Choosing Your Endoscopist: A Retrospective Single-Centre Cohort Study

Area of Science:

• Gastroenterology and General Surgery
• Medical Performance Benchmarking
• Colorectal Cancer Screening and Diagnosis

Background:

• Colorectal cancer is a leading malignancy in Australia, with colonoscopy being a key diagnostic tool.
• Colonoscopies are performed by various specialists, primarily general surgeons and gastroenterologists.
• Analyzing performance differences between specialties can enhance service quality and patient outcomes.

Purpose of the Study:

• To compare colonoscopy performance indicators between general surgeons and gastroenterologists.
• To identify inter-specialty differences in key procedural metrics and adenoma detection.
• To provide insights for improving colonoscopy quality and patient care.

Main Methods:

• A retrospective cohort study of 2086 patients undergoing colonoscopies between July 2021 and June 2023.
• Comparison of primary outcomes: caecal intubation rates (CIR), photo documentation rates (PDR), documented withdrawal rates (DWR), withdrawal times (WT), and adenoma detection rates (ADR).
• Analysis of secondary outcomes including adenoma frequency, optimal WT, and indications for colonoscopy.

Main Results:

• Gastroenterologists demonstrated significantly higher CIR (99% vs 94.9%), PDR (99.1% vs 95.9%), DWR (87.3% vs 17.4%), WT >6 min (97.8% vs 82.3%), and ADR (59.7% vs 37.9%) compared to surgeons.
• Optimal withdrawal time was identified as ≥9 minutes, associated with higher adenoma detection.
• Specialty indications differed: surgeons for surveillance and rectal bleeding, gastroenterologists for bowel symptoms and polyp surveillance.

Conclusions:

• Significant performance differences exist between surgeons and gastroenterologists in colonoscopy quality indicators, despite both exceeding national benchmarks.
• Adenoma detection rate disparities may be linked to differing patient indications for colonoscopy.
• Increasing withdrawal times to ≥9 minutes and improving documentation practices are recommended to enhance adenoma detection and procedural quality.