Abstract
Background: Screening colonoscopy aims to interrupt the adenoma-carcinoma sequence by removing all precancerous adenomatous polyps. Adenomatous polyp detection rate (ADR) can vary between endoscopists as well as between race, age, and risk of colorectal cancer (CRC). The purpose of this study was to compare ADR among academic gastroenterologists (A-GI), non-A-GI, and surgeons for endoscopies performed in the same endoscopic suite of a large medical center with a predominately African American (AA) population.Methods: All screening colonoscopies performed in 2014 for patients aged 62-76 years were identified using the electronic medical records data. Patients with average risk and high risk of CRC defined as having a 'personal history of polyps' or 'family history of CRC', and history of ulcerative colitis and Fecal Occult Blood Test/Fecal Immunochemical Test (FOBT/FIT) positivity were included. Patients with incomplete colonoscopy (defined as failing to achieve cecal intubation or poor preparation) and unrecovered tissue biopsy were excluded. ADR was calculated for three groups of endoscopists: A-GIs, non-A-GIs, and surgeons.Results: A total of 573 screening colonoscopies was analyzed. The endoscopists comprised five A-GIs, eight non-A-GIs, and six surgeons. The majority of patients were of AA decent (71%), female (54%) with an average age of 66 years. Patients classified as average risk comprised 79% of the population. Most of the colonoscopies were performed by A-GI (n=339), followed by non-A-GI (n=144), and surgeons (n=90). The ADR for A-GI was 50% as compared to 32% for non-A-GI (p<0.001) and 25% for surgeons (p<0.001). Also, A-GI were more likely to identify ≥3 adenomas during screening colonoscopies. Significant differences were observed (p<0.001) in the mean time of colonoscopy for A-GI (30 mins) non-A-G (14 mins), and surgeons (18 mins).Conclusion: Significant variation in the ADR between endoscopists belonging to different specialties were observed. Although all appear to achieve acceptable ADR (ie at least 25 for men and 15 for women), academic gastroenterologists had better performance than non-academic GI and surgeons. This may be explained by a significantly longer average duration of procedures for the highest ADR group.
Highlights
Colorectal cancer (CRC) screening is effective in reducing the occurrence and mortality of colorectal disease by identification and removal of adenoma and precursor adenoma lesions by the endoscopist [1,2,3]
Most of the colonoscopies were performed by academic gastroenterologists (A-GI) (n=339), followed by non-A-GI (n=144), and surgeons (n=90)
Studies have shown that risk of interval cancer is greater in patients who had procedures done by endoscopists with Adenomatous polyp detection rate (ADR) less than 20% compared to ones done by endoscopists with ADR more than 20% [8]
Summary
Colorectal cancer (CRC) screening is effective in reducing the occurrence and mortality of colorectal disease by identification and removal of adenoma and precursor adenoma lesions by the endoscopist [1,2,3]. The effectiveness of this approach has been demonstrated in multiple large population studies where the detection of adenomas as defined by the number of patients who have an adenoma (adenoma detection rate (ADR)) is correlated with reduction of interval cancers [4,5,6,7,8,9,10]. The purpose of this study was to compare ADR among academic gastroenterologists (A-GI), non-A-GI, and surgeons for endoscopies performed in the same endoscopic suite of a large medical center with a predominately African American (AA) population
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