Correlation between proximal serrated polyp detection and clinically significant serrated polyps: inter-endoscopist variability

ObjectiveSerrated polyps (SPs) are an important cause of postcolonoscopy colorectal cancers (PCCRCs), which is likely the result of suboptimal SP detection during colonoscopy. We assessed the long-term effect of a simple educational intervention focusing on optimising SP detection.DesignAn educational intervention, consisting of two 45 min training sessions (held 3 years apart) on serrated polyp detection, was given to endoscopists from 9 Dutch hospitals. Hundred randomly selected and untrained endoscopists from other hospitals were selected as control group. Our primary outcome measure was the proximal SP detection rate (PSPDR) in trained versus untrained endoscopists who participated in our faecal immunochemical test (FIT)-based population screening programme.ResultsSeventeen trained and 100 untrained endoscopists were included, who performed 11 305 and 51 039 colonoscopies, respectively. At baseline, PSPDR was equal between the groups (9.3% vs 9.3%). After training, the PSPDR of trained endoscopists gradually increased to 15.6% in 2018. This was significantly higher than the PSPDR of untrained endoscopists, which remained stable around 10% (p=0.018). All below-average (ie, PSPDR ≤6%) endoscopists at baseline improved their PSPDR after training session 1, as did 57% of endoscopists with average PSPDR (6%–12%) at baseline. The second training session further improved the PSPDR in 44% of endoscopists with average PSPDR after the first training.ConclusionA simple educational intervention was associated with substantial long-term improvement of PSPDR in a prospective controlled trial within FIT-based population screening. Widespread implementation of such interventions might be an easy way to improve SP detection, which may ultimately result in fewer PCCRCs.Trial registration numberNCT03902899.

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The proximal serrated polyp detection rate is an easy-to-measure proxy for the detection rate of clinically relevant serrated polyps

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.02.044 ◽

2015 ◽

Vol 82 (5) ◽

pp. 870-877 ◽

Cited By ~ 30

Author(s):

Joep E.G. IJspeert ◽

Sascha C. van Doorn ◽

Ymkje M. van der Brug ◽

Barbara A.J. Bastiaansen ◽

Paul Fockens ◽

...

Keyword(s):

Detection Rate ◽

Polyp Detection ◽

Serrated Polyps ◽

Serrated Polyp ◽

Polyp Detection Rate

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Are adenoma and serrated polyp detection rates correlated with endoscopists’ sensitivity of optical diagnosis?

Endoscopy ◽

10.1055/a-1151-8691 ◽

2020 ◽

Vol 52 (09) ◽

pp. 763-772 ◽

Cited By ~ 1

Author(s):

Maxime E. S. Bronzwaer ◽

Jasper L. A. Vleugels ◽

Sascha C. van Doorn ◽

Marcel G. W. Dijkgraaf ◽

Paul Fockens ◽

...

Keyword(s):

Detection Rate ◽

Lesion Detection ◽

Optical Diagnosis ◽

Polyp Detection ◽

Detection Rates ◽

Serrated Polyps ◽

Serrated Polyp ◽

Polyp Detection Rate ◽

Adenoma Detection ◽

Post Hoc

Abstract Introduction Endoscopists with a high adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) detect these polyps more frequently, which may be attributable to better recognition of their endoscopic features. Little is known about the association between endoscopic lesion detection and differentiation skills. Therefore, we evaluated the correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps. Methods We performed an exploratory post-hoc analysis of the DISCOUNT-2 study, including complete colonoscopies after a positive fecal immunochemical test (FIT) performed by endoscopists who performed ≥ 50 colonoscopies. The correlations between the ADR, PSPDR, and the sensitivity of optical diagnosis were calculated using Pearson’s rho correlation coefficient. Results 24 endoscopists performed ≥ 50 colonoscopies, resulting in a total of 2889 colonoscopies. The overall ADR was 84.5 % (range 71.4 % – 95.3 %) and overall PSPDR was 13.7 % (4.3 % – 29.0 %). The sensitivity of optical diagnosis for adenomas and serrated polyps were 94.5 % (83.3 % – 100 %) and 74.0 % (37.5 % – 94.1 %), respectively. No correlation could be demonstrated between the ADR and the sensitivity of optical diagnosis for adenomas (−0.20; P = 0.35) or between the PSPDR and the sensitivity of optical diagnosis for serrated polyps (−0.12; P = 0.57). Conclusions In a homogeneous FIT-positive population, no correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps could be demonstrated. These exploratory results suggest that lesion detection and differentiation require different endoscopic skills. Further prospective studies are needed; until then, monitoring of both performance indicators is important to secure optimal efficacy of FIT-based colorectal cancer screening.

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Endoscopist factors that influence serrated polyp detection: a multicenter study

Endoscopy ◽

10.1055/a-0597-1740 ◽

2018 ◽

Vol 50 (10) ◽

pp. 984-992 ◽

Cited By ~ 20

Author(s):

Seth Crockett ◽

Rebecca Gourevitch ◽

Michele Morris ◽

David Carrell ◽

Sherri Rose ◽

...

Keyword(s):

Language Processing ◽

Multivariable Analysis ◽

The United States ◽

Polyp Detection ◽

Period Range ◽

Cross Sectional ◽

Serrated Polyps ◽

Serrated Polyp ◽

Polyp Detection Rate ◽

Cancer Precursors

Abstract Background Serrated polyps are important colorectal cancer precursors that are variably detected during colonoscopy. We measured serrated polyp detection rate (SPDR) in a large, multicenter, cross-sectional study of colonoscopy quality to identify drivers of SPDR variation. Methods Colonoscopy and pathology reports were collected for a 2-year period (10/2013-9/2015) from four sites across the United States. Data from reports, including size, location, and histology of polyps, were abstracted using a validated natural language processing algorithm. SPDR was defined as the proportion of colonoscopies with ≥ 1 serrated polyp (not including hyperplastic polyps). Multivariable logistic regression was performed to determine endoscopist characteristics associated with serrated polyp detection. Results A total of 104 618 colonoscopies were performed by 201 endoscopists who varied with respect to specialty (86 % were gastroenterologists), sex (18 % female), years in practice (range 1 – 51), and number of colonoscopies performed during the study period (range 30 – 2654). The overall mean SPDR was 5.1 % (SD 3.8 %, range 0 – 18.8 %). In multivariable analysis, gastroenterology specialty training (odds ratio [OR] 1.89, 95 % confidence interval [CI] 1.33 – 2.70), fewer years in practice (≤ 9 years vs. ≥ 27 years: OR 1.52, 95 %CI 1.14 – 2.04)], and higher procedure volumes (highest vs. lowest quartile: OR 1.77, 95 %CI 1.27 – 2.46)] were independently associated with serrated polyp detection. Conclusions Gastroenterology specialization, more recent completion of training, and greater procedure volume are associated with serrated polyp detection. These findings imply that both repetition and training are likely to be important contributors to adequate detection of these important cancer precursors. Additional efforts to improve SPDR are needed.

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Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000425 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000425

Author(s):

Alan Gordon Fraser ◽

Toby Rose ◽

Philip Wong ◽

Mark Lane ◽

Paul Frankish

Keyword(s):

Detection Rate ◽

Adenoma Detection Rate ◽

Polyp Detection ◽

Audit Process ◽

Withdrawal Time ◽

Serrated Polyps ◽

Serrated Polyp ◽

Polyp Detection Rate ◽

Adenoma Detection ◽

Colonoscopy Quality

BackgroundThe audit process may help improve performance indicators for colonoscopy quality but it is unclear whether this is sustained over several years.Methods44138 procedures for 28 endoscopists from 2004 to 2019 were analysed for polyp detection rate and withdrawal time. From 2012, 14 endoscopists were analysed with additional data on polyp histology and number of polyps removed.ResultsPolyp detection increased from 40.7% in 2004 to 62.2% in 2019; removal of polyps>1 cm remained constant (11%). Adenoma detection rate was 25.8% in 2012 and 28.3% in 2019. Sessile serrated polyp (SSP) detection rate increased from 4.5% to 14.7%; most of the increase was in the first 2 years of the histology part of the audit. There was a significant correlation of adenoma detection rate with mean number of adenomas (r=0.72, p=0.004) and a significant correlation of SSP detection with mean number of SSPs (r=0.85, p=0.0001).ConclusionThe audit process appears to encourage a higher rate of polyp detection. This was due to increased detection of smaller polyps and increased detection of SSPs.

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A117 PROPOFOL SEDATION DOES NOT IMPROVE MEASURES OF COLONOSCOPY QUALITY – FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.115 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 97-98

Author(s):

M Sey ◽

B Yan ◽

Z Hindi ◽

M Brahmania ◽

J C Gregor ◽

...

Keyword(s):

Detection Rate ◽

Conscious Sedation ◽

Intubation Rate ◽

Polyp Detection ◽

Cecal Intubation ◽

Propofol Sedation ◽

Serrated Polyp ◽

Polyp Detection Rate ◽

Cecal Intubation Rate ◽

Colonoscopy Quality

Abstract Background The use of propofol during colonoscopy has gained increased popularity due to deeper anesthesia compared to conscious sedation. Prior studies examining the use of propofol sedation during colonoscopy have primarily focused on anesthesia outcomes. Whether propofol sedation is associated with improvements in colonoscopy outcomes is uncertain. Aims The primary outcome was adenoma detection rate (ADR). Secondary outcomes were the detection of any adenoma (conventional adenoma, sessile serrated polyp, and traditional serrated adenoma), sessile serrated polyp detection rate, polyp detection rate, cecal intubation rate, and perforation rate. Methods The Southwest Ontario Colonoscopy cohort consists of all patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 hospitals serving a large geographic area in Southwest Ontario. Procedures performed in patients less than 18 years of age or by endoscopist who perform <50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed. Results A total of 46,634 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others) of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation (e.g. combination of a benzodiazepine and a narcotic). Patients who received propofol were likely to have a screening indication (49.2% vs 45.5%, p<0.0001), not have a trainee endoscopist present and be performed at a non-academic centre (32.2% vs 44.6%, p<0.0001). Compared to conscious sedation, use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p<0.0001) and detection of any adenoma (27.7% vs. 29.8%, p<0.0001); no difference was observed in the detection ofsessile serrated polyps (5.0% vs. 4.7%, p=0.26), polyp detection rate (41.2% vs 41.2%, p=0.978), cecal intubation rate (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%,p=0.45). On multi-variable analysis, the use of propofol was not significantly associated with any improvement in ADR (RR=0.90, 95% CI 0.74–1.10, p=0.30), detection of any adenoma (RR=0.93, 95% CI 0.75–1.14, p=0.47), sessile serrated polyp detection rate (RR=1.20, 95%CI 0.90–1.60, p=0.22), polyp detection rate (RR=1.00, 95% CI 0.90–1.11, p=0.99), or cecal intubation rate (RR=1.00, 95%CI 0.80–1.26, p=0.99). Conclusions The use of propofol sedation does not improve colonoscopy quality metrics. Funding Agencies None

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