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Ebner DW, Burger KN, Mahoney DW, Broderick BT, Eckmann JD, Devens ME, Lowrie KL, League JB, Bering J, Kahn A, Rodriguez EA, Prichard DO, Wallace MB, Kane SV, Leighton JA, Buttar NS, Rutten LJF, Gurudu SR, Kisiel JB. Neoplasia Diagnosis After Multi-target Stool DNA Is Enhanced Among Lowest Baseline Detectors. Dig Dis Sci 2023; 68:3721-3731. [PMID: 37486445 PMCID: PMC10882559 DOI: 10.1007/s10620-023-08038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND AIMS Variation in colorectal neoplasia detection limits the effectiveness of screening colonoscopy. By evaluating neoplasia detection rates of individual colonoscopists, we aimed to quantify the effects of pre-procedural knowledge of a positive (+) multi-target stool DNA (mt-sDNA) on colonoscopy quality metrics. METHODS We retrospectively identified physicians who performed a high volume of + mt-sDNA colonoscopies; colorectal neoplasia at post-mt-sDNA colonoscopy was recorded. These colonoscopists were stratified into quartiles based on baseline adenoma detection rates. Baseline colonoscopy adenoma detection rates and sessile serrated lesion detection rates were compared to post-mt-sDNA colonoscopy neoplasia diagnosis rates among each quartile. Withdrawal times were measured from negative exams. RESULTS During the study period (2014-17) the highest quartile of physicians by volume of post-mt-sDNA colonoscopies were evaluated. Among thirty-five gastroenterologists, their median screening colonoscopy adenoma detection rate was 32% (IQR, 28-39%) and serrated lesion detection rate was 13% (8-15%). After + mt-sDNA, adenoma diagnosis increased to 47% (36-56%) and serrated lesion diagnosis increased to 31% (17-42%) (both p < 0.0001). Median withdrawal time increased from 10 (7-13) to 12 (10-17) minutes (p < 0.0001) and was proportionate across quartiles. After + mt-sDNA, lower baseline detectors had disproportionately higher rates of adenoma diagnosis in female versus male patients (p = 0.048) and higher serrated neoplasia diagnosis rates among all patients (p = 0.0092). CONCLUSIONS Knowledge of + mt-sDNA enriches neoplasia diagnosis compared to average risk screening exams. Adenomatous and serrated lesion diagnosis was magnified among those with lower adenoma detection rates. Awareness of the mt-sDNA result may increase physician attention during colonoscopy. Pre-procedure knowledge of a positive mt-sDNA test improves neoplasia diagnosis rates among colonoscopists with lower baseline adenoma detection rates, independent of withdrawal time.
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Affiliation(s)
- Derek W Ebner
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kelli N Burger
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Jason D Eckmann
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Mary E Devens
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kari L Lowrie
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John B League
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Eduardo A Rodriguez
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, UT, USA
| | | | | | - Sunanda V Kane
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | | | | | - John B Kisiel
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Sedlack RE, Sedlack AR, Kelley SR, League JB. Defining the learning curves of colorectal surgical trainees in colonoscopy using the Assessment of Competency in Endoscopy tool. Gastrointest Endosc 2022; 96:301-307.e3. [PMID: 35217019 DOI: 10.1016/j.gie.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/15/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Gastroenterology fellows require on average 250 to 275 colonoscopies to achieve competency. For surgical trainees, 50 colonoscopies is deemed adequate. Two training pathways using different assessment methods make any direct comparison impossible. At the Mayo Clinic colonoscopy training of gastroenterology and colorectal surgery (CRS) fellows were merged in 2017, providing a unique opportunity to define the learning curves of CRS trainees using the Assessment of Competency in Endoscopy (ACE) evaluation tool. METHODS In a single-center retrospective descriptive study, ACE scores were collected on colonoscopies performed by CRS fellows over a period of 4 academic years. By calculating the average scores at every 25 procedures of experience, the CRS colonoscopy learning curves were described for each core cognitive and motor skill. RESULTS Twelve CRS fellows (men, 8; women, 4) had an average prior experience of 123 colonoscopies (range, 50-266) during the general surgical residency. During CRS fellowship, an average of 136 colonoscopies (range, 116-173) were graded per fellow. Although the competency goals for a few metrics were met earlier, most motor and cognitive ACE metrics reached the minimum competency thresholds at 275 to 300 procedures. CONCLUSIONS CRS fellows reached competency in colonoscopy at around 275 to 300 procedures of experience, a trajectory similar to previously reported data for gastroenterology fellows, suggesting little difference in the learning curves between these 2 groups. In addition, no trainee was deemed competent at the onset of training despite an average experience well over the 50 colonoscopies required during residency.
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Affiliation(s)
- Robert E Sedlack
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Scott R Kelley
- Division of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John B League
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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