Abstract
Background Serrated polyps are important colorectal cancer precursors that are variably detected
during colonoscopy. We measured serrated polyp detection rate (SPDR) in a large, multicenter,
cross-sectional study of colonoscopy quality to identify drivers of SPDR variation.
Methods Colonoscopy and pathology reports were collected for a 2-year period (10/2013-9/2015)
from four sites across the United States. Data from reports, including size, location,
and histology of polyps, were abstracted using a validated natural language processing
algorithm. SPDR was defined as the proportion of colonoscopies with ≥ 1 serrated polyp
(not including hyperplastic polyps). Multivariable logistic regression was performed
to determine endoscopist characteristics associated with serrated polyp detection.
Results A total of 104 618 colonoscopies were performed by 201 endoscopists who varied with
respect to specialty (86 % were gastroenterologists), sex (18 % female), years in
practice (range 1 – 51), and number of colonoscopies performed during the study period
(range 30 – 2654). The overall mean SPDR was 5.1 % (SD 3.8 %, range 0 – 18.8 %). In
multivariable analysis, gastroenterology specialty training (odds ratio [OR] 1.89,
95 % confidence interval [CI] 1.33 – 2.70), fewer years in practice (≤ 9 years vs.
≥ 27 years: OR 1.52, 95 %CI 1.14 – 2.04)], and higher procedure volumes (highest vs.
lowest quartile: OR 1.77, 95 %CI 1.27 – 2.46)] were independently associated with
serrated polyp detection.
Conclusions Gastroenterology specialization, more recent completion of training, and greater
procedure volume are associated with serrated polyp detection. These findings imply
that both repetition and training are likely to be important contributors to adequate
detection of these important cancer precursors. Additional efforts to improve SPDR
are needed.
