopy. Ann Surg Treat Res 2019; 97:319-325. [PMID: 31824887 PMCID: PMC6893215 DOI: 10.4174/astr.2019.97.6.319] [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] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose This study aimed to validate an automated calculating system developed for determining the adenoma detection rate (ADR). Methods To calculate the automated ADR, the data linking processes were as follows: (1) matching the selected colonoscopy results with the pathological results, (2) matching the polyp number from colonoscopy with that from pathology and confirming the histopathological results of each colonic polyp, and (3) confirming the histopathological results, especially the adenoma status of each colonic polyp. To verify the accuracy of the automated ADR calculating system, we manually calculated the ADR for 3 months through medical record review. Accuracy was calculated by measuring the error rate for each value. The cause of error was analyzed by additional order and chart review. Results After excluding 318 cases, 2,543 patients (1,351 men and 1,192 women; median age, 57.9 years) who underwent colonoscopy were included in this study. When the automated calculating system was used, polyps were found in 1,336 cases (52.6%) and adenomas were found in 1,003 cases (39.4%). When the manual calculating system was used, polyps were found in 1,327 cases (52.2%) and adenomas were found in 1,003 cases (39.4%). The accuracies of the polyp detection rate and ADR according to the automated calculating system were 99.3% and 100%, respectively. Conclusion We developed a system to automatically calculate the ADR by extracting hospital electronic medical record results and verified that it provided satisfactory results. It may help to improve colonoscopy quality.
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Affiliation(s)
- Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Il Won Shin
- Information Technology Team, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jeonghwa Yeon
- Endoscopy Room, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jin Yoo
- Endoscopy Room, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Ko CW, Doria-Rose VP, Barrett MJ, Kamineni A, Enewold L, Weiss NS. Screening colonoscopy and flexible sigmoidoscopy for reduction of colorectal cancer incidence: A case-control study. PLoS One 2019; 14:e0226027. [PMID: 31805156 PMCID: PMC6894764 DOI: 10.1371/journal.pone.0226027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Flexible sigmoidoscopy and colonoscopy are both recommended colorectal cancer screening options, but their relative effectiveness needs clarification. The aim of this study was to compare the effectiveness of colonoscopy and flexible sigmoidoscopy for reduction of colorectal cancer incidence. METHODS We conducted a case-control study within the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Cases were subjects age 70-85 years in the SEER-Medicare database diagnosed with CRC during 2004-2013. Up to 3 controls were matched to each case by birth year, sex, race, and SEER region. Receipt of screening colonoscopy or flexible sigmoidoscopy was ascertained from Medicare claims. Conditional logistic regression models were developed to estimate the odds ratios (ORs) and 95% confidence intervals (CI) for a history of screening in cases vs. controls. We conducted secondary analyses by sex, race, endoscopist characteristics, and with varying timing and duration of the look-back period. RESULTS Receipt of screening colonoscopy and sigmoidoscopy was associated with a 59% (OR 0.41, 95%CI 0.39, 0.43) and 22% reduction (OR 0.78, 95%CI 0.67, 0.92) in colorectal cancer incidence, respectively. Colonoscopy was associated with greater reduction in the distal colorectal cancer incidence (OR 0.22, 95%CI 0.20, 0.24) than proximal colorectal cancer incidence (OR 0.62, 95%CI 0.59, 0.66). Sigmoidoscopy was associated with a 52% reduction in distal colorectal cancer incidence (OR 0.48, 95%CI 0.37, 0.63), but with no reduction in proximal colorectal cancer incidence. These associations were stronger in men than in women. No differences by race or endoscopist characteristics were observed. CONCLUSION Both screening colonoscopy and sigmoidoscopy were associated with reductions in overall colorectal cancer incidence, with a greater magnitude of reduction observed with colonoscopy.
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Affiliation(s)
- Cynthia W. Ko
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - V. Paul Doria-Rose
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michael J. Barrett
- Information Management Services, Inc., Calverton, Maryland, United States of America
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States of America
| | - Lindsey Enewold
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Noel S. Weiss
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
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Screening flexible sigmoidoscopy versus colonoscopy for reduction of colorectal cancer mortality. Int J Colorectal Dis 2019; 34:1273-1281. [PMID: 31152198 PMCID: PMC7071949 DOI: 10.1007/s00384-019-03300-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Colonoscopy and flexible sigmoidoscopy are both recommended colorectal cancer (CRC) screening strategies, but their relative effectiveness is unclear. We sought to evaluate the ability of each of these two modalities to reduce CRC mortality. METHODS We conducted a case-control study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Cases were persons aged 70-85 years who died of CRC and were matched to up to three non-CRC controls. Receipt of endoscopy was ascertained from Medicare claims and endoscopy indication assigned using a validated algorithm. Conditional logistic regression models were developed to estimate the association between screening colonoscopy or sigmoidoscopy and CRC mortality. We conducted secondary analyses by race, sex, and endoscopist characteristics, and with varying duration of the look-back period. RESULTS In the initial analysis using all available look-back years, screening flexible sigmoidoscopy was associated with a 35% reduction in CRC mortality (OR 0.65, 95% CI 0.48, 0.89), while screening colonoscopy was associated with a 74% reduction (OR 0.26, 95% CI 0.23, 0.30). Sigmoidoscopy was not associated with any reduction in proximal CRC mortality. The association between colonoscopy and reduced CRC mortality was stronger in the distal than the proximal colon. Results were similar in analyses using a 5-year look-back period. CONCLUSIONS Screening colonoscopy was associated with greater reductions in CRC mortality than screening sigmoidoscopy, and with a greater reduction in the distal than the proximal colon. These results provide additional information on the relative benefits of screening for CRC with sigmoidoscopy and colonoscopy.
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Chen CW, Chiu CT, Su MY, Lin CJ, Hsu CM, Lim SN, Yeh CT, Lin WR. Factors associated with polyp detection during colonoscopy: A retrospective observational study. Kaohsiung J Med Sci 2019; 35:572-577. [PMID: 31162814 DOI: 10.1002/kjm2.12090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/06/2019] [Indexed: 12/24/2022] Open
Abstract
The polyp detection rate (PDR) is an important quality indicator for colonoscopy. Several factors have been shown to be associated with PDR. However, whether the moderate sedation is a factor for polyp detection remains controversial. This study aims to assess factors associated with polyp detection including the moderate sedation factor during colonoscopy. Patients who underwent colonoscopy from June 1, 2014 to May 31, 2015 were enrolled into this retrospective study. Patients with poor colon preparation and failure to reach the cecum were excluded. The clinical factors, including patient's sex, age, midazolam/fentanyl sedation, indications, endoscopist colonoscopy volume, and use of antispasmodic agent were evaluated by multivariate analysis. A total of 3373 patients were included in this study. The mean age was 55.8 years, and 1980 patients (58.7%) were male. Among the 3373 patients, 2513 (74.5%) underwent midazolam/fentanyl-based sedated colonoscopy. The multivariate analysis showed that male sex, age over 50 years old, midazolam/fentanyl sedation and indications of screening and surveillance were significantly associated with polyp detection. Moreover, when stratified by sex and age, the midazolam/fentanyl sedation was associated with polyp detection in male patients and patients over 50 years old. This study has highlighted the role of midazolam/fentanyl sedation administered by colonoscopists as a modifiable factor that may increase polyp detection during colonoscopy.
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Affiliation(s)
- Chun-Wei Chen
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Yao Su
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Jung Lin
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Ming Hsu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chau-Ting Yeh
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Liver Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Liver Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Baker FA, Mari A, Hosadurg D, Suki M, Ovadia B, Gal O, Kopelamn Y. The impact of colonoscopy indication on polyp detection rate. Ann Gastroenterol 2019; 32:278-282. [PMID: 31040625 PMCID: PMC6479646 DOI: 10.20524/aog.2019.0374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/11/2019] [Indexed: 12/30/2022] Open
Abstract
Background Adenoma/polyp detection rates are considered to be among the most important quality indicators of colonoscopy and are key measures of a quality procedure. However, they are designed for use in the screening setting and are not amenable to other colonoscopy indications. Little is known about their significance in other colonoscopy indications. We aimed to evaluate the impact of the various indications on polyp detection rate (PDR). Methods This was a retrospective, single-center study. Electronic reports of index colonoscopy procedures with adequate bowel preparation over a 10-year period were reviewed. Patients were divided into 7 groups based on the study indication. PDR was determined for each group and was compared to that of a control group, the screening indication group. Adjustment was made for potential confounders such as age, sex, and procedural setting. Results A total of 13,054 patients were considered suitable for the study. PDR was greatest in the positive fecal occult blood test group, with a value of 33.1% (P<0.01). Overall, the remaining groups showed similar PDRs compared with screening (22.1% vs. 20.4%; P=0.15). This trend persisted in a multivariate analysis, which showed the odds ratio in the positive fecal occult blood test group to be significantly higher, with a value of 1.955 (1.759-2.172, P<0.001) compared with the screening group. Conclusion PDR was highest for the positive fecal occult blood test indication, but was not affected significantly by most indications. Further randomized studies are warranted to confirm these findings and help calculate recommended thresholds for "overall" PDR.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel; Affiliated to the Technion Faculty of Medicine, Haifa, Israel (Fadi Abu Baker, Muhammed Suki, Baruch Ovadia, Oren Gal, Yael Kopelamn)
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital; Affiliated with the Faculty of Medicine, Bar Illan University (Amir Mari)
| | | | - Muhammed Suki
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel; Affiliated to the Technion Faculty of Medicine, Haifa, Israel (Fadi Abu Baker, Muhammed Suki, Baruch Ovadia, Oren Gal, Yael Kopelamn)
| | - Baruch Ovadia
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel; Affiliated to the Technion Faculty of Medicine, Haifa, Israel (Fadi Abu Baker, Muhammed Suki, Baruch Ovadia, Oren Gal, Yael Kopelamn)
| | - Oren Gal
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel; Affiliated to the Technion Faculty of Medicine, Haifa, Israel (Fadi Abu Baker, Muhammed Suki, Baruch Ovadia, Oren Gal, Yael Kopelamn)
| | - Yael Kopelamn
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel; Affiliated to the Technion Faculty of Medicine, Haifa, Israel (Fadi Abu Baker, Muhammed Suki, Baruch Ovadia, Oren Gal, Yael Kopelamn)
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Tasa de detección de adenomas e intubación cecal: indicadores de calidad de la colonoscopia. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:253-255. [DOI: 10.1016/j.gastrohep.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022]
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Segal JP, Kanagasundaram C, Mills P, Bassett P, Greenfield SM. Polyp detection rate: does length matter? Frontline Gastroenterol 2019; 10:107-112. [PMID: 31205648 PMCID: PMC6540303 DOI: 10.1136/flgastro-2017-100945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/20/2018] [Accepted: 07/09/2018] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Polyp detection rate is a surrogate marker for adenoma detection rate and therefore a surrogate marker of quality colonoscopy. To our knowledge, this is the first study that compares distance from the monitor to the endoscopist on polyp detection rate. METHODS This was a retrospective study comparing polyp detection rate across two different endoscopy room set-ups. All colonoscopies performed between December 2013 and November 2014 were retrieved. The difference in the room set-up was the distance from the endoscopist to the endoscopy monitor. Room A had a distance of 219 cm and Room B had 147 cm. We used two identical rooms, C and D, as a control arm with a distance of 190 cm between the endoscopist and the monitor. RESULTS There were significant differences in polyp detection rates between Room A and Room B in the bowel cancer screening lists. For these lists, the room with the closest distance from the endoscopist to the monitor (147 cm) had a statistically significant higher polyp detection rate than the room that had a further monitor to endoscopist distance of 219 cm (p<0.0006) and a trend towards a higher polyp detection rate compared with the room where the distance between the monitor and the endoscopist was 190 cm (p=0.08). This effect was not noticed across the service lists. CONCLUSIONS This study has suggested that the distance from the endoscopist to the monitor can affect polyp detection rate. It appears that for bowel cancer screening lists, the further the endoscopist from the monitor the lower their polyp detection rate.
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Affiliation(s)
- Jonathan P Segal
- Department of Gastroenterology, St Mark’s Hospital, Harrow, UK,Department of Surgery and Cancer, Imperial College, London, UK
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Lund M, Erichsen R, Valori R, Møller Jensen T, Helle Njor S, Laurberg S, Andersen B. Data quality and colonoscopy performance indicators in the prevalent round of a FIT-based colorectal cancer screening program. Scand J Gastroenterol 2019; 54:471-477. [PMID: 30978128 DOI: 10.1080/00365521.2019.1597158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: From the prevalent round of the Danish FIT-based colorectal cancer (CRC) screening program, we aimed (i) to evaluate the quality of recorded data and (ii) to characterize the colonoscopies by measuring variation in performance indicators between colonoscopists and assessing the ratio between adenoma detection rate (ADR) and polyp detection rate (PDR). Materials and methods: This study included screening colonoscopies performed in Central Denmark Region within 60 days of a positive FIT-result from 1 July 2015 through 30 June 2017. The participants were the colonoscopists, performing these procedures. The quality indicators cecal intubation rate (CIR), PDR, polyp retrieval rate (PRR), ADR and withdrawal time (WT) were evaluated. ADR/PDR ratios were calculated. Results: The concordance between the recorded data and the colonoscopy reports showed Kappa values in the range of 0.47-0.97. The overall CIR was 90.6% (range 73.7%-100%), PDR: 51.9% (range 18.4%-70.2%), PRR: 94.6% (range 69.6%-100%), ADR (conventional adenomas): 50.6% (range 18.4%-70.2%), ADRx (conventional adenomas, traditional serrated adenomas and sessile serrated lesions with dysplasia): 50.9% (range 18.4%-70.2%) and the mean WT was 11.3 min (range 4.5-24.9 min). The ADR/PDR ratio was 92.8% (95% CI: 92.0%-93.6%) and the ADRx/PDR ratio was 93.2% (95% CI: 92.4%-93.9%). Conclusion: Data quality was generally high. We found considerable variation in performance indicators between colonoscopists reflecting the potential for improvement. Further, our findings revealed that the PDR might be a good proxy for ADR in the context of the prevalent round of FIT-based CRC screening programs.
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Affiliation(s)
- Martin Lund
- a Department of Public Health Programmes , Randers Regional Hospital , Randers , Denmark
| | - Rune Erichsen
- b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark
| | - Roland Valori
- c Department of Gastroenterology , Gloucestershire Hospitals NHS Foundation Trust , Gloucester , UK
| | | | - Sisse Helle Njor
- a Department of Public Health Programmes , Randers Regional Hospital , Randers , Denmark
| | - Søren Laurberg
- e Department of Surgery , Section for Colorectal Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Berit Andersen
- a Department of Public Health Programmes , Randers Regional Hospital , Randers , Denmark.,f Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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Maida M, Morreale G, Sinagra E, Ianiro G, Margherita V, Cirrone Cipolla A, Camilleri S. Quality measures improving endoscopic screening of colorectal cancer: a review of the literature. Expert Rev Anticancer Ther 2019; 19:223-235. [PMID: 30614284 DOI: 10.1080/14737140.2019.1565999] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a major health-care problem all over the world and CRC screening is effective in reducing mortality and increasing the 5-year survival. Colonoscopy has a central role in CRC screening. It can be performed as a primary test, as a recall policy after a positive result of another screening test, and for surveillance. Since effectiveness of endoscopic screening depends on adequate detection and removal of colonic polyps, consistent quality measures, which are useful in enhancing the diagnostic yield of examination, are essential. Areas covered: The aim of this review is to analyze current evidence from literature supporting quality measures able to refine endoscopic screening of colorectal cancer. Expert commentary: Quality measures namely a) time slot allotted to colonoscopy, b) assessment of indication, c) bowel preparation, d) Cecal intubation, e) withdrawal time, f) adenoma detection rate, g) proper management of lesions (polypectomy technique, polyps retrieval rate and tattooing of resection sites), and h) adequate follow-up intervals play a key role in identifying malignant and at-risk lesions and improving the outcome of screening. Adherence to these quality measures is critical to maximize the effectiveness of CRC screening, as well as, a proper technique of colonoscopy and a quality report of the procedure. Among all recommended measures, adenoma detection rate is the most important and must be kept above the recommended quality threshold by all physicians practicing in the setting of screening.
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Affiliation(s)
- Marcello Maida
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Gaetano Morreale
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Emanuele Sinagra
- b Gastroenterology and Endoscopy Unit , Fondazione Istituto San Raffaele Giglio , Cefalù , Italy
| | - Gianluca Ianiro
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Vito Margherita
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Alfonso Cirrone Cipolla
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Salvatore Camilleri
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
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Popa P, Gheonea DI, Săftoiu A, Calița M. No Interval Cancers in Endoscopic Practice. CURRENT HEALTH SCIENCES JOURNAL 2019; 45:5-18. [PMID: 31297257 PMCID: PMC6592672 DOI: 10.12865/chsj.45.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/12/2019] [Indexed: 11/18/2022]
Abstract
Colonoscopy is long time the most preferred method for CRC screening along with diagnosis and treatment for a range of colon diseases. Based on its difficulty in visualizing precursor CRC lesions, mostly those located on the right colon, this method can be subject of improvement. The colonoscopy quality can be influenced by many factors such as colon preparation, retraction time, the colonoscopists medical training and knowledges as well as the performance of endoscopy equipment. The bad quality of colonoscopy will result in the emergence of interval cancers defined, based on the author, as cancers that appear at 3-5 years up to 10 years from the colonoscopy procedure. Interval cancers have predominantly incriminated both the colonoscopy quality and the clinician competences and less the tumor biology. Subsequently there were set quality indicators of colonoscopy in order to raise the quality of the exploration. Among the important indicators, proving their utility in studies, the ADR (adenoma detection rate) is most commonly used along with PDR (polyp detection rate) and APC (adenoma per colonoscopy). Following the purpose of obtaining a higher colonoscopy quality the medical units should keep in check all indicators. Furthermore, there should be an active involvement in an additional training of non-conforming medical personnel or even restrain of practice, given the medical legal actions that have interval cancers as a main cause.
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Affiliation(s)
- P Popa
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - D I Gheonea
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - A Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - M Calița
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Abu Baker F, Mari A, Feldman D, Suki M, Gal O, Kopelman Y. Melanosis Coli: A Helpful Contrast Effect or a Harmful Pigmentation? CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2018; 11:1179552218817321. [PMID: 30574001 PMCID: PMC6299301 DOI: 10.1177/1179552218817321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/09/2018] [Indexed: 01/17/2023]
Abstract
Background Melanosis coli, a brown discoloration of colonic mucosa, is considered as a benign condition mainly observed in patients under chronic anthranoid laxatives. Recent data link this condition with an increased adenoma detection rate. Moreover, its tumorigenic potential and possible association with the development of colorectal cancer remains uncertain. We conducted this study to compare the polyp detection rate and colorectal cancer diagnosis in patients with melanosis against matched control group without melanosis. Patients and methods A retrospective single-center study. Patients diagnosed with melanosis coli on colonoscopy over a 15-year period were included. Each melanosis coli patient was matched with three controls by age, gender, setting (inpatient/outpatient), and procedure's indication. Polyp detection rate and diagnosis of colorectal cancer were recorded and compared between the groups before and after adjustment for bowel preparation. Results A cohort of 718 patients with melanosis and 2154 controls were included. The polyp detection rates were 33.4% and 21.8% of melanosis and control groups, respectively (P < .001). Melanosis coli, however, was associated with less diagnosis of colorectal cancer than controls (0.3% vs 3.9%; P < .001). In multivariate analysis, melanosis diagnosis on endoscopy was significantly associated with higher polyp detection rate (odds ratio [OR] = 1.986, 95% confidence interval [CI]: 1.626-2.425; P value < .01). Conclusions Melanosis coli is not associated with increased diagnosis of colorectal cancer. It is associated, however, with enhanced polyp detection likely due to chromo-endoscopy-like effect.
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Affiliation(s)
- Fadi Abu Baker
- Fadi Abu Baker, Department of Gastroenterology and Hepatology, Hillel Yaffe Medical center, Technion Faculty of Medicine, Hashalom st., Hadera 38100, Israel.
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Carbon Dioxide Insufflation Increases Colonoscopic Adenoma Detection Rate Compared With Air Insufflation. J Clin Gastroenterol 2018. [PMID: 29521725 DOI: 10.1097/mcg.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS To determine the effect of carbon dioxide insufflation on the most important outcome measure of colonoscopic quality: adenoma detection rate (ADR). BACKGROUND Bowel cancer is the second most common cause of cancer deaths in males and females in Australia. Carbon dioxide has in recent times become the insufflation methodology of choice for screening colonoscopy for bowel cancer, as this has been shown to have significant advantages when compared with traditional air insufflation. STUDY Endoscopies performed over a period of 9 months immediately before and after the implementation of carbon dioxide insufflation at endoscopy centers were eligible for inclusion. RESULTS The difference in ADR between the carbon dioxide and air insufflation methods was statistically significant, with an increased ADR in the carbon dioxide group. The superiority of carbon dioxide insufflation was sustained with a logistic regression model, which showed ADR was significantly impacted by insufflation method. CONCLUSIONS Carbon dioxide insufflation is known to reduce abdominal pain, postprocedural duration of abdominal pain, abdominal distension, and analgesic requirements. This study represents for the first time the beneficial effect of carbon dioxide insufflation upon the key quality colonoscopy indicator of ADR.
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Impact of Changeover to Newer Endoscopic Systems on Quality and Efficiency of Screening and Surveillance Colonoscopy: Equipment or Endoscopist. J Clin Gastroenterol 2018; 52:891-895. [PMID: 28906425 DOI: 10.1097/mcg.0000000000000931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
GOALS The goal of this study is to assess whether changeover to newer endoscopic systems impacts quality or efficiency, and quantify the relation between increased withdrawal time and detection rates of sessile serrated polyps (SSPDR) and adenomas (ADR) in real-world practice. STUDY Beginning 2 months after new endoscopic systems were implemented at 2 endoscopy units, we included all outpatients undergoing screening/surveillance colonoscopy for 4 months. Outpatients during the same 4-month period 1 year earlier comprised the control group. Quality endpoints included ADR, advanced ADR, SSPDR, polyp detection rate (PDR), and withdrawal time. The efficiency endpoint was procedure time. Statistical adjustment for potential confounding factors was performed with multivariable analysis. RESULTS Significant increases occurred in postchangeover (N=1122) versus prechangeover (N=1131) procedure time (difference=2.6 minutes; 1.6 to 3.6) and withdrawal time (difference=1.6 minutes; 0.8 to 2.5). Significant increases also occurred in ADR [435 (39%) vs. 380 (34%)], advanced ADR [82 (7%) vs. 50 (4%)], and PDR [664 (59%) vs. 611 (54%)], but these differences lost significance when withdrawal time was added to the multivariable model. For every minute increase in withdrawal time a significant increase was seen in ADR (OR=1.09; 1.08 to 1.11), advanced ADR (OR=1.10; 1.08 to 1.13), SSPDR (OR=1.07; 1.06 to 1.09), and PDR (OR=1.16; 1.14 to 1.18). CONCLUSIONS After changeover to newer endoscopy systems withdrawal times lengthened, resulting in increased procedure time, ADR, and advanced ADR. Regardless of endoscopic system, lengthening withdrawal time increased SSPDR, ADR, and advanced ADR: odds of detection increased 7% to 10% with every additional minute of withdrawal time. Greater attention to withdrawal time and endoscopist examination may be more productive than upgrading endoscopic systems.
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Amano T, Nishida T, Shimakoshi H, Shimoda A, Osugi N, Sugimoto A, Takahashi K, Mukai K, Nakamatsu D, Matsubara T, Yamamoto M, Hayashi S, Nakajima S, Fukui K, Inada M. Number of polyps detected is a useful indicator of quality of clinical colonoscopy. Endosc Int Open 2018; 6:E878-E884. [PMID: 29978009 PMCID: PMC6032632 DOI: 10.1055/a-0605-3264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/12/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Adenoma detection rate (ADR) is a well-known quality indicator (QI) for colonoscopy. It is, however, difficult to evaluate ADR during practice. The aim of this study was to investigate the number of endoscopically detected polyps as a QI for colonoscopy. PATIENTS AND METHODS This was a retrospective single-center cohort study of 5,190 consecutive patients who underwent colonoscopy from January 2015 to May 2016. Among these patients, we ultimately enrolled 1,937 patients for initial colonoscopy. We evaluated QIs including bowel preparation, cecum intubation time, withdrawal time, number of endoscopically detected polyps, ADR and advanced neoplasia detection rate (ANDR). RESULTS The mean number of endoscopically detected polyps, ADR and ANDR were 1.5 ± 2.3 (95 % confidence interval (CI)1.4 - 1.6), 38.6 % (95 % CI 36.5-40.8), and 18.3 % (95 % CI 16.6 - 20.1), respectively. ADR and ANDR increased with the number of endoscopically detected polyps, but the correlation reached a plateau at five or more polyps. We divided the patients into three groups based on the number of polyps (1 to 2, 3 to 4, and 5 or more). Logistic regression analysis adjusted by age and sex revealed that presence of a large number of polyps was a strong predictor of advanced neoplasia (odds ratio: 3.1 [95 % CI 2.2 - 4.3] for 3 to 4 polyps and 7.9 [95 % CI 5.4 - 11.8] for 5 or more polyps when using the presence of 1 or 2 polyps as a reference). CONCLUSION The number of endoscopically detected polyps can predict risk of advanced neoplasia and may thus be a new QI for colonoscopy.
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Affiliation(s)
- Takahiro Amano
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Hiromi Shimakoshi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Akiyoshi Shimoda
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Naoto Osugi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Aya Sugimoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kei Takahashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kaori Mukai
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Tokuhiro Matsubara
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Shiro Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Sachiko Nakajima
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Koji Fukui
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masami Inada
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
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Abstract
BACKGROUND Adenoma detection rate (ADR) is defined as the number of colonoscopies with at least one adenoma, expressed as the ratio of the total number of colonoscopies performed. Recently, an application of a conversion factor to estimate the ADR from the polyp detection rate (PDR) was described. AIM In this meta-analysis, we examined the correlation between ADR and PDR in the published studies and assessed the relative ratio of these ratios for a better and more accurate estimation. METHODS English Medical literature searches were performed for 'PDR' AND 'ADR'. A meta-analysis was carried out for papers that fulfilled the inclusion criteria using comprehensive meta-analysis software. RESULTS Twenty-five studies and 42 sets of data, including 31 623 patients, from nine countries published till 31 August 2017, were found. Funnel plot did not indicate a significant publication bias. relative ratio for ADR calculated from PDR was 0.688, 95% confidence intervals: 0.680-0.695, P value of less than 0.0001 in the meta-analysis fixed model. Heterogeneity (the proportion of inconsistency in individual studies) between studies was significant, with Q=492.753, d.f. (Q) 41, P<0.0001, and I 91.679. CONCLUSION We found the ratio of 0.688 can be used to calculate ADR from PDR for the individual endoscopist or for a group of endoscopists before receiving the formal results from the pathology department.
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Affiliation(s)
- Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Liang PS, Pochapin MB. Adhering to quality metrics in colonoscopy: we can do better. Gastrointest Endosc 2018; 87:752-754. [PMID: 29454449 DOI: 10.1016/j.gie.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/02/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Peter S Liang
- Division of Gastroenterology, NYU School of Medicine, VA New York Harbor Health Care System, New York, New York
| | - Mark B Pochapin
- Division of Gastroenterology, NYU School of Medicine, NYU Langone Health, New York, New York
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Ngu WS, Rees C. Can technology increase adenoma detection rate? Therap Adv Gastroenterol 2018; 11:1756283X17746311. [PMID: 29383029 PMCID: PMC5784538 DOI: 10.1177/1756283x17746311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/16/2017] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer is the third most common cancer worldwide and the second most common cause of cancer-related death in Europe and North America. Colonoscopy is the gold standard investigation for the colon but is not perfect, and small or flat adenomas can be missed which increases the risk of patients subsequently developing colorectal cancer. Adenoma detection rate is the most widely used marker of quality, and low rates are associated with increased rates of post-colonoscopy colorectal cancer. Standards of colonoscopy and adenoma detection vary widely between different endoscopists. Interventions to improve adenoma detection rate are therefore required. Many devices have been purported to increase adenoma detection rate. This review looks at current available evidence for device technology to improve adenoma detection rate during colonoscopy.
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Affiliation(s)
- Wee Sing Ngu
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Colin Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, NE34 0PL, UK
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49
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The use of high definition colonoscopy versus standard definition: does it affect polyp detection rate? Surg Endosc 2017; 32:2676-2682. [DOI: 10.1007/s00464-017-5962-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/23/2017] [Indexed: 12/18/2022]
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50
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Murchie B, Tandon K, Zackria S, Wexner SD, O'Rourke C, Castro FJ. Can polyp detection rate be used prospectively as a marker of adenoma detection rate? Surg Endosc 2017; 32:1141-1148. [PMID: 28812147 DOI: 10.1007/s00464-017-5785-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/28/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adenoma detection rate (ADR) is a quality indicator for screening colonoscopy, but its calculation is time-consuming. Polyp detection rate (PDR) has been found to correlate with ADR; however, its use as a quality indicator has been criticized out of concern for endoscopists artificially inflating the PDR. We aim to evaluate whether active monitoring affects PDR. METHODS In March 2015, 14 endoscopists were made aware that their personal PDRs would be tracked monthly as a quality improvement project. Endoscopists received a report of their individual monthly and cumulative PDR, departmental averages, and a benchmark PDR. Following the intervention, data were collected for consecutive patients undergoing average risk screening colonoscopy for six months. PDR, ADR, and adenoma to polyp detection ratio quotient (APDRQ) were compared to a six-month pre-intervention period. RESULTS 2203 patients were included in the study. There was no statistically significant difference in PDR when comparing pre- and post-intervention (44 vs. 45%, OR 1.04; 95% CI 0.77-1.36). No statistically significant difference in ADR was observed when comparing pre- and post-intervention (29 vs. 30%, OR 1.03; 95% CI 0.64-1.52). There was no statistically significant difference in APDRQ when comparing pre- and post-intervention (0.67 vs. 0.66, OR 0.99; 95% CI 0.69-1.33). CONCLUSIONS Monthly report cards did not result in a change in PDR or APDRQ. In some environments, PDR can be used as a surrogate marker of ADR, despite endoscopist awareness that PDR is being measured.
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Affiliation(s)
- Brent Murchie
- Department of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Kanwarpreet Tandon
- Department of Internal Medicine, Blake Medical Center, Bradenton, FL, USA
| | - Shamiq Zackria
- Department of Internal Medicine, Aultman Hospital, Canton, OH, USA
| | - Steven D Wexner
- Department of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Colin O'Rourke
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Fernando J Castro
- Department of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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