Endoscopists with low adenoma detection rates benefit from high-definition endoscopy
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An endoscopists adenoma detection rate (ADR) of less than 20 % correlates with high risk for occurrence of interval cancer. The impact of high-definition (HD) imaging on the ADR is discussed controversially. We aimed to investigate whether detection rates of individual endoscopists increase within 1 year before and 1 year after the switch from standard to HD endoscopy.
This cohort study analyzed 6,330 screening colonoscopies (2,968 with standard and 3,362 with HD) performed by 42 endoscopists between November 2007 and March 2013 within a nationwide quality assurance program for screening colonoscopy.
The ADR of endoscopists with a low ADR (<20 %) increased significantly higher (from 11.8 to 18.1 %, p = 0.003) than of those with a high ADR (≥20 %) (from 28.6 to 30.7 %, p = 0.439) after switch from standard to HD colonoscopes (p = 0.0076). The proportion of endoscopists with an ADR < 20 % decreased from 45 to 42.9 % (p = 0.593). There was no significant increase in age- and sex-adjusted detection rates of adenomas (20.2 vs 23.7 %; p = 0.089), advanced adenomas (4.7 vs 5.5 %; p = 0.479), flat adenomas (2.7 vs 3.1 %; p = 0.515), polyps (38.8 vs 41.5 %; p = 0.305), proximal polyps (18.5 vs 20 %; p = 0.469) and hyperplastic polyps (15 vs 17.2 %; p = 0.243) of endoscopists after switch to HD colonoscopes. There was no difference in detection rates of flat polyps (5.5 vs 5.5 %; p = 0.987).
The use of HD scopes is associated with marginal improvement in adenoma detection rates limited to those endoscopists with low adenoma detection rates prior to its introduction.
KeywordsColorectal cancer Endoscopy Technical Quality control
We would like to thank all participants of the project for their support and data input. A list of contributing endoscopists is available online at www.vorsorgekoloskopie.at and www.krebshilfe.net. We would like to thank Josef Probst, Ph.D., from Austrian Federation of the Statutory Insurance Institutions, Vienna, Austria, for his support in the organization. No support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work. The project “Quality certificate for screening colonoscopy” was conducted in cooperation with the Main Association of Austrian Social Security Institutions and funded by fund § 447 h ASVG (Fund for preventive checkups and health promotion).
Elisabeth Waldmann, Martha Britto-Arias, Irina Gessl, Georg Heinze, Petra Salzl, Daniela Sallinger, Michael Trauner, Werner Weiss, Arnulf Ferlitsch and Monika Ferlitsch have no conflicts of interest or financial ties to disclose.
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