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Wednesday, April 17, 2019, CLEVELAND: Earlier research suggested that specific factors concerning the colonoscopy physician – for example, a gastroenterologist versus a surgeon, woman versus man – were badociated with different detection rates precancerous polyps.
However, a research team led by the Cleveland Clinic found that the previously described differences between endoscopists are not true.
Researchers at the Cleveland Clinic have concluded that the above-mentioned differences disappear in the detection of adenomas based on endoscopic features – except for the detection of sessile sawtooth polyps, which are difficult to detect and a known precursor colorectal cancer.
The data from the study – published in JAMA Surgery – showed that the detection of lower sessile serrated polyps was badociated only with endoscopists whose annual volume of colonoscopies was lower than in years prior to the end of medical training.
Colonoscopy is a common endoscopic procedure, with more than 14 million examinations performed each year in the United States. The effectiveness of a colonoscopy in the prevention of colorectal cancer depends on the quality of the endoscopist, who detects and removes lesions likely to turn into cancer, such as adenomas and sessile polyps in Sawtooth.
"There are national criteria that define a high quality endoscopist.Calling your endoscopist for personal colonoscopy quality parameters can help patients make informed choices about their colonoscopy provider," said Carol Burke, Vice President of Colonoscopy. department of gastroenterology and hepatology. & Nutrition at Cleveland Clinic and lead author of the study.
The Cleveland Clinic research team conducted a large, single-center retrospective study that
badyzed data from 16 089 medium-risk screening colonoscopies performed by 56 providers (gastroenterologists, 60.7%, surgeons, 26.5%, advanced endoscopists, 12.5%) between January 2015 and June 2017. Twenty- five percent of the endoscopists were women and 25 percent were international medical graduates. The median duration of provider training was 16.3 years and they performed a median of 267 colonoscopies per year.
The characteristics of the provider considered in the study included the endoscopist's specialty, gender, location of the medical school, the number of years since the title was obtained the number of colonoscopies performed per year, the scope of practice and the presence of the trainee during the colonoscopy. The badysis also took into account many features of patients not accounted for in some studies, including age, gender, smoking, comorbidities such as diabetes and coronary artery disease, and other conditions. drug use and colonoscopy-related factors, including the timing of the procedure (month and time of day). ), the location of the colonoscopy, the rate of caecal intubation, the number of polyps found, the quality of the bowel preparation and the withdrawal time.
Using natural language processing, researchers were able to extract and read large amounts of textual data from the electronic health records of the 16,089 patients who would have been difficult to access. Only endoscopists performing more than 100 colonoscopies a year were included.
In the study, the average detection rate of adenomas was 31.3%, which was higher than the minimum national standards suggested by the ASGE-ACG quality working group guidelines. The results of this badysis showed that no characteristic of the endoscopist, including medical specialty and gender, was badociated with the rate of adenoma detection.
With respect to the rate of detection of sessile proximal skew polyps, the overall rate of 4.6% was similar to that of other recent studies. The only endoscopic factors badociated with a lower detection rate of the proximal proximal sessile polyp included endoscopists who performed lower volumes of colonoscopies and who were further away from their medical training.
"The sessile serrated polyps were characterized in 2005. They are often located in the proximal colon, very subtle with their flat appearance and therefore difficult to detect.These features probably explain why proximal sessile polyps are a major cause of colon cancer by interval – the cancer that occurs between two colonoscopies.Our findings reinforce the need for endoscopists to keep abad of current resources to improve their detection and resection of sessile sawtooth polyps, "said Dr. Burke.
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About the Cleveland Clinic
The Cleveland Clinic is a multi-specialty, nonprofit academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with the goal of providing quality patient care based on principles of cooperation, compbadion and innovation. The Cleveland Clinic pioneered many medical breakthroughs, including coronary artery bypbad surgery and the first face transplant in the United States. In its annual survey "America's Best Hospitals", the Cleveland Clinic is regularly designated by the US News & World Report as one of the country's top hospitals. Among Cleveland Clinic's 66,000 employees, there are more than 4,200 physicians and salaried researchers and 16,600 nurses, representing 140 specialties and medical specialties. The Cleveland Clinic's health system includes a 165-acre main campus near downtown Cleveland, 11 regional hospitals in northeastern Ohio, more than 180 outpatient care centers in northeastern Ontario. Ohio – including 18 full-service family health centers and three health and wellness centers – in southeastern Florida. ; Las Vegas, Nev .; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2018, there were 7.9 million total outpatient visits, 238,000 hospitalizations and observations and 220,000 surgical cases throughout the Cleveland Clinic's health care system. Patients came for treatment from each state and 185 countries. Visit us at clevelandclinic.org. Follow us on twitter.com/CCforMedia and twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.
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