scholarly journals A147 ENDOSCOPIST FEEDBACK IS ASSOCIATED WITH IMPROVEMENTS IN COLONOSCOPY QUALITY INDICATORS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 10-11
Author(s):  
K Bishay ◽  
N Calo ◽  
M A Scaffidi ◽  
C M Walsh ◽  
J Anderson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Indicators ◽  
Meta Analysis ◽  
Audit And Feedback ◽  
Screening Colonoscopy ◽  
Withdrawal Time ◽  
Random Effects Models ◽  
Manual Search ◽  
Adenoma Detection ◽  
Colonoscopy Quality

Abstract Background Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. Endosocpist feedback may be associated with improvements in ADR and other quality indicators. Aims To conduct a systematic review and meta-analysis to determine whether an association exists between endoscopist feedback and improvements in colonoscopy quality indicators. Methods An electronic and manual search was conducted through May 2019 for studies reporting on endoscopist feedback and associations with ADR or other colonoscopy quality indicators. Studies primarily assessing the effect of audit and feedback on trainees and studies that included interventions other then feedback were excluded from the analysis. Pooled rate ratios (RR) and weighted mean differences (WMD) were calculated using DerSimonian and Laird random effects models. Subgroup, sensitivity and meta-regression analyses were performed to assess for potential methodological or clinical factors associated with outcomes. Results Of 1,326 initial studies, 12 studies were included in the meta-analysis for ADR, representing 33,184 colonoscopies. Endoscopist feedback was associated with an improvement in ADR (RR 1.21, 95% confidence interval, CI, 1.09 to 1.34). Low performers derived a greater benefit from feedback (RR 1.62, 95% CI 1.18 to 2.23) compared to moderate performers (RR 1.19, 95% CI 1.11 to 1.29), while high performers did not derive a significant benefit (RR 1.06, 95% CI 0.99 to 1.13). Feedback was not associated with increases in withdrawal time (WMD +0.43 minutes, 95% CI -0.50 to +1.36 minutes) or improvements in cecal intubation rate (RR 1.00, 95% CI 0.99 to 1.01). Conclusions Endoscopist feedback is associated with modest improvements in ADR. Routine audit and feedback may be a feasible strategy to optimize outcomes in screening colonoscopy. Funding Agencies None

scholarly journals Impact of real-time use of artificial intelligence in improving adenoma detection during colonoscopy: A systematic review and meta-analysis

2021 ◽  
Vol 09 (04) ◽  
pp. E513-E521
Author(s):  
Munish Ashat ◽  
Jagpal Singh Klair ◽  
Dhruv Singh ◽  
Arvind Rangarajan Murali ◽  
Rajesh Krishnamoorthi
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Meta Analysis ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Polyp Detection ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
The Impact

Abstract Background and study aims With the advent of deep neural networks (DNN) learning, the field of artificial intelligence (AI) is rapidly evolving. Recent randomized controlled trials (RCT) have investigated the influence of integrating AI in colonoscopy and its impact on adenoma detection rates (ADRs) and polyp detection rates (PDRs). We performed a systematic review and meta-analysis to reliably assess if the impact is statistically significant enough to warrant the adoption of AI -assisted colonoscopy (AIAC) in clinical practice. Methods We conducted a comprehensive search of multiple electronic databases and conference proceedings to identify RCTs that compared outcomes between AIAC and conventional colonoscopy (CC). The primary outcome was ADR. The secondary outcomes were PDR and total withdrawal time (WT). Results Six RCTs (comparing AIAC vs CC) with 5058 individuals undergoing average-risk screening colonoscopy were included in the meta-analysis. ADR was significantly higher with AIAC compared to CC (33.7 % versus 22.9 %; odds ratio (OR) 1.76, 95 % confidence interval (CI) 1.55–2.00; I2 = 28 %). Similarly, PDR was significantly higher with AIAC (45.6 % versus 30.6 %; OR 1.90, 95 %CI, 1.68–2.15, I2 = 0 %). The overall WT was higher for AIAC compared to CC (mean difference [MD] 0.46 (0.00–0.92) minutes, I2 = 94 %). Conclusions There is an increase in adenoma and polyp detection with the utilization of AIAC.

scholarly journals Association between Endoscopist Specialty and Colonoscopy Quality: Protocol for a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Nauzer Forbes ◽  
Matthew Mazurek ◽  
Alistair Murray ◽  
Yibing Ruan ◽  
Robert J Hilsden ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
A Priori ◽  
Study Data ◽  
Related Factors ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Meta Analyses ◽  
Colonoscopy Quality

Abstract Background Colonoscopy is an important modality in the provision of colorectal cancer screening. Though effective and safe, the performance of screening-related colonoscopy is variable in terms of its overall quality, with endoscopist-related factors playing an important role in this variation. The purpose of this study is to systematically review the association between endoscopist specialty and colonoscopy quality and outcomes. Methods A comprehensive electronic search will be carried out to determine the association between endoscopist specialty and colonoscopy quality metrics and/or outcomes in adult patients undergoing colonoscopy. Two abstracters will independently determine study eligibility, assess study quality, and abstract study data. The primary outcome will be the adenoma detection rate (ADR); secondary outcomes will include cecal intubation rate (CIR), withdrawal time (WT), adverse events (AEs) and post-colonoscopy colorectal cancer (PCCRC). Rates of the above metrics and outcomes will also be compared between clinically relevant subgroups determined a priori. DerSimonian and Laird models will be used to perform meta-analyses for each outcome. Sources of heterogeneity will be explored via meta-regression analyses, if possible. Discussion Given the significant established variation in colonoscopy quality, endoscopist-related factors need to be explored. Our meta-analysis will address the important question of whether the specialty of the endoscopist impacts colonoscopy quality and/or outcomes. Systematic Review Registration PROSPERO CRD42021226251.

scholarly journals Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

2020 ◽  
Vol 08 (10) ◽  
pp. E1321-E1331
Author(s):  
Natalia S. Causada-Calo ◽  
Emmanuel I. Gonzalez-Moreno ◽  
Kirles Bishay ◽  
Risa Shorr ◽  
Catherine Dube ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Prediction Interval ◽  
Meta Analysis ◽  
Educational Interventions ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Improvement Programs ◽  
Colonoscopy Quality

Abstract Background and study aims The quality of screening-related colonoscopy depends on several physician- and patient-related factors. Adenoma detection rate (ADR) varies considerably between endoscopists. Educational interventions aim to improve endoscopists’ ADRs, but their overall impact is uncertain. We aimed to assess whether there is an association between educational interventions and colonoscopy quality indicators. Methods A comprehensive search was performed through August 2019 for studies reporting any associations between educational interventions and any colonoscopy quality indicators. Our primary outcome of interest was ADR. Two authors assessed eligibility criteria and extracted data independently. Risk of bias was also assessed for included studies. Pooled rate ratios (RR) with 95 % confidence intervals (CI) were reported using DerSimonian and Laird random effects models. Results From 2,253 initial studies, eight were included in the meta-analysis for ADR, representing 86,008 colonoscopies. Educational interventions were associated with improvements in overall ADR (RR 1.29, 95 % CI 1.25 to 1.42, 95 % prediction interval 1.09 to 1.53) and proximal ADR (RR 1.39, 95 % CI 1.29 to 1.48), with borderline increases in withdrawal time, ([WT], mean difference 0.29 minutes, 95 % CI – 0.12 to 0.70 minutes). Educational interventions did not affect cecal intubation rate ([CIR], RR 1.01, 95 % CI 1.00 to 1.01). Heterogeneity was considerable across many of the analyses. Conclusions Educational interventions are associated with significant improvements in ADR, in particular, proximal ADR, and are not associated with improvements in WT or CIR. Educational interventions should be considered an important option in quality improvement programs aiming to optimize the performance of screening-related colonoscopy.

scholarly journals A142 ENDOSCOPIST EDUCATIONAL INTERVENTIONS ARE ASSOCIATED WITH IMPROVEMENTS IN ADENOMA DETECTION RATE: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 3-5
Author(s):  
E González Moreno ◽  
K Bishay ◽  
N Calo ◽  
M A Scaffidi ◽  
S C Grover ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Quality Indicators ◽  
Detection Rate ◽  
Meta Analysis ◽  
Educational Interventions ◽  
Post Intervention ◽  
Cecal Intubation ◽  
Adenoma Detection ◽  
Colonoscopy Quality

Abstract Background Screening-related colonoscopy reduces the overall morbidity and mortality associated with colorectal cancer. In order for screening-related colonoscopy to be effective and safe, endoscopists must be well trained. However, a significant degree of variation exists between endoscopists in terms of adenoma detection rate (ADR) and cecal intubation rate (CIR). ADR in particular is an important colonoscopy quality metric that has been directly and inversely related to the rate of post colonoscopy colorectal cancer (PCCRC). Educational interventions aimed at endoscopists have been developed in an attempt to optimize the performance of colonoscopy. It is unknown what benefit these have on colonoscopy quality indicators or outcomes, if any. Aims We performed a systematic review and meta-analysis to determine whether there is an association between educational interventions aimed at endoscopists and improvements in colonoscopy quality indicators or outcomes. Methods An electronic search was conducted through August 2019 for studies reporting on targeted endoscopist educational interventions and associations with ADR or other colonoscopy quality indicators, or outcomes. Interventions such as hands-on training modules, skills enhancement courses were included Pooled rate ratios (RR) and weighted mean differences (WMD) were calculated using DerSimonian and Laird random effects models. A priori subgroup and sensitivity analyses were performed to assess for potential methodological or clinical factors associated with any of the outcomes of interest. Results From 2,253 initial studies, 14 were included in the systematic review, and 8 were included in the meta-analysis for ADR, representing 76,373 colonoscopies. Educational interventions were associated with improvements in ADR (RR 1.28, 95% confidence intervals, CI, 1.19–1.38). Educational interventions were also associated with improvements in overall polyp detection rate, PDR (RR 1.17, 95% confidence intervals, CI, 1.02–1.35). Educational interventions were not associated with longer withdrawal times (WMD -0.03 minutes, 95% CI, -0.57 - 0.51) or improved CIR (RR 1.00, 95% CI, 0.99 to 1.02), though unadjusted CIR was high in both the pre- and post-intervention groups, at 94.5% and 95.0%, respectively. Figure 1 shows Forest plots comparing pre-intervention and post-intervention rates for A) ADR, b) PDR and c) CIR. Conclusions Our study provides evidence that educational interventions aimed at endoscopists significantly improve ADR and overall PDR. Educational interventions did not impact withdrawal time or cecal intubation rates, and thus, the specific mechanisms for their benefit remain incompletely clear. As part of quality improvement programs to optimize colonoscopy performance, educational interventions should be considered. Funding Agencies None

scholarly journals A141 ENDOSCOPIST PROCEDURAL VOLUME AND COLONOSCOPY OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 1-3
Author(s):  
N Forbes ◽  
D Boyne ◽  
D R Brenner ◽  
M S Mazurek ◽  
R J Hilsden ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Quality Indicators ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Procedural Volume ◽  
Adenoma Detection ◽  
Screening Procedures ◽  
Annual Volume ◽  
Colonoscopy Quality

Abstract Background In addition to monitoring adverse events (AEs) and post-colonoscopy colorectal cancers (PCCRC), several indicators are used to assess the overall quality of colonoscopy performance, including adenoma detection rate (ADR) and cecal intubation rate (CIR). It is unclear whether there is an association between an endoscopist’s annual colonoscopy volumes and ADR, CIR, AEs or PCCRC. Aims We performed a systematic review and meta-analysis to determine whether there is an association between annual colonoscopy volume and colonoscopy quality indicators, or between annual volume and colonoscopy outcomes. Methods A comprehensive electronic search was performed through March of 2019 for any studies assessing the potential association between annual colonoscopy volume and outcomes, or quality indicators, including ADR, CIR, AEs or PCCRC. Pooled odds ratios (OR) were calculated using DerSimonian and Laird random effects models. Subgroup and sensitivity analyses were also performed to assess for any potential methodological or clinical factors associated with outcomes. These included dividing procedural volume into total procedures or screening procedures performed. Results Out of an initial 9,235 studies, 27 were included in our systematic review, representing 11,276,244 colonoscopies performed by over 530 endoscopists. There was no association between procedural volume and ADR (OR 1.00, 95% confidence intervals, CI, 0.98 to 1.02 per additional 100 annual total colonoscopy procedures performed by an endoscopist). CIR was improved with each additional 100 annual colonoscopy procedures (OR 1.17, 95% CI 1.08 to 1.28). There was a trend toward decreased overall adverse events per additional 100 annual procedures that did not meet significance (OR 0.95, 95% CI 0.90 to 1.00), although there was a decreased incidence of colonic perforations with increasing colonoscopy volume. Figure 1 - Forest plots demonstrating the odds of A) detecting an adenoma, B) intubating the cecum, and C) incurring an overall or specific adverse event, per additional 100 annual procedures, for total and screening procedures. Conclusions In this meta-analysis, higher annual colonoscopy volumes correlated with higher CIR, but not with ADR or PCCRC. Trends toward lower AE rates were also demonstrated with higher volumes. All studies included in this review examined endoscopists performing above respective recommended minimum volume thresholds for their health region. Thus, data are lacking on endoscopists performing very low numbers or very high numbers of colonoscopies annually. Future studies should focus on measuring colonoscopy quality metrics and outcomes among these extreme performers to more clearly determine associations between annual volume and colonoscopy outcomes. Funding Agencies Alberta Health Services Digestive Health Strategic Care Network

scholarly journals Adenomas per colonoscopy and adenoma per positive participant as quality indicators for screening colonoscopy

2020 ◽  
Vol 08 (11) ◽  
pp. E1560-E1565
Author(s):  
Shuo Wang ◽  
Adam S. Kim ◽  
Timothy R. Church ◽  
David G. Perdue ◽  
Aasma Shaukat
Keyword(s):  
Quality Indicators ◽  
Screening Colonoscopy ◽  
Community Practice ◽  
Withdrawal Time ◽  
Factors Associated ◽  
Additional Information ◽  
Adenoma Detection ◽  
Male Patients ◽  
Associated Risk Factors ◽  
Colonoscopy Quality

Abstract Background and study aims Adenomas per colonoscopy (APC) and adenomas per positive patient (APP) have been proposed as additional quality indicators but their association with adenoma detection rate (ADR) is not well studied. The aim of our study was to evaluate the variability in APC and APP, their association with ADR, and associated risk factors in screening colonoscopies from a community practice. Patients and methods We calculated the APC, APP, and ADR from all screening colonoscopies performed over 5 years. We used adjusted hierarchical logistic regression to assess the association of factors with APC, APP, and ADR. Results There were 80,915 screening colonoscopies by 60 gastroenterologists. The median (Q1-Q3) APC, APP, and ADR were 0.41 (0.36 – 0.53), 1.33 (1.23 – 1.40), and 0.32 (0.28 – 0.38), respectively. Despite the high correlation between APC and ADR, 47.6 % of endoscopists with the lowest APC had a higher ADR, and no endoscopists with the highest APC had a lower ADR. Of endoscopists with the lowest APP, 74.3 % had a higher ADR and 5.6 % of endoscopists with the highest APP had a lower ADR. Factors associated with higher APC after multivariable adjustment included: older patients age (OR 1.003; 95 % CI 1.002 – 1.005), male patients (OR 1.123; 95 % CI 1.090 – 1.156), younger endoscopist age (OR 0.943; 95 % CI 0.941 – 0.945), and longer withdrawal time (OR 3.434; 95 % CI 2.941 – 4.010). Factors associated with higher APP were male sex, younger endoscopist age, and longer withdrawal time. Conclusion APC and APP provides additional information about endoscopist performance. Younger endoscopist age and longer withdrawal time are associated with colonoscopy quality.

scholarly journals Effect of dynamic position changes on adenoma detection rate during colonoscope withdrawal: systematic review and meta-analysis

2020 ◽  
Vol 08 (12) ◽  
pp. E1842-E1849
Author(s):  
Venkat Nutalapati ◽  
Madhav Desai ◽  
Vivek Sandeep Thoguluva-Chandrasekar ◽  
Mojtaba Olyaee ◽  
Amit Rastogi
Keyword(s):  
Systematic Review ◽  
Detection Rate ◽  
Meta Analysis ◽  
Lateral Position ◽  
Adenoma Detection Rate ◽  
Position Change ◽  
Withdrawal Time ◽  
Left Lateral Position ◽  
Adenoma Detection ◽  
Withdrawal Phase

Abstract Background and study aims The adenoma detection rate (ADR) is an important quality metric of colonoscopy. Higher ADR correlates with lower incidence of interval colorectal cancer. ADR is variable between endoscopists and depends upon the withdrawal technique amongst other factors. Dynamic position change (lateral rotation of patients with a view to keep the portion of the colon being inspected at a higher level) helps with luminal distension during the withdrawal phase. However, impact of this on ADR is not known in a pooled sample. We performed a systematic review and meta-analysis to study the impact of dynamic position changes during withdrawal phase of colonoscopy on ADR Methods A comprehensive search of MEDLINE, EMBASE, Google Scholar, and the Cochrane Database was conducted from each database’s inception to search for studies comparing dynamic position changes during colonoscope withdrawal with static left lateral position (control). The primary outcome of interest was ADR. Other studied outcomes were polyp detection rate (PDR) and withdrawal time. Outcomes were reported as pooled odds ratio (OR) with 95 % confidence intervals (CI) with statistical significance (P < 0.05). RevMan 5.3 software was used for statistical analysis. Results Six studies were included in our analysis with 2860 patients. Of these, dynamic position change was implemented in 1177 patients while 1183 patients served as the controls. ADR was significantly higher in the dynamic position change group with pooled OR 1.36 (95 % CI, 1.15–1.61; P < 0.01). There was low heterogeneity in inclusion studies (I2 = 0 %). PDR was numerically higher in position change group (53.4 % vs 49.6 %) but not statistically significant (P = 0.16). Mean withdrawal time did not significantly change with dynamic position change (12.43 min vs 11.46 min, P = 0.27). Conclusion Position change during the withdrawal phase of colonoscopy can increase the ADR compared to static left lateral position. This is an easy and practical technique that can be implemented to improve ADR.

scholarly journals Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e026876 ◽  
Author(s):  
A L Barker ◽  
Sze-Ee Soh ◽  
Kerrie M Sanders ◽  
Julie Pasco ◽  
Sundeep Khosla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fracture Risk ◽  
Observational Studies ◽  
Meta Analysis ◽  
Large Population ◽  
Mineral Density ◽  
Random Effects Models ◽  
Manual Search ◽  
Relative Risks ◽  
Hip Bmd

ObjectivesThis review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin.MethodsWe conducted a systematic review and exploratory meta-analysis of observational studies. Electronic searches of MEDLINE and Embase, and a manual search of bibliographies was undertaken for studies published to 28 March 2018. Studies were included if: participants were men or women aged ≥18 years; the exposure of interest was aspirin; and relative risks, ORs and 95% CIs for the risk of fracture or difference (percentage or absolute) in BMD (measured by dual energy X-ray absorptiometry) between aspirin users and non-users were presented. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for observational studies. Pooled ORs for any fracture and standardised mean differences (SMDs) for BMD outcomes were calculated using random-effects models.ResultsTwelve studies met the inclusion criteria and were included in the meta-analysis. Aspirin use was associated with a 17% lower odds for any fracture (OR 0.83, 95% CI 0.70 to 0.99; I2=71%; six studies; n=511 390). Aspirin was associated with a higher total hip BMD for women (SMD 0.03, 95% CI −0.02 to 0.07; I2=0%; three studies; n=9686) and men (SMD 0.06, 95% CI −0.02 to 0.13, I2=0%; two studies; n=4137) although these associations were not significant. Similar results were observed for lumbar spine BMD in women (SMD 0.03, 95% CI −0.03 to 0.09; I2=34%; four studies; n=11 330) and men (SMD 0.08; 95% CI −0.01 to 0.18; one study; n=432).ConclusionsWhile the benefits of reduced fracture risk and higher BMD from aspirin use may be modest for individuals, if confirmed in prospective controlled trials, they may confer a large population benefit given the common use of aspirin in older people.

scholarly journals A65 ENDOSCOPIST-TARGETED INTERVENTIONS TO OPTIMIZE ADENOMA DETECTION RATE - A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 25-26
Author(s):  
A Arora ◽  
C McDonald ◽  
A Iansavitchene ◽  
M Brahmania ◽  
M Sey
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Detection Rate ◽  
Meta Analysis ◽  
Report Card ◽  
Adenoma Detection Rate ◽  
Report Cards ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Statistical Heterogeneity

Abstract Background Adenoma detection rate (ADR) has emerged as the strongest quality assurance metric that has consistently been shown to be inversely associated with the development of colorectal cancer after colonoscopy. Unfortunately, marked variability in ADR exists among endoscopists. A multitude of interventions targeted at endoscopists to optimize their ADR have been reported, including but not limited to withdrawal time, in room observers, physician report cards, and quality improvement and training programs. However, it is unclear which of them are truly effective. Aims We performed a systematic review and meta-analysis of the literature to evaluate the effectiveness of endoscopist-targeted interventions to improve adenoma detection rate (ADR) or polyp detection rate (PDR). Methods Systematic searches of major databases were conducted through to March 2018 to identify potentially relevant studies. Both randomized controlled trials and observational studies were included. Data for ADR and PDR were analyzed on the log-odds scale using a random-effects meta-analysis model using restricted maximum likelihood (with Mantel-Haenszel fixed-effect meta-analysis used for fewer than 4 studies). Statistical effect-size heterogeneity was assessed using a Chi2 test and quantifying the relative proportion of variation using the I2 statistic. Publication bias was assessed by the Harbord regression test. Results From 4299 initial studies, 24 were included in the systematic review and 13 were included in the meta-analysis representing a total of 55,090 colonoscopies. Physician report card interventions (7 studies) and withdrawal time focused interventions (6 studies) were meta-analyzed. The pooled odds ratio for ADR for report card interventions was 1.31 (95% CI: 1.15, 1.50; p&lt;0.0001), favoring report cards to detect more adenomas. Statistical heterogeneity was detected with substantial relative effect-size variability (Chi2, p&lt;0.0001; I2=80.1%). No statistical evidence of publication bias was found. 6 studies reported data for PDR using withdrawal time focused interventions, with 3 of these reporting data on ADR. The pooled odds ratio for ADR was 1.02 (95% CI: 0.86, 1.22; p=0.81) and for PDR was 1.07 (95% CI: 0.88, 1.31; p=0.51) which were not statistically significant. Statistical heterogeneity was detected in both groups (Chi2, p&lt;0.001; I2=82.2% for ADR and I2=89.4% for PDR) and there was statistical evidence of publication bias. Figures 1 and 2 represent Forest plots for the effect of pre-and post-report card and withdrawal time focused interventions on ADR. Conclusions Our study provides evidence that the distribution of colonoscopy quality report cards to physicians significantly improves overall ADR and should strongly be considered as part of quality improvement programs aimed at optimizing colonoscopy performance. Funding Agencies None

scholarly journals Physician Perceptions on Colonoscopy Quality: Results of a National Survey of Gastroenterologists

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Ziad F. Gellad ◽  
Corrine I. Voils ◽  
Li Lin ◽  
Dawn Provenzale
Keyword(s):  
Quality Indicators ◽  
Detection Rate ◽  
Quality Measurement ◽  
Adenoma Detection Rate ◽  
Withdrawal Time ◽  
Physician Perceptions ◽  
Continuous Quality ◽  
Adenoma Detection ◽  
Time Standards ◽  
Colonoscopy Quality

Background. Quality indicators for colonoscopy have been developed, but the uptake of these metrics into practice is uncertain. Our aims were to assess physician perceptions regarding colonoscopy quality measurement and to quantify the perceived impact of quality measurement on clinical practice.Methods. We conducted in-person interviews with 15 gastroenterologists about their perceptions regarding colonoscopy quality. Results from these interviews informed the development of a 34-question web-based survey that was emailed to 1,500 randomlyselected members of the American College of Gastroenterology.Results. 160 invitations were undeliverable, and 167 out of 1340 invited physicians (12.5%) participated in the survey. Respondents and nonrespondents did not differ in age, sex, practice setting, or years since training. 38.8% of respondents receive feedback on their colonoscopy quality. The majority of respondents agreed with the use of completion rate (90%) and adenoma detection rate (83%) as quality indicators but there was less enthusiasm for withdrawal time (61%). 24% of respondents reported usually or always removing diminutive polyps solely to increase their adenoma detection rate, and 20% reported prolonging their procedure time to meet withdrawal time standards.Conclusions. A minority of respondents receives feedback on the quality of their colonoscopy. Interventions to increase continuous quality improvement in colonoscopy screening are needed.

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