Automatic quality control system improves adenoma detection rates during colonoscopy
Key takeaways:
- Adenoma detection rate was more than 10% higher in the automatic quality control system (AQCS)-assisted group.
- Low- and medium-level detectors had improved rates during routine colonoscopy with use of AQCS.
Use of an automatic quality control system during routine colonoscopy increased adenoma detection rate among low- and medium-level detectors in China, according to a study published in JAMA Network Open.
The efficacy of colonoscopies varies across patients, colonoscopists and procedures, according to the researchers, despite the introduction of specific quality indicators.
“An automatic quality control system (AQCS) has been developed for the timing of the colonoscopy intubation and withdrawal phase, monitoring withdrawal stability, evaluating bowel preparation and detecting polyps during high-definition white-light colonoscopy procedures,” Jing Liu, MD, PhD, of the department of gastroenterology at Qilu Hospital of Shandong University and Shandong Provincial Clinical Research Center for Digestive Disease in China, and colleagues wrote.
This multicenter, single-blind randomized clinical trial evaluated the impact of AQCS on ADR among colonoscopists with low- to moderate-level detection rates during routine colonoscopies.
Lui and colleagues recruited 1,254 adults aged 18 to 80 years (46.3% women; mean age, 51.21; standard deviation [SD], 12.1 years) who did not have a history of advanced colorectal cancer or polyposis undergoing colonoscopy at six medical centers in China. The researchers randomly assigned participants 1:1 to standard colonoscopy or AQCS-assisted colonoscopy.
The AQCS system functioned as a second monitor adjacent to the original endoscopic video screen and provided additional video and audio notices during the withdrawal phase, including prompts to control withdrawal speed and clean excess mucosa and liquid pools.
In the intention-to-treat analysis, the researchers found that the ACQS-assisted group had a significantly greater ADR compared with the standard colonoscopy group (32.7% vs. 22.6%; RR = 1.6; 95% CI, 1.23-2.09), with 0.86 adenomas detected per colonoscopy in the AQRS group vs. 0.48 in the standard group (RR = 1.5; 95% CI, 1.17-1.91). The researchers noted this trend persisted in a per-protocol analysis that excluded patients with incomplete colonoscopy and unqualified bowel preparation.
Compared with the standard colonoscopy group, ADRs also were significantly greater in the AQRS group when accounting for pathology (nonadvanced adenomas, 30.1% vs. 21.2%; RR = 1.52; 95% CI, 1.16-1.99) and morphology (flat or sessile, 29.3% vs. 20.4%; RR = 1.52; 95% CI, 1.16-2).
Further, use of AQCS increased ADRs of both low-level (30% vs. 20%; RR = 1.71; 95% CI, 1.24-2.35) and moderate-level detectors (38.1% vs. 27.7%; RR = 1.61; 95% CI, 1.07-2.43), with similar increases at academic (29.3% vs. 20.8%; RR = 1.58; 95% CI, 1.1-2.29) and nonacademic (36.1% vs. 24.5%; RR = 1.74; 95% CI, 1.23-2.46) centers.
Finally, the researchers found that mean withdrawal time without intervention was longer in the AQRS-assisted group compared with the standard colonoscopy group (6.78 minutes vs. 6.46 minutes; RR = 1.38; 95% CI, 1.26-1.52).
No serious adverse events were reported.
The researchers noted several limitations to this study, including potential overestimation of the effectiveness of AQCS due to improved performance of detectors under scrutiny.
“Routine use of AQCS to assist in colorectal adenoma detection and quality improvement should be considered,” Liu and colleagues wrote. “A possible association between adenoma findings by AQCS and long-term data, including CRC and cost-effectiveness, needs further investigation.”
Collapse
Read more about