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Training interventions to improve adenoma detection rates during colonoscopy: a systematic review and meta-analysis

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Abstract

Background

Colonoscopies are effective means of detecting and removing precancerous adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy quality and an independent predictor of colorectal cancer incidence. Focused training interventions may improve an endoscopist’s ADR, but the supporting research is limited. This systematic review and meta-analysis identified, critically appraised, and meta-analyzed data from randomized trials (RCTs) evaluating the effect of training interventions on ADRs.

Methods

Ovid Medline, EMBASE, CENTRAL, Eric, CINAHL, Scopus, Web of Science, and ClinicalTrials.gov were searched for RCTs investigating the effect of an educational intervention on ADRs. Two reviewers independently screened, identified, and extracted trial-level data. Internal validity was assessed in duplicate using the Risk of Bias tool. Our primary outcome was the ADR. Secondary outcomes were advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were post-polypectomy bleeding rate and colonoscopy-related perforation rate.

Results

From 2837 screened citations, we identified 3 trials (119 endoscopists) meeting our inclusion criteria. Training interventions were associated with a trend toward increased ADRs (odds ratio 1.16, 95% confidence interval (CI) 1.00–1.34; I2 83%; 3 trials; 119 endoscopists). When limited to screening colonoscopies, the odds ratio for ADRs associated with training interventions was 1.17 (95% CI 1.00–1.36; I2 80%; 3 trials; 119 endoscopists). There was a high level of heterogeneity between the trials’ training interventions. Training intervention improved the advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were not reported.

Conclusions

A focused training intervention was associated with a strong trend toward increased ADRs among certified endoscopists. While the described training interventions definitely show promise, further efforts around continuing professional developments activities are needed to more consistently improve ADRS among certified endoscopists.

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Funding

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Author information

Authors and Affiliations

  1. Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Stephanie Lim, Sydney Hammond, Jason Park & David Hochman

  2. Faculty of Graduate Studies, University of Manitoba, Winnipeg, MB, Canada

    Stephanie Lim

  3. Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada

    Mê-Linh Lê

  4. Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Rasheda Rabbani, Ahmed Abou-Setta & Ryan Zarychanski

  5. George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB, Canada

    Rasheda Rabbani, Ahmed Abou-Setta & Ryan Zarychanski

  6. Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Ryan Zarychanski

  7. St Boniface General Hospital, Winnipeg, MB, Canada

    Jason Park

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  1. Stephanie Lim
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Correspondence to Jason Park.

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Disclosures

Stephanie Lim, Sydney Hammond, Jason Park, David Hochman, Mê-Linh Lê, Rasheda Rabbani, Ahmed Abou-Setta, and Ryan Zarychanski confirm they hold no conflict of interest or financial ties to disclose.

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Appendices

Appendix 1: Inclusion and exclusion criteria

Inclusion criteria

  1. 1.

    Certified endoscopists who perform screening colonoscopies

  2. 2.

    Use of an educational training intervention that aims to improve colonoscopy quality

  3. 3.

    Comparator is no educational intervention

  4. 4.

    ADR is calculated pre-training and post-training

  5. 5.

    Parallel-design and cluster-randomized, controlled trials

Exclusion criteria

  1. 1.

    Studies where the ADR is calculated on non-humans (e.g., utilizing a colonoscopy simulator)

  2. 2.

    Observational or quasi-randomized study designs

  3. 3.

    Cross-over trials, unless outcome data are provided before the cross-over

Appendix 2: Systematic review team members

One physician (SL) with general surgery and endoscopy training coordinated all aspects of the review, including developing the literature search strategy, screening relevant material, extracting and analyzing data, analyzing risk of bias, and preparing the final manuscript. A second reviewer (SH) with general surgery and endoscopy training screened relevant material, extracted data, and analyzed risk of bias in duplicate. A general surgeon with specialty training surgical oncology (JP) and a general surgeon with specialty training in colorectal surgery (DH) provided content expertise and methodological advice. One librarian (ML) with expertise in systematic review search methodology developed the individualized search strategies and performed the literature search. One senior statistician and methodologist (RR) with extensive systematic review experience provided statistical expertise and oversight.

Appendix 3: MEDLINE (Ovid) search strategy

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Lim, S., Hammond, S., Park, J. et al. Training interventions to improve adenoma detection rates during colonoscopy: a systematic review and meta-analysis. Surg Endosc 34, 3870–3882 (2020). https://doi.org/10.1007/s00464-019-07153-7

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  • DOI: https://doi.org/10.1007/s00464-019-07153-7

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