Endoscopist Specialty Research Articles

Endoscopist Specialty Predicts Likelihood of Recommending Cessation of CRC Screening in Older Adults: An Analysis of the New Hampshire Colonoscopy Registry

Introduction: Although the US Preventive Services Task Force recommends that routine CRC screening for adults stop at 75 years, it is not clear what endoscopists are recommending in practice. Our goal was to examine current practice including patient- and endoscopist-related factors associated with cessation of screening in older adults. Methods: We included normal, screening colonoscopy exams in patients ≥ 50 years of age within the New Hampshire Colonoscopy Registry (NHCR), excluding incomplete exams or those with inadequate bowel preparation. We evaluated exams performed by endoscopists with at least 100 screening colonoscopies in NHCR. Primary outcome was endoscopists' recommendation against further screening. Main exposure variables included patient age and endoscopist characteristics. Other variables were patient gender, BMI, family history, smoking, alcohol, exercise, marital status, and education. We used descriptive statistics and chi square test for trend, and performed univariate and multivariable logistic regression models. Results: There were 19,112 normal, screening colonoscopy exams between 2009-2014, of which 4,038 (21%) were in adults age ≥65. These were performed by 73 endoscopists, of which 51 were gastroenterologists, 19 surgeons and 2 family medicine. Median [IQR] adenoma detection rate (ADR) was 24.4% [18.9-29.8]. Nearly 100% of adults aged 65-69 attending screening colonoscopy were recommended to return for another screening colonoscopy in the future (Table 1). Strikingly, only 15% of patients age 70-74 with no FH of CRC were told to stop receiving colonoscopy, while 85% were told to return in 10 years, when they would be 80-84. In univariate analyses, age, FH of CRC, BMI, marital status, endoscopist ADR and specialty were associated with the recommendation to stop colonoscopy (Table 2). In the multivariable model, advancing age and absence of FH of CRC were significantly associated with a recommendation to stop colonoscopy. Gastroenterologists were more likely to recommend stopping colonoscopy in accordance with guidelines than other non-gastroenterology endoscopists (aOR (95% CI) 2.1 (1.4-3.2)).Table: Table. Rates of endoscopists recommending no further CRC screening stratified by patient age and family history of CRCTable: Table. Patient and endoscopists-level factors associated with recommendation of no further CRC screening among adults age 65 and olderConclusion: In a large state-wide colonoscopy registry including 73 endoscopist, the overwhelming majority of patients ≥ age 65 and even age 75 are told to return for screening colonoscopy in 10 years. Having a FH of CRC or non-gastroenterology endoscopist increases the likelihood of being told to return for screening at advanced ages outside of current guideline recommendations.

PTH-016 Factors Associated with Upper Gastrointestinal Cancer Occurrence After OGD that Did Not Detect Cancer in The West Midlands

Introduction Up to 14% of upper gastrointestinal cancer (UGIC) subjects had an OGD that did not diagnose cancer up to 3 years prior to diagnosis. The rate of and associated risk factors for post-OGD upper gastrointestinal cancer (POUGIC) in the West Midlands were examined. Methods Computerised OGD records from 8 NHS trusts in the West Midlands between 1998 and 2010 were retrieved and submitted to the West Midlands Cancer Intelligence Unit (WMCIU) for UGIC registrations linkage. Subjects undergoing OGD 3 to 36 months before diagnosis were identified as POUGIC and subjects with no OGD 3 to 36 months prior to diagnosis served as controls. The influence of age, gender, indication, endoscopist specialty, trainee involvement, sedation, number of biopsies taken from focal abnormalities, site and histology of UGIC on POUGIC were examined by logistic regression analysis. Results 115,113 OGD records were submitted to WMCIU and 3870 UGIC were linked. After exclusions, 2909 UGIC subjects were analysed. There were 275 (9.5%) POUGIC subjects (154 oesophageal cancer (OC) and 121 gastric cancer (GC)). The POUGIC rate ranged from 7.6 to 11.8% between the trusts. Of the POUGIC subjects, 143 (52.0%) had OGD 3 to 12 months and 132 (48.0%) 12 to 36 months prior to UGIC diagnosis. POUGIC subjects were younger (69.6±11.7 yrs) compared with controls (72.0±11.6 yrs) (p = 0.001). There were no association between POUGIC and OC or GC (GC OR 1.15, 95%CI 0.89–1.48, p = 0.289) or subject gender (female 1.14, 0.88–1.48, p = 0.312). Subjects with alarm symptoms (0.33, 0.26–0.43, p Conclusion The POUGIC rate in the West Midlands was 9.5% between 1998 and 2010 and varied between 7.6 and 11.8% between trusts. POUGIC was associated with younger age, a lack of alarm symptoms and less biopsies from abnormalities. There was no significant survival difference between POUGIC subjects and controls at 1 yr. Disclosure of Interest None Declared

Mo1961 Evaluation of the Quality of Colonoscopy Reporting From a Regional Colorectal Cancer Screening Program

Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) Program was created as the Edmonton medical zone arm of the Alberta Colorectal Cancer Screening Program (ACRCSP). The aim of the program was to provide consistent, high quality colon cancer screening while adhering to provincial, national and international screening and endoscopic quality guidelines. AIM To evaluate the quality of colonoscopy and colon cancer screening completed during the first year of the SCOPE program and to assess the impact of the endoscopist's area of expertise on outcomes. METHOD All colonoscopies performed in 2012 through the SCOPE program were assessed for polyp detection rate (PDR), adenoma detection rate (ADR), withdrawal time and rectal retroflexion and then stratified based on the specialty of endoscopist performing the procedure. Data was derived retrospectively from the dictated reports and pathology findings. RESULTS From January 1 to December 31, 2012, a total of 3013 screening colonoscopies were performed through the SCOPE program. Gastroenterologists (GI) performed the majority of the cases (2353), with the remaining cases being performed byGeneral Surgeons (GS)(331), Internists (IM)(221), or a Nurse practitioner (NP)(108). The overall mean PDR and ADR for the program was 53% and 35% respectively. The mean ADR was highest amongst GI (37%) and significantly different compared to GS (27%) (p < 0.001) but not statistically different from IM (31%)(p=0.09) or to nurse practitioner (NP) (32%)(p=0.24). GI had significantly longer withdrawal times compared to GS (6.82 min vs. 5.92 min; p<0.001) and to IM (6.82 min vs. 4.08 min; p < 0.001) but no different compared to the NP (6.82 min vs. 7.17 min; p=0.07). The highest mean retroflexion reporting rate was achieved by IM at 93%, which was significantly superior to GI (81%), NP (82%) and GS (52%), all with p < 0.0001. Both GI and NP had significantly higher retroflexion reporting rates than GS (each p < 0.001), but were similar between GI and NP (p=0.91). CONCLUSION The SCOPE program currently meets endoscopic quality standards for overall ADR and withdrawal time, even though there is some variability in the quality of colonoscopy between specialties. This data represents a baseline standard, allowing individual endoscopists participating in the SCOPE program to reflect on areas to maintain or improve patient care through high quality colorectal cancer screening.

Mo1957 Evaluation of the Performance Characteristics of a Regional Colon Cancer Screening Program

Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) Program was created as the Edmonton medical zone arm of the Alberta Colorectal Cancer Screening Program (ACRCSP). The aim of the program was to provide consistent, high quality colon cancer screening while adhering to provincial, national and international screening and endoscopic quality guidelines. AIM To evaluate the quality of colonoscopy and colon cancer screening completed during the first year of the SCOPE program and to assess the impact of the endoscopist's area of expertise on outcomes. METHOD All colonoscopies performed in 2012 through the SCOPE program were assessed for polyp detection rate (PDR), adenoma detection rate (ADR), withdrawal time and rectal retroflexion and then stratified based on the specialty of endoscopist performing the procedure. Data was derived retrospectively from the dictated reports and pathology findings. RESULTS From January 1 to December 31, 2012, a total of 3013 screening colonoscopies were performed through the SCOPE program. Gastroenterologists (GI) performed the majority of the cases (2353), with the remaining cases being performed byGeneral Surgeons (GS)(331), Internists (IM)(221), or a Nurse practitioner (NP)(108). The overall mean PDR and ADR for the program was 53% and 35% respectively. The mean ADR was highest amongst GI (37%) and significantly different compared to GS (27%) (p < 0.001) but not statistically different from IM (31%)(p=0.09) or to nurse practitioner (NP) (32%)(p=0.24). GI had significantly longer withdrawal times compared to GS (6.82 min vs. 5.92 min; p<0.001) and to IM (6.82 min vs. 4.08 min; p < 0.001) but no different compared to the NP (6.82 min vs. 7.17 min; p=0.07). The highest mean retroflexion reporting rate was achieved by IM at 93%, which was significantly superior to GI (81%), NP (82%) and GS (52%), all with p < 0.0001. Both GI and NP had significantly higher retroflexion reporting rates than GS (each p < 0.001), but were similar between GI and NP (p=0.91). CONCLUSION The SCOPE program currently meets endoscopic quality standards for overall ADR and withdrawal time, even though there is some variability in the quality of colonoscopy between specialties. This data represents a baseline standard, allowing individual endoscopists participating in the SCOPE program to reflect on areas to maintain or improve patient care through high quality colorectal cancer screening.

Mo1958 Identifying Who Can Best Assess Barriers to Colorectal Cancer Screening: Implications for Quality Improvement

Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) Program was created as the Edmonton medical zone arm of the Alberta Colorectal Cancer Screening Program (ACRCSP). The aim of the program was to provide consistent, high quality colon cancer screening while adhering to provincial, national and international screening and endoscopic quality guidelines. AIM To evaluate the quality of colonoscopy and colon cancer screening completed during the first year of the SCOPE program and to assess the impact of the endoscopist's area of expertise on outcomes. METHOD All colonoscopies performed in 2012 through the SCOPE program were assessed for polyp detection rate (PDR), adenoma detection rate (ADR), withdrawal time and rectal retroflexion and then stratified based on the specialty of endoscopist performing the procedure. Data was derived retrospectively from the dictated reports and pathology findings. RESULTS From January 1 to December 31, 2012, a total of 3013 screening colonoscopies were performed through the SCOPE program. Gastroenterologists (GI) performed the majority of the cases (2353), with the remaining cases being performed byGeneral Surgeons (GS)(331), Internists (IM)(221), or a Nurse practitioner (NP)(108). The overall mean PDR and ADR for the program was 53% and 35% respectively. The mean ADR was highest amongst GI (37%) and significantly different compared to GS (27%) (p < 0.001) but not statistically different from IM (31%)(p=0.09) or to nurse practitioner (NP) (32%)(p=0.24). GI had significantly longer withdrawal times compared to GS (6.82 min vs. 5.92 min; p<0.001) and to IM (6.82 min vs. 4.08 min; p < 0.001) but no different compared to the NP (6.82 min vs. 7.17 min; p=0.07). The highest mean retroflexion reporting rate was achieved by IM at 93%, which was significantly superior to GI (81%), NP (82%) and GS (52%), all with p < 0.0001. Both GI and NP had significantly higher retroflexion reporting rates than GS (each p < 0.001), but were similar between GI and NP (p=0.91). CONCLUSION The SCOPE program currently meets endoscopic quality standards for overall ADR and withdrawal time, even though there is some variability in the quality of colonoscopy between specialties. This data represents a baseline standard, allowing individual endoscopists participating in the SCOPE program to reflect on areas to maintain or improve patient care through high quality colorectal cancer screening.

Commentaire du travail de Kozbial K et al., pp. 207

See also: High quality of screening colonoscopy in Austria is not dependent on endoscopist specialty or settingEndoscopy 2015; 10(03): 207-216DOI: 10.1055/s-0034-1390910

High quality of screening colonoscopy in Austria is not dependent on endoscopist specialty or setting.

International studies have shown differences in the outcome of screening colonoscopies related to the endoscopist's specialty and setting of colonoscopy. The aim of this study was to investigate the impact of these two factors on quality parameters for screening colonoscopy in a quality-assured screening program. Adenoma detection rate (ADR), cecal intubation rate (CIR), polypectomy rate, flat polyp detection rate, carcinoma detection rate, sedation rate, complication rates, and other parameters of 59 901 screening colonoscopies performed by 178 endoscopists were analyzed in relation to specialty (35 gastroenterologists: 10 066 colonoscopies [16.8 %]; 84 nongastroenterologists: 26 271 colonoscopies [43.9 %]; 59 surgeons: 23 564 [39.3 %]), and setting (hospital: 12 580 [21.6 %] colonoscopies; office: 45 781 [78.4 %] colonoscopies). The overall ADR was 20.5 % and the CIR was 95.6 %. The ADR did not show any statistical significance, either in relation to specialty or to setting. A significant difference in the CIR was found between hospital-based and office-based internists (98.5 % vs. 96.8 %, respectively; P = 0.0005; odds ratio [OR] 2.2, 95 % confidence interval [CI] 1.4 - 3.4). Hospital-based internists had a significantly higher flat polyp detection rate (7.5 % vs. 4.1 %; P = 0.02; OR 1.9, 95 %CI 1.1 - 3.2) and a significantly lower carcinoma detection rate (0.4 % vs. 0.6 %; P = 0.03; OR 0.7, 95 %CI 0.5 - 1.0) compared with office-based internists. Complication rates were significantly lower among surgeons than among internists (0.1 % vs. 0.2 %; P = 0.03; OR 0.5, 95 %CI 0.3 - 1.0). Endoscopists participating in the Austrian quality assurance program offered high quality screening colonoscopy regardless of their specialty and setting. The implementation of a standardized quality program is therefore a decisive factor in quality improvement of screening colonoscopy.

Adenoma and sessile serrated polyp detection rates: variation by patient sex and colonic segment but not specialty of the endoscopist.

Adenoma detection rate is an important quality indicator. High adenoma detection rate is related to fewer interval cancers. Interval cancers arise from sessile serrated polyps, often in the proximal colon. The detection of adenomas and sessile serrated polyps by location may enhance colonoscopy efficacy. The aim of this study was to determine entire colon and segmental adenoma and sessile serrated polyp detection rates and to assess the impact of endoscopist specialty on polyp detection. Colonoscopies performed by 65 multispecialty endoscopists were studied. This study was conducted at an academic medical center. Average-risk outpatients undergoing screening colonoscopy were selected. Polyp detection rates were determined by sex, colon segment, and each endoscopist. Included were 2167 patients. Adenoma and sessile serrated polyp detection rates were 25% and 2% and not significantly different by specialty of the endoscopist. The adenoma detection rate was higher in men (31%) than in women (20%), including each segment in the colon. It was higher proximally (20%) than distally (16%) (p = 0.027) in men, but no different in proximal (11%) and distal colon (11%) (p = 0.66) in women. Sessile serrated polyp detection was the same in men and women at 2% (p = 0.84) and 3-fold higher in the proximal than in the distal colon (1.4% vs 0.5%), but only significantly so in women (p = 0.041). We found a poor correlation between adenoma and sessile serrated polyp detection rates (r = 0.35). This study was limited by its retrospective nature. Prevalent adenomas are detected more often in men than in women, including overall and by colon segment. The proximal adenoma detection rate is significantly higher than the distal adenoma detection rate in men, but segmental rates are similar in women. Sessile serrated polyp detection rates are low, albeit 3-fold higher in the proximal colon, and are found as frequently in men and women. High-quality colonoscopy, as evidenced by adenoma detection rate, varies by endoscopist but is independent of colonoscopist subspecialty.

Sa1421 Assessing Quality Indicators in Screening Colonoscopy: Does the Endoscopist Specialty and Technique Care?

Colonoscopy is the gold standard for colorectal cancer (CRC) screening and success depends on colonoscopy quality. Many factors influence on quality and outcomes in colonoscopy. The relationship between endoscopist specialty and different techniques with colonoscopy quality has not been examined.

Tu1017 Endoscopist Specialty and Withdrawal Time Impact the Detection Rate of Proximal Serrated Polyps

Tu1017 Endoscopist Specialty and Withdrawal Time Impact the Detection Rate of Proximal Serrated Polyps

Quality Measures for Colonoscopy: A Critical Evaluation

In a recent article in The New York Times, "The $2.7 Trillion Medical Bill,"(1) colonoscopy was singled out for its cost. In their response, the leading gastroenterology professional societies highlighted colonoscopy's effectiveness and cost-effectiveness for the prevention of colorectal cancer (CRC). Affirming colonoscopy's central role in CRC prevention, both as a frontline test and as the final common pathway for other CRC screening modalities, requires strategies to measure and improve colonoscopy quality, particularly by controlling operator-dependent factors. Although colonoscopy is a powerful CRC screening test,(2-6) several recent studies have highlighted decreased protection, mainly against right-sided CRC,(5,7-16) an observation that has been linked to performance quality.

Risk Factors for Early Colonoscopic Perforation Include Non-Gastroenterologist Endoscopists: A Multivariable Analysis

Bowel perforation is a rare but serious complication of colonoscopy. Its prevalence is increasing with the rapidly growing volume of procedures performed. Although colonoscopies have been performed for decades, the risk factors for perforation are not completely understood. We investigated risk factors for perforation during colonoscopy by assessing variables that included sedation type and endoscopist specialty and level of training. We performed a retrospective multivariate analysis of risk factors for early perforation (occurring at any point during the colonoscopy but recognized during or immediately after the procedure) in adult patients by using the Clinical Outcomes Research Initiative National Endoscopic Database. Risk factors were determined from published articles. Additional variables assessed included endoscopist specialty and years of experience, trainee involvement, and sedation with propofol. We identified 192 perforation events during 1,144,900 colonoscopies from 85 centers entered into the database from January 2000-March 2011. On multivariate analysis, increasing age, American Society of Anesthesia class, female sex, hospital setting, any therapy, and polyps >10 mm were significantly associated with increased risk of early perforation. Colonoscopies performed by surgeons and endoscopists of unknown specialty had higher rates of perforation than those performed by gastroenterologists (odds ratio, 2.00; 95% confidence interval, 1.30-3.08). Propofol sedation did not significantly affect risk for perforation. In addition to previously established risk factors, non-gastroenterologist specialty was found to affect risk for perforations detected during or immediately after colonoscopy. This finding could result from differences in volume and style of endoscopy training. Further investigation into these observed associations is warranted.

OC-013 How often is upper Gastrointestinal Cancer Missed during Endoscopy?

<h3>Introduction</h3> Meta-analysis of published literature suggests that up to 14% of upper gastrointestinal cancer (UGIC) subjects had a negative oesophagogastroduodenoscopy (OGD) up to 3 years prior to diagnosis. We have examined how often UGIC is missed at OGD in our organisation and associated risk factors. <h3>Methods</h3> Computerised OGD records from Sandwell General and City Hospitals between 1999 and 2007 were retrieved and submitted to the West Midlands Cancer Intelligence Unit (WMCIU) for UGIC registrations linkage. Subjects undergoing OGD 3 months to 5 years before diagnosis were identified as potentially missed UGIC cases and those with no OGD 3 months to 5 years before diagnosis served as controls. The influence of age, gender, indication, endoscopist specialty, trainee involvement, sedation use, number of biopsies taken, site and histology of UGIC on missed UGIC were examined by logistic regression analysis. <h3>Results</h3> 36577 OGD records were submitted to WMCIU for cancer linkage and 524 UGIC were linked. 419 control UGIC: 388 (93%) diagnosed at initial OGD; 31 (7%) diagnosed at repeat OGD appropriately (within 90 days, with previous benign histology). 105 (20%) potentially missed UGIC cases: 39 (37%) oesophageal cancer (OC) and 66 (63%) gastric cancer (GC); 42 (40%) had OGD 3 months to 1 year prior to diagnosis; 33 (31%) had OGD 1–3 years prior and 30 (29%) had OGD 3–5 years prior. Furthermore, 30% of missed UGIC cases had OGD where abnormality at site of UGIC was seen but not biopsied or benign histology from an inadequate number of biopsies ( &lt; 4) within 3 months to 1 year prior to diagnosis. Lack of alarm symptoms (2.51, 95%CI 1.58–4.00, p = 0.0001) and female gender (1.79, 1.16–2.79, p = 0.009) were associated with missed UGIC. The number of biopsies taken was significantly lower in the missed UGIC group than in the controls (2.1 ± 0.2 vs 5.4 ± 0.1, p &lt; 0.05). In subjects with OC, mid-oesophageal OC appeared more likely to be missed than lower-oesophageal OC (2.04, 0.99–4.23, p = 0.05). Oesophageal squamous cell carcinoma was much more likely to be missed than oesophageal adenocarcinoma (4.47, 1.88–10.65, p &lt; 0.001). In GC subjects, there was no association between missed UGIC and tumour site (1.10, 0.61–1.97, p = 0.3) or histology subtype (1.10, 0.46–2.67, p = 0.8). Age (1.5, –0.8–3.8, p = 0.2), endoscopist specialty (1.39, 0.70–2.76, p = 0.34), trainee involvement (1.2, 0.78 – 1.86, p = 0.39) and sedation use (0.98, 0.64–1.51, p = 0.9) were not associated with increased risk of missing UGIC. <h3>Conclusion</h3> Missing UGIC at OGD was seen in 14.3% of subjects within 3 years of diagnosis. It was associated with lack of alarm symptoms, female gender, oesophageal squamous cell carcinoma and an insufficient number of biopsies from recognised abnormalities. <h3>Disclosure of Interest</h3> None Declared

Endoscopist specialty is associated with colonoscopy quality

BackgroundSome studies have shown that endoscopist specialty is associated with colorectal cancers missed by colonoscopy. We sought to examine the relationship between endoscopist specialty and polypectomy rate, a colonoscopy quality indicator. Polypectomy rate is defined as the proportion of colonoscopies that result in the removal of one or more polyps.MethodsA cross-sectional study was conducted of endoscopists and their patients from 7 Montreal and 2 Calgary endoscopy clinics. Eligible patients were aged 50–75 and covered by provincial health insurance. A patient questionnaire assessed family history of colorectal cancer, history of large bowel conditions and symptoms, and previous colonoscopy. The outcome, polypectomy status, was obtained from provincial health administrative databases. For each city, Bayesian hierarchical logistic regression was used to estimate the odds ratio for polypectomy comparing surgeons to gastroenterologists. Model covariates included patient age, sex, family history of colorectal cancer, colonoscopy indication, and previous colonoscopy.ResultsIn total, 2,113 and 538 colonoscopies were included from Montreal and Calgary, respectively. Colonoscopies were performed by 38 gastroenterologists and 6 surgeons in Montreal, and by 31 gastroenterologists and 5 surgeons in Calgary. The adjusted odds ratios comparing surgeons to gastroenterologists were 0.48 (95% CI: 0.32–0.71) in Montreal and 0.73 (95% CI: 0.43–1.21) in Calgary.ConclusionsAn association between endoscopist specialty and polypectomy was observed in both cities after adjusting for patient-level covariates. Results from Montreal suggest that surgeons are half as likely as gastroenterologists to remove polyps, while those from Calgary were associated with a wide, non-significant Bayesian credible interval. However, residual confounding from patient-level variables is possible, and further investigation is required.

Predictors of Perforation in Adult Colonoscopy Including the Impact of Endoscopist Specialty

Predictors of Perforation in Adult Colonoscopy Including the Impact of Endoscopist Specialty

Volume and accreditation, but not specialty, affect quality standards in colonoscopy

The Global Rating Scale, defined by the Joint Advisory Group for Gastrointestinal Endoscopy, requires monitoring of endoscopic performance indicators. There are known variations in colonoscopic performance, and investigation of factors causing this is needed. This study aimed to analyse the impact of endoscopist specialty and procedural volume on the quality of colonoscopy. Data collected prospectively from a UK hospital endoscopy service between June 2007 and January 2010 were analysed. The main endpoint was the adenoma detection rate (ADR). Secondary endpoints were polyp detection rate (PDR), reported caecal intubation rate (CIR) and reported complications. Multivariable binary regression models were built to adjust for confounding patient-level and endoscopist-level variation. A total of 10,026 colonoscopies were included, with an overall ADR of 19.2 per cent, a CIR of 90.2 per cent and a perforation rate of 0.06 per cent. In univariable analyses, surgeons had a higher ADR and higher PDR, but lower CIR, compared with physicians. Surgeons had a significantly different case mix in terms of age, sex and indication for colonoscopy. After adjusting for this case mix in multivariable analysis, specialty was no longer a significant predictor of ADR; however, surgeons retained their higher PDR and physicians their higher CIR. Endoscopists accredited for screening and those performing more than 100 colonoscopies per year had a higher ADR. Adjusting for case mix, physicians and surgeons performed equally well in terms of ADR. Accreditation and a higher annual number of colonoscopies were more important factors in achieving quality standards.

Endoscopist specialty affects CRC prevention rate, costs in the US

Endoscopist specialty affects CRC prevention rate, costs in the US

Association Between Colonoscopy and Colorectal Cancer Mortality in a US Cohort According to Site of Cancer and Colonoscopist Specialty

We designed this study to evaluate the association of colonoscopy with colorectal cancer (CRC) death in the United States by site of CRC and endoscopist specialty. We designed a case-control study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. We identified patients (cases) diagnosed with CRC age 70 to 89 years from January 1998 through December 2002 who died as a result of CRC by 2007. We selected three matched controls without cancer for each case. Controls were assigned a referent date (date of diagnosis of the case). Colonoscopy performed from January 1991 through 6 months before the diagnosis/referent date was our primary exposure. We compared exposure to colonoscopy in cases and controls by using conditional logistic regression controlling for covariates, stratified by site of CRC. We determined endoscopist specialty by linkage to the American Medical Association (AMA) Masterfile. We assessed whether the association between colonoscopy and CRC death varied with endoscopist specialty. We identified 9,458 cases (3,963 proximal [41.9%], 4,685 distal [49.5%], and 810 unknown site [8.6%]) and 27,641 controls. In all, 11.3% of cases and 23.7% of controls underwent colonoscopy more than 6 months before diagnosis. Compared with controls, cases were less likely to have undergone colonoscopy (odds ratio [OR], 0.40; 95% CI, 0.37 to 0.43); the association was stronger for distal (OR, 0.24; 95% CI, 0.21 to 0.27) than proximal (OR, 0.58; 95% CI, 0.53 to 0.64) CRC. The strength of the association varied with endoscopist specialty. Colonoscopy is associated with a reduced risk of death from CRC, with the association considerably and consistently stronger for distal versus proximal CRC. The overall association was strongest if colonoscopy was performed by a gastroenterologist.

PTU-233 In vivo polyp size and histology assessment at colonoscopy: are we ready to resect and discard? a multi-centre analysis of 1212 polypectomies

IntroductionThe current paradigm of colonoscopic management of polyps is to resect and send for pathologic assessment. Such practice incurs substantial costs for a group of lesions with limited clinical importance....

Endoscopist Specialty Is Associated with High-Quality Endoscopy in Korea

PurposeThe present study was aimed to determine whether endoscopist specialty is associated with high-quality endoscopy.Materials and MethodsWe prospectively collected endoscopy quality related data based on the Endoscopy Quality Rating Scale (EQRS) of 277 endoscopy units in a hospital setting from the National Cancer Screening Program of Korea in 2009. Gastroenterology medical professors (n=154) from university hospitals visited each endoscopy unit and graded the unit according to the EQRS. The scores from the EQRS were analyzed and compared in relation to endoscopy training during residency and endoscopy subspecialist certification.ResultsAfter excluding data from 3 endoscopy units, EQRS data from 274 endoscopy units were analyzed: 263 esophagogastroduodenoscopy (EGD) screening units and 90 colonoscopy screening units. There were no significant differences in the scores of EQRS with respect to endoscopy training during residency (p=no significance), except for scores of EGDs for "Facility and Equipment" (p=0.030). However, EQRS scores were significantly higher in the endoscopy units where endoscopy subspecialists performed the endoscopies than those where Endoscopy Subspecialists did not perform the endoscopies (p<0.05, except p=0.08 for the "Process" criteria of EGD).ConclusionEndoscopist specialty is an important determinant of high-quality endoscopy in Korea.