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Beaton D, Sharp L, Lu L, Trudgill N, Thoufeeq M, Nicholson B, Rogers P, Docherty J, Jenkins A, Morris AJ, Rösch T, Rutter M. Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database. Aliment Pharmacol Ther 2024; 59:1589-1603. [PMID: 38634291 DOI: 10.1111/apt.18003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The value of lower gastrointestinal endoscopy (LGIE; colonoscopy or sigmoidoscopy) relates to its ability to detect clinically relevant findings, predominantly cancers, preneoplastic polyps or inflammatory bowel disease. There are concerns that many LGIEs are performed on low-risk patients with limited benefit. AIMS To determine the diagnostic outcomes of LGIE for common symptoms. METHODS We performed a cross-sectional study of diagnostic LGIE between March 2019 and February 2020 using the UK National Endoscopy Database. We used mixed-effects logistic regression models, incorporating random (endoscopist) and fixed (symptoms, patient age, and sex) effects upon two dependent variables (large polyp [≥10 mm] and cancer diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS We analysed 384,510 LGIEs; 33.2% were performed on patients aged under 50 and 53.6% on women. Regarding colonoscopies, the unadjusted PPV for cancer was 1.5% (95% CI: 1.4-1.5); higher for men than women (1.9% vs. 1.1%, p < 0.01). The PPV for large polyps was 3.2% (95% CI: 3.1-3.2). The highest colonoscopy cancer aPPVs were in the over 50s (1.9%) and in those with rectal bleeding (2.5%) or anaemia (2.1%). Cancer aPPVs for other symptoms were <1% despite representing 54.3% of activity. In patients under 50, aPPVs were 0.4% for cancer and 1.6% for large polyps. Results were similar for sigmoidoscopy. CONCLUSIONS Most colonoscopies were performed on patients with low-risk symptoms, where cancer risk was similar to the general population. Cancer and large polyp yield was highest in elderly patients with rectal bleeding or anaemia, although still fell short of FIT-based screening yields.
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Affiliation(s)
- David Beaton
- Northumbria NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Mo Thoufeeq
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian Nicholson
- NIHR Clinical Lecturer, Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, UK
| | | | | | - Anna Jenkins
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - A John Morris
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthew Rutter
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
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Beaton DR, Sharp L, Lu L, Trudgill NJ, Thoufeeq M, Nicholson BD, Rogers P, Docherty J, Jenkins A, Morris AJ, Rösch T, Rutter MD. Diagnostic yield from symptomatic gastroscopy in the UK: British Society of Gastroenterology analysis using data from the National Endoscopy Database. Gut 2024:gutjnl-2024-332071. [PMID: 38697772 DOI: 10.1136/gutjnl-2024-332071] [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: 01/29/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation. DESIGN A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett's oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50).Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%.The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms. CONCLUSIONS Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation.
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Affiliation(s)
- David Robert Beaton
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Mo Thoufeeq
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian D Nicholson
- University of Oxford Department of Primary Care Health Sciences, Oxford, UK
| | | | | | | | | | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf Department of Interdisciplinary Endoscopy, Hamburg, Germany
| | - Matthew D Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
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Lu L, Catlow J, Rutter MD, Sharp L. Initiatives to increase colonoscopy capacity - is there an impact on polyp detection? A UK National Endoscopy Database analysis. Endoscopy 2024; 56:302-310. [PMID: 37989199 PMCID: PMC10978102 DOI: 10.1055/a-2214-9840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND To address mismatch between routine endoscopy capacity and demand, centers often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). However, there are concerns that such initiatives may negatively impact quality. We investigated polyp detection for weekend vs. weekday and insourced vs. standard procedures using data from the UK National Endoscopy Database. METHODS We conducted a national, retrospective, cross-sectional study of diagnostic colonoscopies performed during 01/01-04/04/2019. The primary outcome was mean number of polyps (MNP) and the secondary outcome was polyp detection rate (PDR). Multi-level mixed-effect regression, fitting endoscopist as a random effect, was used to examine associations between procedure day (weekend/weekday) and type (insourced/standard) and these outcomes, adjusting for patient age, sex, and indication. RESULTS 92 879 colonoscopies (weekends: 19 977 [21.5 %]; insourced: 9909 [10.7 %]) were performed by 2496 endoscopists. For weekend colonoscopies, patients were less often male or undergoing screening-related procedures; for insourced colonoscopies, patients were younger and less often undergoing screening-related procedures (all P < 0.05). Fully adjusted MNP was significantly lower for weekend vs. weekday (incidence rate ratio [IRR] 0.86 [95 %CI 0.83-0.89]) and for insourced vs. standard procedures (IRR 0.91 [95 %CI 0.87-0.95]). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures; there was no interaction between procedure day and type. Similar associations were found for PDR. CONCLUSIONS Strategies to increase colonoscopy capacity may negatively impact polyp detection and should be monitored for quality. Reasons for this unwarranted variation require investigation.
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Affiliation(s)
- Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Jamie Catlow
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
- Gastroenterology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Matthew D. Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Saunsbury E, Haddadin Y, Gadhok R, Ratcliffe E, Raju SA. UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come. Frontline Gastroenterol 2024; 15:35-41. [PMID: 38487564 PMCID: PMC10935528 DOI: 10.1136/flgastro-2023-102468] [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: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method The British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform. Results 40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments.Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a 'bleed rota', this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents. Conclusion Respondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.
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Affiliation(s)
- Emma Saunsbury
- Department of Hepatology, John Radcliffe Hospital, Oxford, UK
| | - Yazan Haddadin
- Department of Clinical and Experimental Medicine, University of Sussex, Brighton, UK
| | - Radha Gadhok
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Elizabeth Ratcliffe
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust Rochdale Care Organisation, Rochdale, UK
| | - Suneil A Raju
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Chilton A, Dziedziak O, Jones S, Verma AM. Wind of change: what can we learn from the National Endoscopy Database? Frontline Gastroenterol 2022; 14:94-96. [PMID: 36818794 PMCID: PMC9933592 DOI: 10.1136/flgastro-2022-102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/13/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Andrew Chilton
- Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Olga Dziedziak
- NHS England and NHS Improvement Midlands, Birmingham, UK
| | - Sean Jones
- NHS England and NHS Improvement Midlands, Birmingham, UK
| | - Ajay M Verma
- Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
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