TY - JOUR
T1 - Factors determining the quality of screening colonoscopy
T2 - A prospective study on adenoma detection rates, from12 134 examinations (Berlin colonoscopy project 3, BECOP-3)
AU - Adler, Andreas
AU - Wegscheider, Karl
AU - Lieberman, David
AU - Aminalai, Alireza
AU - Aschenbeck, Jens
AU - Drossel, Rolf
AU - Mayr, Michael
AU - Mroß, Michael
AU - Scheel, Mathias
AU - Schröder, Andreas
AU - Gerber, Katharina
AU - Stange, Gabriela
AU - Roll, Stephanie
AU - Gauger, Ulrich
AU - Wiedenmann, Bertram
AU - Altenhofen, Lutz
AU - Rosch, Thomas
PY - 2013/2
Y1 - 2013/2
N2 - Background: Screening colonoscopy (SC) outcome quality is best determined by the adenoma detection rate (ADR). The substantial variability in the ADRs between endoscopists may reflect different skills, experience and/or equipment. Objective: To analyse the potential factors that may influence ADR variance, including case volume. Design: 12 134 consecutive SCs (mean age 64.5 years, 47% men) from 21 Berlin private-practice colonoscopists were prospectively studied during 18 months. The data were analysed using a two-level mixed linear model to adequately address the characteristics of patients and colonoscopists. The ADR was regressed after considering the following factors: sex, age, bowel cleanliness, NSAID intake, annual SC case volume, lifetime experience, instrument withdrawal times, instrument generations used, and the number of annual continuing medical education (CME) meetings attended by the physician. The case volume was also retrospectively analysed from the 2007 national SC registry data (312 903 colonoscopies and 1004 colonoscopists). Results: The patient factors that correlated with the ADR were sex, age (p<0.001) and low quality of bowel preparation (p=0.005). The factors that were related to the colonoscopists were the number of CME meetings attended (p=0.012) and instrument generation (p=0.001); these factors accounted for approximately 40% of the interphysician variability. Within a narrow range (6-11 min), the withdrawal time was not correlated with the ADR. Annual screening case volume did not correlate with the ADR, and this finding was confirmed by the German registry data. Conclusions: The outcome quality of screening colonoscopies is mainly influenced by individual colonoscopist factors (ie, CME activities) and instrument quality. Clinical trial registration number: Clinical Trial Gov Registration number: NCT00860665.
AB - Background: Screening colonoscopy (SC) outcome quality is best determined by the adenoma detection rate (ADR). The substantial variability in the ADRs between endoscopists may reflect different skills, experience and/or equipment. Objective: To analyse the potential factors that may influence ADR variance, including case volume. Design: 12 134 consecutive SCs (mean age 64.5 years, 47% men) from 21 Berlin private-practice colonoscopists were prospectively studied during 18 months. The data were analysed using a two-level mixed linear model to adequately address the characteristics of patients and colonoscopists. The ADR was regressed after considering the following factors: sex, age, bowel cleanliness, NSAID intake, annual SC case volume, lifetime experience, instrument withdrawal times, instrument generations used, and the number of annual continuing medical education (CME) meetings attended by the physician. The case volume was also retrospectively analysed from the 2007 national SC registry data (312 903 colonoscopies and 1004 colonoscopists). Results: The patient factors that correlated with the ADR were sex, age (p<0.001) and low quality of bowel preparation (p=0.005). The factors that were related to the colonoscopists were the number of CME meetings attended (p=0.012) and instrument generation (p=0.001); these factors accounted for approximately 40% of the interphysician variability. Within a narrow range (6-11 min), the withdrawal time was not correlated with the ADR. Annual screening case volume did not correlate with the ADR, and this finding was confirmed by the German registry data. Conclusions: The outcome quality of screening colonoscopies is mainly influenced by individual colonoscopist factors (ie, CME activities) and instrument quality. Clinical trial registration number: Clinical Trial Gov Registration number: NCT00860665.
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U2 - 10.1136/gutjnl-2011-300167
DO - 10.1136/gutjnl-2011-300167
M3 - Article
C2 - 22442161
AN - SCOPUS:84872089655
SN - 0017-5749
VL - 62
SP - 236
EP - 241
JO - Gut
JF - Gut
IS - 2
ER -