Clin Endosc.  2016 Jan;49(1):61-68. 10.5946/ce.2016.49.1.61.

The Colonoscopist's Expertise Affects the Characteristics of Detected Polyps

Affiliations
  • 1Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. qufehdrhdwn@hanmail.net

Abstract

BACKGROUND/AIMS
The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist.
METHODS
We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist.
RESULTS
No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies.
CONCLUSIONS
Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.

Keyword

Colonic polyps; Colonoscopy; Experience

MeSH Terms

Colon
Colonic Polyps
Colonoscopy
Humans
Mass Screening
Polyps*

Figure

  • Fig. 1. The overall polyp detection rate (PDR) and adenoma detection rate (ADR) by summing all of the patients who had polyps in three fellows’ groups.

  • Fig. 2. The detection rate of polyps of methods (A) A and (B) B. The significant increase of polyp detection rate was observed with experience of >400 colonoscopies by method B (arrow).

  • Fig. 3. The detection rate of polyps less than 5 mm using methods (A) A and (B) B. The detection rate of polyps <5 mm increased in method B, significantly, with an accumulation of experience of >300 colonoscopies (arrow).

  • Fig. 4. The detection rate of flat polyps by methods (A) A and (B) B.

  • Fig. 5. The detection rate of polyps at proximal position by methods (A) A and (B) B. (A) The polyp detection rate (PDR) determined with method A began to increase steadily after 200 procedures, although it declined slightly after 700 procedures (arrows). (B) On the other hand, with method B, the PDR for proximal sites was increased steadily after 300 colonoscopies (arrow).


Cited by  1 articles

Can We Measure the Learning Curve of Colonoscopy Using Polyp Detection Rate?
Jin Young Yoon, Jae Myung Cha
Clin Endosc. 2016;49(1):6-7.    doi: 10.5946/ce.2016.49.1.6.


Reference

1. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993; 329:1977–1981.
2. Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M; Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001; 48:812–815.
Article
3. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000; 343:162–168.
4. Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997; 112:24–28.
Article
5. Winawer SJ, Stewart ET, Zauber AG, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med. 2000; 342:1766–1772.
6. Winawer SJ, Zauber AG. Colonoscopic polypectomy and the incidence of colorectal cancer. Gut. 2001; 48:753–754.
Article
7. Pohl H, Robertson DJ. Colorectal cancers detected after colonoscopy frequently result from missed lesions. Clin Gastroenterol Hepatol. 2010; 8:858–864.
Article
8. Hixson LJ, Fennerty MB, Sampliner RE, Garewal HS. Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps. Gastrointest Endosc. 1991; 37:125–127.
Article
9. Heresbach D, Barrioz T, Lapalus MG, et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy. 2008; 40:284–290.
Article
10. Lieberman D. A call to action: measuring the quality of colonoscopy. N Engl J Med. 2006; 355:2588–2589.
11. Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007; 102:856–861.
Article
12. Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc. 2000; 51:33–36.
Article
13. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006; 355:2533–2541.
Article
14. Peters SL, Hasan AG, Jacobson NB, Austin GL. Level of fellowship training increases adenoma detection rates. Clin Gastroenterol Hepatol. 2010; 8:439–442.
Article
15. Lee SH, Chung IK, Kim SJ, et al. An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve. Gastrointest Endosc. 2008; 67:683–689.
Article
16. Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol. 2006; 101:2866–2877.
Article
17. Rogart JN, Siddiqui UD, Jamidar PA, Aslanian HR. Fellow involvement may increase adenoma detection rates during colonoscopy. Am J Gastroenterol. 2008; 103:2841–2846.
Article
18. Eckardt AJ, Swales C, Bhattacharya K, Wassef WY, Leung K, Levey JM. Does trainee participation during colonoscopy affect adenoma detection rates? Dis Colon Rectum. 2009; 52:1337–1344.
Article
19. Kudo S, Kashida H, Tamura T. Early colorectal cancer: flat or depressed type. J Gastroenterol Hepatol. 2000; 15 Suppl:D66–D70.
Article
20. Kudo S, Lambert R, Allen JI, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008; 68(4 Suppl):S3–S47.
Article
21. Kudo S, Tamura S, Hirota S, et al. The problem of de novo colorectal carcinoma. Eur J Cancer. 1995; 31A:1118–1120.
Article
22. American Society for Gastrointestinal Endoscopy. Guidelines for credentialing and granting privileges for gastrointestinal endoscopy. Gastrointest Endosc. 1998; 48:679–682.
23. Cass OW, Freeman ML, Peine CJ, Zera RT, Onstad GR. Objective evaluation of endoscopy skills during training. Ann Intern Med. 1993; 118:40–44.
Article
24. Cass OW, Freeman ML, Cohen J, et al. Acquisition of competency in endoscopic skills (ACES) during training: a multicenter study. Gastrointest Endosc. 1996; 43:308.
Article
25. Spier BJ, Benson M, Pfau PR, Nelligan G, Lucey MR, Gaumnitz EA. Colonoscopy training in gastroenterology fellowships: determining competence. Gastrointest Endosc. 2010; 71:319–324.
Article
26. Rex DK, Bond JH, Winawer S, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002; 97:1296–1308.
Article
27. Kiesslich R, von Bergh M, Hahn M, Hermann G, Jung M. Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy. 2001; 33:1001–1006.
Article
28. Brooker JC, Saunders BP, Shah SG, et al. Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. Gastrointest Endosc. 2002; 56:333–338.
Article
29. Rex DK, Helbig CC. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. Gastroenterology. 2007; 133:42–47.
Article
30. Rex DK, Chadalawada V, Helper DJ. Wide angle colonoscopy with a prototype instrument: impact on miss rates and efficiency as determined by back-to-back colonoscopies. Am J Gastroenterol. 2003; 98:2000–2005.
Article
31. Deenadayalu VP, Chadalawada V, Rex DK. 170 Degrees wide-angle colonoscope: effect on efficiency and miss rates. Am J Gastroenterol. 2004; 99:2138–2142.
32. Fatima H, Rex DK, Rahmani E, et al. Wide-angle (WA) (170 degrees angle of view) versus standard (ST) (140 degrees angle of view) colonoscopy. Am J Gastroenterol. 2006; 101:AB1382.
33. Shenoy K, Friedenberg FK. Performance of high-definition colonoscopy for the detection of colorectal neoplasia. Gastrointest Endosc. 2007; 65:AB93.
Article
34. Dellon ES, Lippmann QK, Sandler RS, Shaheen NJ. Gastrointestinal endoscopy nurse experience and polyp detection during screening colonoscopy. Clin Gastroenterol Hepatol. 2008; 6:1342–1347.
Article
35. Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. 1993; 88:825–831.
36. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000; 343:169–174.
Article
37. Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003; 58:76–79.
Article
38. Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005; 61:378–384.
Article
39. Chiu HM, Lin JT, Wang HP, Lee YC, Wu MS. The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms: a prospective endoscopist-blinded randomized trial. Am J Gastroenterol. 2006; 101:2719–2725.
40. Sanchez W, Harewood GC, Petersen BT. Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy. Am J Gastroenterol. 2004; 99:1941–1945.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr