Quality of Performance at Screening Flexible Sigmoidoscopy Correlates with Adenoma Detection Rates

Abstract

Background: Adenoma detection rates (ADR) at screening flexible sigmoidoscopy (FS) are known to be variable. We have previously described an objective performance score for screening FS based on video footage. Aims: To determine whether quality of exam performance correlates with ADR. Methods: Video footage from 260 FS cases was selected from 40000 cases from the UK Flexible Sigmoidoscopy Screening Trial. The endoscopic view of the extubation phase of 20 cases from each of the 13 endoscopists were edited together in batches of 5, (4 batches per endoscopist) and then randomised. Each batch of 5 was from the same endoscopist. Cases in each batch had the same grade of bowel preparation, Excellent, Good, Adequate or a mixture of these grades. Each endoscopist had cases with all grades of prep. An experienced scorer, blinded to the endoscopists' identity, gave a single ‘quality of performance’ score for each batch of 5 cases; scores given were from 5-1 where 5/4=Excellent/Good, 2/1=Not Good Enough/ Unacceptable. Results: Total scores for endoscopist performance ranged from 9-17 (maximum possible 20) and the mean batch score for each endoscopist ranged from 2.25-4.25. The endoscopists fell into two groups. 6 of the 13 with a mean batch score > 3 had a higher ADR of 12.6-15.9%. 7 of the 13 with a mean batch score ≤3 had a lower ADR of 8.6-11.8%; 5 of these had a score of <3, defined as being ‘Not Good Enough’ or ‘Unacceptable’. ADR was strongly correlated with the total performance score: Pearson correlation coefficient 0.79 p=0.001. Conclusions: An endoscopist's performance at screening flexible sigmoidoscopy can be judged using video footage. Good performance correlates with higher adenoma detection rates. This tool could be used to improve technique and ensure quality in screening flexible sigmoidoscopy.