Abstract
Background
We aimed to assess the effect of a colonoscopy skills improvement (CSI) course on quality indicators at our institution.
Methods
This retrospective cohort study included ten surgeons and nine gastroenterologists practicing in a tertiary referral center who had undergone CSI training between 2014 and 2015. Procedural data for 50 colonoscopies by each physician was collected immediately before and after CSI training, and again 8 months after training. The primary outcome was adenoma detection rate (ADR) and secondary outcomes included colonoscopy completion rate (CCR), and withdrawal time (WT). Univariate analysis followed by stepwise multivariable logistic regression was performed to assess for predictors of these outcomes. These variables included patient age, gender, indication for colonoscopy, quality of bowel preparation, and CSI training.
Results
2533 colonoscopies were included. There was no improvement in ADR for the entire group immediately after training and at 8 months (31.8% vs. 33.6% vs. 35.3%, p = 0.319). In subgroup analysis, the ADR of surgeons improved non-significantly immediately after completing the course and increased further at 8 months (30.9% vs. 31.6% vs. 37.6%, p = 0.065). The same changes were not observed for the gastroenterology subgroup (32.9% vs. 36.0% vs. 32.8%, p = 0.550). No change was noted in CCR or WT. In multivariate analysis of the surgical subgroup, increased patient age, male gender, and the 8-month time point following CSI training were associated with higher ADR.
Conclusion
CSI training is associated with an improvement in ADR for surgeons at our institution.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Corley DA, Jensen CD, Marks AR et al (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370(14):1298–1306. https://doi.org/10.1056/NEJMoa1309086
Kaminski MF, Wieszczy P, Rupinski M et al (2017) Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology 153(1):98–105
Rex DK, Schoenfeld PS, Cohen J et al (2015) Quality indicators for colonoscopy. Am J Gastroenterol 110(1):72–90. https://doi.org/10.1038/ajg.2014.385
Canadian Association of Gastroenterology. Skills enhancement for endoscopy (SEE) program. https://www.cag-acg.org/quality/see-program. Accessed May 2017
Kaminski MF, Kraszewska E, Rupinski M, Laskowska M, Wieszczy P, Regula J (2015) Design of the polish colonoscopy screening program: a randomized health services study. Endoscopy 47(12):1144–1150. https://doi.org/10.1055/s-0034-1392769
Kaminski MF, Anderson J, Valori R et al (2016) Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial. Gut 65(4):616–624. https://doi.org/10.1136/gutjnl-2014-307503
Coe SG, Crook JE, Diehl NN, Wallace MB (2013) An endoscopic quality improvement program improves detection of colorectal adenomas. Am J Gastroenterol 108(2):219–226. https://doi.org/10.1038/ajg.2012.417(quiz 227)
Ussui V, Coe S, Rizk C, Crook JE, Diehl NN, Wallace MB (2015) Stability of increased adenoma detection at colonoscopy. Follow-up of an endoscopic quality improvement program-EQUIP-II. Am J Gastroenterol 110(4):489–496. https://doi.org/10.1038/ajg.2014.314
Borgaonkar MR, Pace D, Lougheed M et al (2016) Canadian association of gastroenterology indicators of safety compromise following colonoscopy in clinical practice. Can J Gastroenterol Hepatol 2016:2729871. https://doi.org/10.1155/2016/2729871
Francis N, Fingerhut A, Bergamaschi R, Motson R (2015) Training in minimal access surgery, 1st edn. Springer, London
IBM Corp. (2010) IBM corp. released 2010. IBM SPSS statistics for windows, version 19.0. IBM corp, Armonk
Ko CW, Dominitz JA, Green P, Kreuter W, Baldwin LM (2010) Specialty differences in polyp detection, removal, and biopsy during colonoscopy. Am J Med 123(6):528–535. https://doi.org/10.1016/j.amjmed.2010.01.016
Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L (2011) Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 140(1):65–72. https://doi.org/10.1053/j.gastro.2010.09.006
Pace D, Borgaonkar M, Lougheed M et al (2016) Effect of colonoscopy volume on quality indicators. Can J Gastroenterol Hepatol 2016:2580894. https://doi.org/10.1155/2016/2580894
Kim YD, Bae WK, Choi YH et al (2014) Difference in adenoma detection rates according to colonoscopic withdrawal times and the level of expertise. Korean J Gastroenterol. 64(5):278–283
Pace D, Borgaonkar M, Evans B et al (2017) Annual colonoscopy volume and maintenance of competency for surgeons. Surg Endosc 31(6):2630–2635. https://doi.org/10.1007/s00464-016-5275-1
Acknowledgements
We would like to acknowledge Eastern Health for their support of this project through a Quality Healthcare Scholarship.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Evans, Pace, Borgaonkar, Harnett, Miné-Goldring, Boone and McGrath and medical students Ge and Brodie have no conflict of interests or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Evans, B., Pace, D., Borgaonkar, M. et al. Effect of an educational intervention on colonoscopy quality outcomes. Surg Endosc 34, 5142–5147 (2020). https://doi.org/10.1007/s00464-019-07304-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-019-07304-w