Assessing colon polypectomy competency and its association with established quality metrics

Area of Science:

• Gastroenterology
• Medical Education
• Quality Improvement

Background:

• Inadequate polypectomy can lead to incomplete resection and interval colorectal cancer.
• Current methods for assessing polypectomy competency are lacking.
• Established colonoscopy quality metrics may not reflect polypectomy proficiency.

Purpose of the Study:

• To assess polypectomy competency among gastroenterologists.
• To determine the correlation between polypectomy competency and adenoma detection rate (ADR).
• To measure the association between polypectomy competency and colonoscopy withdrawal time.

Main Methods:

• Prospective observational study involving 13 high-volume screening colonoscopists.
• Video recording and random selection of 10 polypectomies per colonoscopist for review.
• Utilized the Direct Observation of Polypectomy Skills (DOPS) tool for competency assessment by two raters.

Main Results:

• 64% of 130 evaluated polypectomies were rated as competent.
• Significant variation in overall DOPS competency scores among colonoscopists (30%-90%).
• Polypectomy competency did not significantly correlate with ADR (r=0.4) or withdrawal time (r=0.2).

Conclusions:

• Polypectomy competency is highly variable among endoscopists.
• Current quality metrics like ADR and withdrawal time do not adequately reflect polypectomy skills.
• There is a need for improved polypectomy training and a dedicated quality metric.