Abstract
Background. The purpose of this study is to determine if colonoscopy quality is associated with the annual case volume of endoscopists. Methods. A retrospective cohort study was performed on 3235 patients who underwent colonoscopy in the city of St. John's, NL, between January and June 2012. Data collected included completion of colonoscopy (CCR) and adenoma detection rates (ADR). Endoscopists were divided into quintiles based on annual case volume. To account for potential confounding variables, univariate analyses followed by multivariable logistic regression were used to identify variables independently associated with CCR and ADR. Results. A total of 13 surgeons and 8 gastroenterologists were studied. There was a significant difference in CCR (p < 0.001) and ADR (p < 0.001) based on annual volume. Following multivariable regression, predictors of successful colonoscopy completion included annual colonoscopy volume, lower age, male sex, an indication of screening or surveillance, and a low ASA score. Predictors of adenoma detection included older age, male sex, an indication of screening or surveillance, and gastroenterology specialty. Conclusion. Higher annual case volume is associated with better quality of colonoscopy in terms of completion. However, gastroenterology specialty appears to be a better predictor of ADR than annual case volume.
Highlights
The National Polyp Study suggested that colonoscopy with polypectomy can reduce the chance of subsequent colorectal cancer by as much as 90% [1]
Data were obtained from the endoscopy procedure reports, the nursing records of the endoscopy, and the pathology reports in the electronic medical record system
Though there were 6 patients with no dictated reports from the endoscopist, the colonoscopy completion rate (CCR), the adenoma detection rates (ADR), and the polyp detection rate (PDR) from these cases could be extracted from the nursing and pathology records
Summary
The National Polyp Study suggested that colonoscopy with polypectomy can reduce the chance of subsequent colorectal cancer by as much as 90% [1]. More recent studies have found less of an impact [2,3,4] and at least one study has suggested that this benefit is only limited to the left colon [5] Some of these differences are likely the result of missed adenomas and incomplete colonoscopy. The Society of Gastrointestinal and Endoscopic Surgeons (SAGES) Colonoscopy Outcomes Study Group found in 2001 that endoscopists were significantly more likely to complete colonoscopy to the cecum if they had performed at least 100 colonoscopies annually [6]. Another recent study found a similar relationship between colonoscopy volume and cecal intubation [7]. Gastroenterology specialty appears to be a better predictor of ADR than annual case volume
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