Tu1717 Predictors of High Grade Dysplasia (HGD) or Adenocarcinoma (AC) on Endoscopic Mucosal Resection (EMR) of Large Colonic Polyps

The Endoscopist a New Quality Indicator for Colorectal Cancer Screening? Karoline G. Reinhart*, Christina Bannert, Petra Salzl, Georg Heinze, Christian Zwatz, Werner Weiss, Michael H. Trauner, Monika Ferlitsch Working Group for Quality Assurance, Austrian Society for Gastroenterolgy and Hepatology, Vienna, Austria; Department of Internal Medicine III, Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria Background: Colonoscopy is widely accepted as the gold standard for colon cancer prevention. The efficacy of screening strategies is highly variable and not least endoscopist dependent. Methods: In order to assess the influence of the endoscopist’s performance on screening colonoscopy we obtained data of 192 endoscopists who participate the nationwide quality measurement program “Qualitiy Certificate for Colon Cancer Prevention” and subdivided them into internists and surgeons. Furthermore we analyzed differences between internists with specialization for gastroenterology and those without. We defined following quality indicators: sedation rate, cecal intubation rate, polyp and flat polyp, adenoma detection rate and number of complications. Generalized mixed models were performed and a pvalue of 0.05 was considered to be statistically significant. Results: The study included 61588 patients, who were mean 61.2 years of age with a nearly identical sex ratio: 51.93 % women, 48.07 % men. The endoscopists were composed of 130 internists (38,016 examinations), including 41 gastroenterologists and 62 surgeons (23,572 examinations). The sedation rate was 86.58% for internists and 86.16% for surgeons, cecal intubation could be achieved in 95.56% of all examinations performed by internists, compared to 95.84% for surgeons. The polyp detection rate (20.14% vs. 16.83%) and the flat polyp detection rate (9.09% vs. 8.43%) were higher for internists than for surgeons. However, these differences did not reach statistical significance. We found a statistically significant difference concerning the adenoma detection rate between internists and surgeons: 21.57% vs. 18.84% (OR 1.20, 95% CI 1.011.42, p 0.042). Furthermore endoscopists with specialization for gastroenterolgy had a higher flat polyp detection rate than those without: 10.85% vs. 8.28% (OR 1.69, 95% CI 1.012.86, p 0.046). Interestingly, internists had a higher complication rate than surgeons: 0.33% vs. 0.14% (OR 1.77, 95% CI 1.023.05, p 0.041). Conclusion: Endoscopists characteristics influence screening colonoscopy and and can be used as quality indicators. We conclude that internists and surgeons in Austria are both able to offer high quality screening colonoscopy. As the adenoma detection rate seems to be a key component of CRC screening strategies, we could find a tendency for internists to have a superior success rate. Further studies need to be addressed to evaluate the reasons and to define the clinical impact for this findings in order to find the room for improvement concerning colon cancer prevention.