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Technician assistance improves ADR in screening colonoscopy
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HONOLULU — Active technician involvement during screening colonoscopy improved physician adenoma detection rate, according to data presented in a plenary session at ACG 2015.
“We all understand adenoma detection rate is an important quality measure during screening procedure,” Rahul Sao, MD, resident physician, New York Medical College at Westchester Medical Center, Valhalla, New York, said during his presentation. “Our study was performed with the aim of how to improve adenoma detection rate.”
Sao and colleagues analyzed and evaluated colonoscopies performed by physicians with active technician involvement at two community endoscopy centers between February and April 2015. All technicians at Wake Endoscopy center and Wake Forest Endoscopy Center in North Carolina were asked to participate in polyp recognition, as well as provide input on possible missed folds and physician withdrawal time. After 3 months, all physicians' adenoma detection rates (ADRs) were calculated and compared with their baseline ADR using chi-squared analysis.
Among the two centers, 1,108 consecutive screening colonoscopies were performed by physicians with active technician involvement within 3 months, with 424 procedures with detected adenomas. Prior to the proposed intervention, the same number of physicians performed 1,351 screening colonoscopies with 465 procedures with adenomas detected. Screening colonoscopies with active technician assistance showed an overall improvement in ADR from 34.4% to 38.3% (OR = 1.18; 95% CI, 1.001-1.393).
Physicians with below average ADRs (n = 4/7) performed 573 of the total 1,108 screening colonoscopies during study period and 703 out of 1,351 screening colonoscopies during the baseline period. These physicians found adenomas in 206 cases with active technician assistance compared to 194 cases with adenomas detected solely by physicians, according to Sao’s presentation. As a result of the technician involvement among below average ADR clinicians, ADR improved to 36% from a below average ADR of 27% at baseline (OR = 1.47; 95% CI, 1.16-1.86).
Sao concluded: “Having technicians actively engaged with physicians during screening colonoscopy can improve quality of procedures. Physicians with low baseline ADR benefited the most.” – by Melinda Stevens
Reference:
Sao R, et al. Abstract 28. Presented at: ACG; Oct. 16-21, 2015; Honolulu.
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Carol Burke, MD
Recently presented data at the American College of Gastroenterology annual meeting in Honolulu Hawaii 2015 reconfirms that a second pair of eyes watching the colon lining during colonoscopy increases the detection of precancerous polyps. This study adds to previously published studies that have shown this finding.
The community of gastroenterologists continue to be concerned with identifying strategies to enhance the quality and effectiveness of colonoscopy to decrease the incidence and mortality of colorectal cancer in our patients.
The adenoma detection rate is an important quality metric, as it has been directly related to the occurrence of interval colorectal cancers. Previous studies show that for every one percent increase in adenoma detection rate there is a 3% decrease in colorectal cancer occurrence.
Ensuring all staff in the endoscopy suite watch the video monitor and alert the endoscopist to lesions they may have missed is a no-cost, high-impact approach to enhance the quality of colonoscopy.
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