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Factors determining the quality of screening colonoscopy

The latest issue of Gut identifies factors determining adenoma detection rates in colonoscopy.

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Screening colonoscopy outcome quality is best determined by the adenoma detection rate.

The substantial variability in the adenoma detection rates between endoscopists may reflect different skills, experience and/or equipment.

Dr Andreas Adler from Germany analyzed the potential factors that may influence adenoma detection rate variance, including case volume.

The researchers prospectively studied 12,134 consecutive screening colonoscopies from 21 Berlin private-practice colonoscopists over 18 months.

The data were analyzed using a 2-level mixed linear model to adequately address the characteristics of patients and colonoscopists.

The adenoma detection rate was regressed after considering sex, age, bowel cleanliness, NSAID intake, annual Screening colonoscopy case volume, lifetime experience, instrument withdrawal times, instrument generations used, and the number of annual continuing medical education meetings attended by the physician.

The factors that were related to the colonoscopists were the number of CME meetings attended
Gut

The case volume was also retrospectively analyzed from the 2007 national screening colonoscopy registry data.

The team of doctors found that patient factors that correlated with the adenoma detection rate were sex, age and low quality of bowel preparation.

The factors that were related to the colonoscopists were the number of CME meetings attended and instrument generation.

The team observed that these factors accounted for approximately 40% of the interphysician variability.

With the findings of the study the researchers noted that within a narrow range, the withdrawal time was not correlated with the adenoma detection rate.

Annual screening case volume did not correlate with the adenoma detection rate, and this finding was confirmed by the German registry data.

Dr Adler's team concludes "The outcome quality of screening colonoscopies is mainly influenced by individual colonoscopist factors and instrument quality."

Gut 2013; 62: 236-241
22 January 2013

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