The UK Flexible Sigmoidoscopy Screening Trail found wide between-center variation in adenoma detection rates (ADRs).
In this study, researchers from England determined whether the observed differences could be attributed to varying performance by endoscopists. The team also examined the effect of experience on performance.
In addition, they identified a standard ADR to which endoscopists could aspire.
Overall, 13 medical endoscopists, each performed about 3000 examinations using the same equipment and protocol.
|Higher detectors had adenoma detection rates of 15% overall.|
The team compared overall and monthly ADRs using multivariable logistic regression.
The researchers found that differences in ADRs could not be explained by patient characteristics, incidence of colorectal cancer, or the endoscopists’ medical specialty or experience.
However, they found that average ADRs increased significantly with screening experience.
Endoscopists were classified as higher, intermediate, or lower adenoma detectors, and performance levels were maintained over time.
The team found that higher detectors had ADRs of 15% overall (men, 20%; women, 10%). Higher detectors also found more adenomas per case.
Dr Wendy Atkin's team concluded, "The differences in ADRs were due to variation in performance of the endoscopists".
"Long-term follow-up will determine whether this variation is clinically important".
"We suggest that the standards in higher detecting centers should be achievable by all endoscopists screening unscreened populations aged older than 55 years".
"Endoscopists should aim to stay above the lower 95% confidence interval band for 200 examinations (10% overall; 5% in women, 15% in men)".