CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1560-E1565
DOI: 10.1055/a-1261-9074
Original article

Adenomas per colonoscopy and adenoma per positive participant as quality indicators for screening colonoscopy

Shuo Wang
1  Division of Epidemiology & Community Health, School of Public health, University of Minnesota, Minneapolis, Minnesota, United States
,
Adam S. Kim
2  Minnesota Gastroenterology PA – GI, Minneapolis, Minnesota, United States
,
Timothy R. Church
3  Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
,
David G. Perdue
2  Minnesota Gastroenterology PA – GI, Minneapolis, Minnesota, United States
,
Aasma Shaukat
3  Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
4  Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, United States
5  Division of Gastroenterology, Minneapolis VA Medical Center, Minneapolis, Minnesota, United States
› Author Affiliations
  

Abstract

Background and study aims Adenomas per colonoscopy (APC) and adenomas per positive patient (APP) have been proposed as additional quality indicators but their association with adenoma detection rate (ADR) is not well studied. The aim of our study was to evaluate the variability in APC and APP, their association with ADR, and associated risk factors in screening colonoscopies from a community practice.

Patients and methods We calculated the APC, APP, and ADR from all screening colonoscopies performed over 5 years. We used adjusted hierarchical logistic regression to assess the association of factors with APC, APP, and ADR.

Results There were 80,915 screening colonoscopies by 60 gastroenterologists. The median (Q1-Q3) APC, APP, and ADR were 0.41 (0.36 – 0.53), 1.33 (1.23 – 1.40), and 0.32 (0.28 – 0.38), respectively. Despite the high correlation between APC and ADR, 47.6 % of endoscopists with the lowest APC had a higher ADR, and no endoscopists with the highest APC had a lower ADR. Of endoscopists with the lowest APP, 74.3 % had a higher ADR and 5.6 % of endoscopists with the highest APP had a lower ADR. Factors associated with higher APC after multivariable adjustment included: older patients age (OR 1.003; 95 % CI 1.002 – 1.005), male patients (OR 1.123; 95 % CI 1.090 – 1.156), younger endoscopist age (OR 0.943; 95 % CI 0.941 – 0.945), and longer withdrawal time (OR 3.434; 95 % CI 2.941 – 4.010). Factors associated with higher APP were male sex, younger endoscopist age, and longer withdrawal time.

Conclusion APC and APP provides additional information about endoscopist performance. Younger endoscopist age and longer withdrawal time are associated with colonoscopy quality.



Publication History

Received: 19 March 2020

Accepted: 30 July 2020

Publication Date:
22 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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