167 Temporal Trends in the Detection of Right-Sided Colon Polyps: Summary Data of Large GI Practices

Abstract

167 Temporal Trends in the Detection of Right-Sided Colon Polyps: Summary Data of Large GI Practices Nalini M. Guda*, Neil Gupta, Dominic Klyve, John I. Allen, Thomas M. Deas, Lin Huang, Scott R. Ketover, Kyle P. Etzkorn, Kumar G. Gutta, Steven Morris, Prateek Sharma, Lyndon V. Hernandez GI Associates, Milwaukee, WI; Yale University, New Haven, CT; Central Washington University, Ellensburg, WA; Atlanta Gastroenterology Associates, Atlanta, GA; Gastroenterology Associates, Fort Worth, TX; Boorland-Groover Clinic, Jacksonville, FL; Minnesota Gastroneterology, Minneapolis, MN; Digestive Health Specialists, Tacoma, WA; GI Associatesof N. Texas, Fort Worth, TX; Gastroenterology, University of Kansas Medical Center, Kansas City, KS; Gastroenterology, Loyola Medicine, Chicago, IL Although overall colorectal cancer incidence and mortality has decreased in those undergoing colonoscopy, there is still a concern regarding efficacy of colonoscopy in detection of right-sided colonic lesions and prevention of colon cancers on the right side. Quality measures in colonoscopy have traditionally looked at detecting adenomatous polyps from throughout the colon. Data regarding polyp detection and cancer prevention in the left vs. right side are sparse. Aim: To assess the temporal trends in polyp detection (right vs. left-sided) Methods: Data from the Gastroenterology Practice Management Group (GPMG) which comprises of large GI practices in the country were analyzed. All the participating groups did not have electronic records (EHR) and data collection was not consistent. There were seven groups that had contributed de-identified from January of 2009 to October of 2013. Locations of polyps, time trends for polyp detection and in particular detection of right-sided polyps were analyzed(proximal). Left-sided polyps included those distal to hepatic flexure and those proximal to hepatic flexure were considered right sided for the purpose of this analysis(distal). Statistical and time-series analysis of quarterly detection rates was conducted for individual sites and for the entire group. Special attention was paid to determine temporal trends p values refer to the probability of seeing changes in detection rates in random data. Results: During the five-year period summary there was an overall increase in colon polyp detection rates from 39% in 2009 to 47% in 2013. Based on polyp location there was no significant increase in left colon polyp detection rate the average annual increase was 0.6% (p Z 0.214). However, the right colon detection rate during the same time period increased by 2.1% per annum, and almost entirely accounted for the increase in detection rates (p! 0.001)(See graph and table). Conclusions: 1. There was an overall increase in polyp detection rates based on a registry from major GI practices in the country. 2. Majority of the increased detection appear to be accounted for by right-sided colonic polyps.3. Increased awareness, improvement in technology, quality improvement programs likely have contributed to the increase. None of these practice groups have any financial incentives attached to polyp detection rates.4. This is summary level data and hence there are limitations regarding demographics, pathology of the polyps detected, and indications for colonoscopy as predictive factors for polyp detection.