Quality of Colonoscopy: A Comparison Between Gastroenterologists and Nongastroenterologists.

BACKGROUND Colonoscopy performance by gastroenterologists has been shown to be associated with lower rates of developing interval colorectal cancer. However, it is unclear if this difference among specialists stems from a difference in meeting colonoscopy quality indicators. OBJECTIVE The purpose of this study is to determine and compare the rates of colonoscopy quality indicators between different specialties. DESIGN This is a cohort study of patients undergoing screening colonoscopy investigating quality metrics as compared by the proceduralist specialty. SETTING All screening colonoscopies performed at the Cleveland Clinic between 2012 and 2014 were followed by manual chart review. PATIENTS Average-risk patients, ≥50 years of age, who had a complete screening colonoscopy were included. MAIN OUTCOME MEASURES Adenoma detection rate, cecal intubation rate, withdrawal time, and other nonestablished overall and segment-specific rates were calculated and compared using t tests. RESULTS A total of 4151 patients were included in the analysis. Colonoscopies were performed by 54 (64.3%) gastroenterologists, 21 (25%) colorectal surgeons, and 9 (10.7%) general surgeons. Gastroenterologists had the highest overall adenoma detection rate (28.6 ± 1.2; p < 0.001), followed by colorectal surgeons (24.3 ± 1.5) and general surgeons (18.4 ± 2.3), as well as the highest adenoma detection rate in men (34.7 ± 1.3; p < 0.001), followed by colorectal surgeons (28.2 ± 1.6) and general surgeons (23.7 ± 2.6). Similarly, gastroenterologists had the highest adenoma detection rate in women (24.3 ± 1.1; p < 0.001), followed by colorectal surgeons (21.6 ± 1.4) and general surgeons (12.9 ± 2.0). Withdrawal time was the longest among general surgeons (11.1 ± 5.5; p = 0.041), followed by colorectal surgeons (10.94 ± 5.2) and gastroenterologists (10.16 ± 1.26). LIMITATIONS We could not adjust for some procedure-related details such as retroflexion in the right colon and the use of end-of-scope devices. CONCLUSIONS In this study, only gastroenterologists met the currently accepted overall and sex-specific adenoma detection rate benchmarks. They also outperformed nongastroenterologists in many other nonestablished quality metrics. See Video Abstract at http://links.lww.com/DCR/B232. CALIDAD DE LA COLONOSCOPIA UNA COMPARACION ENTRE GASTROENTEROLOGOS Y NO GASTROENTEROLOGOS: Se ha demostrado que el rendimiento de la colonoscopia por parte de los gastroenterologos, se asocia con tasas mas bajas de cancer colorrectal en intervalos de desarrollo. Sin embargo, no esta claro si esta diferencia entre especialistas, se deriva de una diferencia en el cumplimiento de los indicadores de calidad de la colonoscopia.El proposito del estudio, es determinar y comparar las tasas de indicadores de calidad de colonoscopia entre diferentes especialidades.Este es un estudio de cohorte de pacientes sometidos a una colonoscopia de deteccion, que investiga metricas de calidad en comparacion con la especialidad de procesos.Todas las colonoscopias de deteccion realizadas en la Clinica Cleveland entre 2012 y 2014, fueron seguidas por una revision manual del expediente.Pacientes de riesgo promedio, ≥50 anos de edad que se sometieron a una colonoscopia de deteccion completa.La tasa de deteccion de adenomas, tasa de intubacion cecal, tiempo de retirada y otras tasas generales y especificas de segmento no establecidas, se calcularon y compararon usando pruebas t.Un total de 4,151 pacientes fueron incluidos en el analisis. Las colonoscopias fueron realizadas por 54 (64.3%) gastroenterologos, 21 (25%) cirujanos colorrectales y 9 (10.7%) cirujanos generales. Los gastroenterologos tuvieron la tasa de deteccion mas alta de adenomas en general (28.6 ± 1.2; p < 0.001), seguidos por los cirujanos colorrectales (24.3 ± 1.5) y los cirujanos generales (18.4 ± 2.3), asi como la tasa de deteccion mas alta de adenoma en hombres (34.7 ± 1.3; p < 0.001) seguido por cirujanos colorrectales (28.2 ± 1.6) y cirujanos generales (23.7 ± 2.6). Del mismo modo, los gastroenterologos tuvieron la tasa mas alta de deteccion de adenoma en mujeres (24.3 ± 1.1; p < 0.001), seguidos por los cirujanos colorrectales (21.6 ± 1.4) y los cirujanos generales (12.9 ± 2.0). El tiempo de extraccion fue el mas largo entre los cirujanos generales (11.1 ± 5.5; p = 0.041) seguido por los cirujanos colorrectales (10.94 ± 5.2) y los gastroenterologos (10.16 ± 1.26).No pudimos ajustar algunos detalles relacionados con el procedimiento, tales como la retroflexion en el colon derecho y el uso de accesorios endoscopicos.En este estudio, solo los gastroenterologos cumplieron con los indices de referencia actualmente aceptados, de deteccion de adenomas en general y especificas de genero. Tambien superaron a los no gastroenterologos en muchas otras metricas no establecidas de calidad. Consulte Video Resumen en http://links.lww.com/DCR/B232. (Traduccion-Dr. Fidel Ruiz Healy).