Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox

Background: Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. Objecti...

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Detalles Bibliográficos
Autores: Mangas-Sanjuan, C., Herreros De Tejada López, Albe, Fernández Díez, Servando, Marín Gabriel, José Carlos
Tipo de recurso: artículo
Fecha de publicación:2018
País:España
Institución:Universidad Complutense de Madrid (UCM)
Repositorio:Docta Complutense
Idioma:inglés
OAI Identifier:oai:docta.ucm.es:20.500.14352/130728
Acceso en línea:https://hdl.handle.net/20.500.14352/130728
Access Level:acceso abierto
Palabra clave:Colon cancer
Colonoscopy quality metrics
Adenoma detection rate
Colonoscopy
Surveillance
Gastroenterología y hepatología
3205.03 Gastroenterología
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spelling Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradoxMangas-Sanjuan, C.Herreros De Tejada López, AlbeFernández Díez, ServandoMarín Gabriel, José CarlosColon cancerColonoscopy quality metricsAdenoma detection rateColonoscopySurveillanceGastroenterología y hepatología3205.03 GastroenterologíaBackground: Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. Objective: The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. Methods: This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. Results: A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p = 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19-0.97) and ADR (HR 0.94; 95% CI 0.89-0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89-0.99). Conclusions: Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.WileyUniversidad Complutense de Madrid20182018-01-0120182018-01-01journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.14352/130728reponame:Docta Complutenseinstname:Universidad Complutense de Madrid (UCM)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:docta.ucm.es:20.500.14352/1307282026-06-02T12:44:21Z
dc.title.none.fl_str_mv Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
title Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
spellingShingle Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
Mangas-Sanjuan, C.
Colon cancer
Colonoscopy quality metrics
Adenoma detection rate
Colonoscopy
Surveillance
Gastroenterología y hepatología
3205.03 Gastroenterología
title_short Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
title_full Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
title_fullStr Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
title_full_unstemmed Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
title_sort Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection-surveillance paradox
dc.creator.none.fl_str_mv Mangas-Sanjuan, C.
Herreros De Tejada López, Albe
Fernández Díez, Servando
Marín Gabriel, José Carlos
author Mangas-Sanjuan, C.
author_facet Mangas-Sanjuan, C.
Herreros De Tejada López, Albe
Fernández Díez, Servando
Marín Gabriel, José Carlos
author_role author
author2 Herreros De Tejada López, Albe
Fernández Díez, Servando
Marín Gabriel, José Carlos
author2_role author
author
author
dc.contributor.none.fl_str_mv Universidad Complutense de Madrid
dc.subject.none.fl_str_mv Colon cancer
Colonoscopy quality metrics
Adenoma detection rate
Colonoscopy
Surveillance
Gastroenterología y hepatología
3205.03 Gastroenterología
topic Colon cancer
Colonoscopy quality metrics
Adenoma detection rate
Colonoscopy
Surveillance
Gastroenterología y hepatología
3205.03 Gastroenterología
description Background: Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. Objective: The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. Methods: This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. Results: A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p = 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19-0.97) and ADR (HR 0.94; 95% CI 0.89-0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89-0.99). Conclusions: Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.
publishDate 2018
dc.date.none.fl_str_mv 2018
2018-01-01
2018
2018-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.14352/130728
url https://hdl.handle.net/20.500.14352/130728
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:Docta Complutense
instname:Universidad Complutense de Madrid (UCM)
instname_str Universidad Complutense de Madrid (UCM)
reponame_str Docta Complutense
collection Docta Complutense
repository.name.fl_str_mv
repository.mail.fl_str_mv
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