Carolina Mangas-Sanjuan1, Pedro Zapater2, Joaquín Cubiella3, Óscar Murcia1, Luis Bujanda4, Vicent Hernández5, David Martínez-Ares5, María Pellisé6, Agustín Seoane7, Ángel Lanas8, David Nicolás-Pérez9, Alberto Herreros-de-Tejada10, María Chaparro11, Guillermo Cacho12, Servando Fernández-Díez13, José-Carlos Marín-Gabriel14, Enrique Quintero9, Antoni Castells6, Rodrigo Jover1. 1. 1Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain. 2. 2Unit of Clinical Pharmacology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain. 3. Department of Gastroenterology, Complexo Hospitalario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra y Vigo, Ourense, Spain. 4. Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, CIBERehd, Universidad del País Vasco, San Sebastián, Spain. 5. Department of Gastroenterology, Grupo de Investigación en Patología Digestiva, Instituto de Investigación Biomédica, Xerencia de Xestión Integrada de Vigo, Vigo, Spain. 6. Department of Gastroenterology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain. 7. Department of Gastroenterology, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain. 8. Department of Gastroenterology, Hospital Clínico Lozano Blesa, Universidad de Zaragoza, CIBERehd, Zaragoza, Spain. 9. Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas y Centro de Investigación Biomédica de Canarias (CIBICan), Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain. 10. Department of Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain. 11. Department of Gastroenterology, Hospital de la Princesa, Madrid, Spain. 12. Department of Gastroenterology, Fundación Hospital de Alcorcón, Madrid, Spain. 13. 13Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain. 14. 14Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain.
Abstract
BACKGROUND: Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. OBJECTIVE: The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. METHODS: This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. RESULTS: A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p = 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19-0.97) and ADR (HR 0.94; 95% CI 0.89-0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89-0.99). CONCLUSIONS: Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.
BACKGROUND: Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. OBJECTIVE: The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. METHODS: This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. RESULTS: A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p = 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19-0.97) and ADR (HR 0.94; 95% CI 0.89-0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89-0.99). CONCLUSIONS: Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.
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