Surgical Endoscopy

, Volume 29, Issue 2, pp 466–473 | Cite as

Endoscopists with low adenoma detection rates benefit from high-definition endoscopy

  • Elisabeth Waldmann
  • Martha Britto-Arias
  • Irina Gessl
  • Georg Heinze
  • Petra Salzl
  • Daniela Sallinger
  • Michael Trauner
  • Werner Weiss
  • Arnulf Ferlitsch
  • Monika Ferlitsch
Article
First Online:
Received:
Accepted:

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Colorectal cancer Endoscopy Technical Quality control 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

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).

Disclosures

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.

References

  1. 1.
    Vemulapalli KC, Rex DK (2011) Evolving techniques in colonoscopy. Curr Opin Gastroenterol 27:430–438CrossRefPubMedGoogle Scholar
  2. 2.
    Kondo S, Yamaji Y, Watabe H, Yamada A, Sugimoto T, Ohta M, Ogura K, Okamoto M, Yoshida H, Kawabe T, Omata M (2007) A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol 102:75–81CrossRefPubMedGoogle Scholar
  3. 3.
    Deenadayalu VP, Chadalawada V, Rex DK (2004) 170 degrees wide-angle colonoscope: effect on efficiency and miss rates. Am J Gastroenterol 99:2138–2142CrossRefPubMedGoogle Scholar
  4. 4.
    Togashi K, Hewett DG, Radford-Smith GL, Francis L, Leggett BA, Appleyard MN (2009) The use of indigocarmine spray increases the colonoscopic detection rate of adenomas. J Gastroenterol 44:826–833CrossRefPubMedGoogle Scholar
  5. 5.
    Adler A, Pohl H, Papanikolaou IS, Abou-Rebyeh H, Schachschal G, Veltzke-Schlieker W, Khalifa AC, Setka E, Koch M, Wiedenmann B, Rösch T (2008) A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect? Gut 57:59–64CrossRefPubMedGoogle Scholar
  6. 6.
    Pohl J, Schneider A, Vogell H, Mayer G, Kaiser G, Ell C (2011) Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial. Gut 60:485–490CrossRefPubMedGoogle Scholar
  7. 7.
    Rex DK (2010) Update on colonoscopic imaging and projections for the future. Clin Gastroenterol Hepatol 8:318–321CrossRefPubMedGoogle Scholar
  8. 8.
    Obstein KL, Valdastri P (2013) Advanced endoscopic technologies for colorectal cancer screening. World J Gastroenterol 19:431–439PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    East JE, Stavrindis M, Thomas-Gibson S, Guenther T, Tekkis PP, Saunders BP (2008) A comparative study of standard vs. high definition colonoscopy for adenoma and hyperplastic polyp detection with optimized withdrawal technique. Aliment Pharmacol Ther 28:768–776CrossRefPubMedGoogle Scholar
  10. 10.
    Rastogi A, Early DS, Gupta N, Bansal A, Singh V, Ansstas M, Jonnalagadda SS, Hovis CE, Gaddam S, Wani SB, Edmundowicz SA, Sharma P (2011) Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology. Gastrointest Endosc 74:593–602CrossRefPubMedGoogle Scholar
  11. 11.
    Buchner AM, Shahid MW, Heckman MG, McNeil RB, Cleveland P, Gill KR, Schore A, Ghabril M, Raimondo M, Gross SA, Wallace MB (2010) High-definition colonoscopy detects colorectal polyps at a higher rate than standard white-light colonoscopy. Clin Gastroenterol Hepatol 8:364–370CrossRefPubMedGoogle Scholar
  12. 12.
    Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, the National Polyp Study Workgroup (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981CrossRefPubMedGoogle Scholar
  13. 13.
    Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF, Stewart ET, Waye JD (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366:687–696PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Snover DC (2011) Update on the serrated pathway to colorectal carcinoma. Hum Pathol 42:1–10CrossRefPubMedGoogle Scholar
  15. 15.
    Fearon ER, Vogelstein B (1990) A genetic model for colorectal tumorigenesis. Cell 61:759–767CrossRefPubMedGoogle Scholar
  16. 16.
    Jass JR (2007) Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 50:113–130CrossRefPubMedGoogle Scholar
  17. 17.
    Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AM, Bos JL (1988) Genetic alterations during colorectal tumor development. N Engl J Med 319:525–532CrossRefPubMedGoogle Scholar
  18. 18.
    Kinzler KW, Vogelstein B (1996) Lessons from hereditary colorectal cancer. Cell 87:159–170CrossRefPubMedGoogle Scholar
  19. 19.
    Reinhart K, Bannert C, Dunkler D, Salzl P, Trauner M, Renner F, Knoflach P, Ferlitsch A, Weiss W, Ferlitsch M (2013) Prevalence of flat lesions in a large screening population and their role in colonoscopy quality improvement. Endoscopy 45:350–356CrossRefPubMedGoogle Scholar
  20. 20.
    Wolber RA, Owen DA (1991) Flat adenomas of the colon. Hum Pathol 22(1):70–74CrossRefPubMedGoogle Scholar
  21. 21.
    Muto T, Kamiya J, Sawada T, Konishi F, Sugihara K, Kubota Y, Adachi M, Agawa S, Saito Y, Morioka Y et al (1985) Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum 28:847–851CrossRefPubMedGoogle Scholar
  22. 22.
    Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E (2010) Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 362:1795–1803CrossRefPubMedGoogle Scholar
  23. 23.
    Jover R, Herraiz M, Alarcon O, Brullet E, Bujanda L, Bustamante M, Campo R, Carreño R, Castells A, Cubiella J, García-Iglesias P, Hervás AJ, Menchén P, Ono A, Panadés A, Parra-Blanco A, Pellisé M, Ponce M, Quintero E, Reñé JM, Sánchez del Río A, Seoane A, Serradesanferm A, Soriano Izquierdo A, Vázquez Sequeiros E, Society Spanish, Spanish Society of Gastroenterology; Spanish Society of Gastrointestinal Endoscopy Working Group (2012) Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy 44:444–451CrossRefPubMedGoogle Scholar
  24. 24.
    Bannert C, Reinhart K, Dunkler D, Trauner M, Renner F, Knoflach P, Ferlitsch A, Weiss W, Ferlitsch M (2012) Sedation in screening colonoscopy: impact on quality indicators and complications. Am J Gastroenterol 107:1837–1848CrossRefPubMedGoogle Scholar
  25. 25.
    Ferlitsch M, Reinhart K, Pramhas S, Wiener C, Gal O, Bannert C, Hassler M, Kozbial K, Dunkler D, Trauner M, Weiss W (2011) Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA 306:1352–1358CrossRefPubMedGoogle Scholar
  26. 26.
    Jass SL (1989) World Health Organization. Histological typing of intestinal tumours, 2nd edn. Springer, BerlinCrossRefGoogle Scholar
  27. 27.
    Cass OW (1999) Training to competence in gastrointestinal endoscopy: a plea for continuous measuring of objective end points. Endoscopy 31:751–754CrossRefPubMedGoogle Scholar
  28. 28.
    Atkin W, Rogers P, Cardwell C, Cook C, Cuzick J, Wardle J, Edwards R (2004) Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology 126:1247–1256CrossRefPubMedGoogle Scholar
  29. 29.
    Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE, Hoffman B, Jacobson BC, Mergener K, Petersen BT, Safdi MA, Faigel DO, Pike IM, ASGE/ACG Taskforce on Quality in Endoscopy (2006) Quality indicators for colonoscopy. Am J Gastroenterol 101:873–885PubMedGoogle Scholar
  30. 30.
    Kaminski M (2009) Continuous quality improvement of screening colonoscopy: data from a large colorectal cancer screening program. Gastrointest Endosc 69:AB215CrossRefGoogle Scholar
  31. 31.
    Pox CP, Altenhofen L, Brenner H, Theilmeier A, Von Stillfried D, Schmiegel W (2012) Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 142(1460–7):e2PubMedGoogle Scholar
  32. 32.
    Hong SN, Sung IK, Kim JH, Choe WH, Kim BK, Ko SY, Lee JH, Seol DC, Ahn SY, Lee SY, Park HS, Shim CS (2012) The effect of the bowel preparation status on the risk of missing polyp and adenoma during screening colonoscopy: a Tandem Colonoscopic Study. Clin Endosc 45:404–411PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355:2533–2541CrossRefPubMedGoogle Scholar
  34. 34.
    Le Rhun M, Coron E, Parlier D, Nguyen JM, Canard JM, Alamdari A, Sautereau D, Chaussade S, Galmiche JP (2006) High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. Clin Gastroenterol Hepatol 4:349–354CrossRefPubMedGoogle Scholar
  35. 35.
    Tribonias G, Theodoropoulou A, Konstantinidis K, Vardas E, Karmiris K, Chroniaris N, Chlouverakis G, Paspatis GA (2010) Comparison of standard vs high-definition, wide angle colonoscopy for polyp detection: a randomized controlled trial. Colorectal Dis 12(10 Online):e260–e266CrossRefPubMedGoogle Scholar
  36. 36.
    Pellise M, Fernandez-Esparrach G, Cardenas A, Sendino O, Ricart E, Vaquero E, Gimeno-García AZ, de Miguel CR, Zabalza M, Ginès A, Piqué JM, Llach J, Castells A (2008) Impact of wide-angle, high-definition endoscopy in the diagnosis of colorectal neoplasia: a randomized controlled trial. Gastroenterology 135:1062–1068CrossRefPubMedGoogle Scholar
  37. 37.
    Longcroft-Wheaton G, Brown J, Cowlishaw D, Higgins B, Bhandari P (2012) High definition vs. standard-definition colonoscopy in the characterization of small colonic polyps: results from a randomized trial. Endoscopy 44:905–910CrossRefPubMedGoogle Scholar
  38. 38.
    Kahi CJ, Ballard D, Shah AS, Mears R, Johnson CS (2013) Impact of a quarterly report card on colonoscopy quality measures. Gastrointest Endosc 77:925–931CrossRefPubMedGoogle Scholar
  39. 39.
    van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E (2006) Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 101:343–350CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Elisabeth Waldmann
    • 1
    • 2
  • Martha Britto-Arias
    • 1
    • 2
  • Irina Gessl
    • 1
    • 2
  • Georg Heinze
    • 3
  • Petra Salzl
    • 1
    • 2
  • Daniela Sallinger
    • 1
    • 2
  • Michael Trauner
    • 1
    • 2
  • Werner Weiss
    • 2
  • Arnulf Ferlitsch
    • 1
    • 2
  • Monika Ferlitsch
    • 1
    • 2
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
  2. 2.Quality Assurance Working GroupAustrian Society of Gastroenterology and Hepatology (OEGGH)ViennaAustria
  3. 3.Division of Clinical Biometrics, Department for Medical StatisticsMedical University of ViennaViennaAustria

Personalised recommendations