Z Gastroenterol 2015; 53 - P24
DOI: 10.1055/s-0035-1551712

Endoscopists with lowest sedation rates detect more colorectal adenomas in colonoscopy than those most frequently using sedation

P Jeschek 1, E Waldmann 1, I Gessl 1, D Sallinger 1, M Ferlitsch 1
  • 1Medical University of Vienna, Vienna, Austria

Background:

The use of sedation in colonoscopy varies strongly and has been discussed with much controversy over the past few years. Endoscopists using sedation less frequently might do so in order to derive a benefit from a cooperating patient when performing position changes during colonoscopy, consequently improving adenoma detection rate (ADR).

Methods:

This study compared screening colonoscopy outcomes, in particular ADR, among 222 endoscopists with regard to respective examiners sedation rates (SR). An overall of 156,431 colonoscopies performed between 2007 and 2014 were linked to endoscopists who were then compared according to respective sedation rates, after stratification into quintiles.

Results:

The median age of all patients was 60.0 years (IQR 53.8 – 67.6) and 51.0% were female. For all screening colonoscopies, overall sedation rate was 87.3%, with sedation rates of 53.9% for colonoscopies performed by endoscopists in the first quintile of sedation rate (Q1) and 99.8% for those in the last quintile (Q5).

In colonoscopies performed by endoscopists in Q1 adenomas were found in 22.1% (CI 21.6 – 22.6) compared to 19.2% (CI 18.8 – 19.6) in Q5 (RR 1.15; p < 0.0001).

In sex specific analyses, endoscopists in Q1 detected relatively more adenomas in men than those in Q5 [27.8% (CI 27.1 – 28.6) versus 24.1% (CI 23.5 – 24.7); RR 1.16; p < 0.0001]. Likewise, adenoma detection rate for female patients was higher among endoscopists in Q1 than in Q5 [16.1% (CI 15.5 – 16.8) versus 14.5% (CI 14.0 – 15.0); RR 1.11; p < 0.0001]. As for detection rates of advanced adenomas (AADR), there was no difference between endoscopists in Q1 and Q5 (p = 0.36).

Endoscopists in Q1 had lower cecal intubation rates than those in Q5 (94.6%, CI 94.4 – 94.9 versus 97.8%, CI 97.7 – 98.0; RR 0.97; p < 0.0001).

Conclusions:

Although less frequently reaching the cecum, which was mainly attributable to pain in unsedated colonoscopies, endoscopists with lowest sedation rates detected more adenomas than those most frequently using sedation.