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Mangas-Sanjuan C, Zapater P, Cubiella J, Murcia Ó, Bujanda L, Hernández V, Martínez-Ares D, Pellisé M, Seoane A, Lanas Á, Nicolás-Pérez D, Herreros-de-Tejada A, Chaparro M, Cacho G, Fernández-Díez S, Marín-Gabriel JC, Quintero E, Castells A, Jover R. Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox. United European Gastroenterol J 2017; 6:622-629. [PMID: 29881618 DOI: 10.1177/2050640617745458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/06/2017] [Indexed: 12/25/2022] Open
Abstract
Background Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. Objective The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. Methods This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. Results A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p = 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19-0.97) and ADR (HR 0.94; 95% CI 0.89-0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89-0.99). Conclusions Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.
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Affiliation(s)
- Carolina Mangas-Sanjuan
- 1Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
| | - Pedro Zapater
- 2Unit of Clinical Pharmacology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra y Vigo, Ourense, Spain
| | - Óscar Murcia
- 1Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, CIBERehd, Universidad del País Vasco, San Sebastián, Spain
| | - Vicent Hernández
- Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomédica, Xerencia de Xestión Integrada de Vigo, Vigo, Spain
| | - David Martínez-Ares
- Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomédica, Xerencia de Xestión Integrada de Vigo, Vigo, Spain
| | - María Pellisé
- Department of Gastroenterology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Agustín Seoane
- Department of Gastroenterology, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
| | - Ángel Lanas
- Department of Gastroenterology, Hospital Clínico Lozano Blesa, Universidad de Zaragoza, CIBERehd, Zaragoza, Spain
| | - David Nicolás-Pérez
- Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas y Centro de Investigación Biomédica de Canarias (CIBICan), Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | | | - María Chaparro
- Department of Gastroenterology, Hospital de la Princesa, Madrid, Spain
| | - Guillermo Cacho
- Department of Gastroenterology, Fundación Hospital de Alcorcón, Madrid, Spain
| | | | | | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas y Centro de Investigación Biomédica de Canarias (CIBICan), Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rodrigo Jover
- 1Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain
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Raju GS, Lum PJ, Slack RS, Thirumurthi S, Lynch PM, Miller E, Weston BR, Davila ML, Bhutani MS, Shafi MA, Bresalier RS, Dekovich AA, Lee JH, Guha S, Pande M, Blechacz B, Rashid A, Routbort M, Shuttlesworth G, Mishra L, Stroehlein JR, Ross WA. Natural language processing as an alternative to manual reporting of colonoscopy quality metrics. Gastrointest Endosc 2015; 82:512-9. [PMID: 25910665 DOI: 10.1016/j.gie.2015.01.049] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/25/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The adenoma detection rate (ADR) is a quality metric tied to interval colon cancer occurrence. However, manual extraction of data to calculate and track the ADR in clinical practice is labor-intensive. To overcome this difficulty, we developed a natural language processing (NLP) method to identify adenomas and sessile serrated adenomas (SSAs) in patients undergoing their first screening colonoscopy. We compared the NLP-generated results with that of manual data extraction to test the accuracy of NLP and report on colonoscopy quality metrics using NLP. METHODS Identification of screening colonoscopies using NLP was compared with that using the manual method for 12,748 patients who underwent colonoscopies from July 2010 to February 2013. Also, identification of adenomas and SSAs using NLP was compared with that using the manual method with 2259 matched patient records. Colonoscopy ADRs using these methods were generated for each physician. RESULTS NLP correctly identified 91.3% of the screening examinations, whereas the manual method identified 87.8% of them. Both the manual method and NLP correctly identified examinations of patients with adenomas and SSAs in the matched records almost perfectly. Both NLP and the manual method produced comparable values for ADRs for each endoscopist and for the group as a whole. CONCLUSIONS NLP can correctly identify screening colonoscopies, accurately identify adenomas and SSAs in a pathology database, and provide real-time quality metrics for colonoscopy.
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