Individual polyp detection rate in routine daily endoscopy practice depends on case-mix

Area of Science:

• Gastroenterology
• Endoscopic Quality Assessment
• Colorectal Cancer Screening

Background:

• Adenoma detection rate (ADR) is a key quality indicator for colonoscopy.
• ADR can be influenced by selection bias, making its value in routine practice unclear.
• Limited data exists on polyp detection rate (PDR) in unselected patients during daily endoscopy.

Purpose of the Study:

• To evaluate the PDR among different endoscopists over an 11-year period.
• To assess variations in PDR based on endoscopist experience and patient case-mix.
• To investigate the impact of routine practice on PDR and its implications for ADR as a quality metric.

Main Methods:

• Retrospective analysis of 14,908 consecutive colonoscopies over 11 years.
• Data collected included yearly procedures per endoscopist, polyp presence, and specific patient groups (surveillance, post-surgery).
• Comparison of PDR between four endoscopists, considering factors like career length and patient case-mix.

Main Results:

• Significant PDR variations observed among the four endoscopists (p < 0.001).
• Endoscopists with longer careers showed lower PDR.
• Younger endoscopists performed fewer procedures in surveillance or post-surgical patients.
• One endoscopist detected significantly fewer colorectal cancers (p < 0.001).

Conclusions:

• Routine PDR in unselected patients can be lower than literature recommendations for individual endoscopists.
• Patient case-mix significantly influences PDR outcomes.
• The study questions the universal applicability of ADR as an individual quality indicator due to practice variations.