Choosing Your Endoscopist: A Retrospective Single-Centre Cohort Study

Background Colorectal cancer is one of the most common internal malignancies affecting Australians, and colonoscopy is widely accepted as a part of comprehensive large bowel assessment. Different specialties perform colonoscopies, most commonly general surgeons and gastroenterologists. Analysing performance outcomes against benchmarks allows insight into inter-specialty differences and enables the improvement of overall service provision and quality. Methods We performed a retrospective single-centre cohort study on 2086 patients undergoing colonoscopies by seven surgeons (S) and nine gastroenterologists (G) between July 2021 and June 2023. Primary outcomes were comparative caecal intubation rates (CIR), photo documentation rates (PDR), documented withdrawal rates (DWR), withdrawal times (WT), and adenoma detection rates (ADR). Secondary outcomes characterised adenoma frequency, optimal WT, and indications for colonoscopies. Results We found significant differences in CIR (S: 94.9%, 990/1043; G: 99%, 1033/1043, P<0.01), PDR (S: 95.9%, 949/990; G: 99.1%, 1024/1033, P<0.01), DWR (S: 17.4%, 181/1043; G: 87.3%, 911/1043, P<0.01), WT >6 minutes (S: 82.3%, 149/181; G: 97.8%, 891/911, P<0.01), and ADR (S: 37.9%, 193/509; G: 59.7%, 421/705, P<0.01). Subgroup analysis revealed adenoma frequency peaked at 50-70 years old and optimal WT was ≥9 minutes. We demonstrated surgeons mainly perform colonoscopies for diverticulitis surveillance, abnormal imaging, post-cancer resections, and rectal bleeding, but gastroenterologists predominantly investigate bowel symptoms, polyp surveillance, positive faecal occult blood test, and anaemia. Conclusion Despite both specialties surpassing national standards in CIR and ADR, there were significant differences in performance indicators. We believe ADR differences could be explained by different indications specialties perform colonoscopies for. Increasing WT ≥9 minutes could improve ADR, and education on the usage of withdrawal timer on endoscopes will improve DWR.