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Adenoma detection rate improves over time

Presented by
Prof. Kumanan Nalankill, Monash University, Australia
UEGW 2020
Likely due to increased awareness and accumulating experience in detection, an analysis of an Australian tertiary health network showed a significant improvement in overall sessile serrated adenoma detection rate (SSADR) over 4 years. However, a brief educational intervention did not further improve SSADR [1].

The SSADR for colonoscopists is increasingly considered as a quality marker of an effective colonoscopy. As per recent Australian standards, hospitals currently need to monitor the SSADR of their colonoscopists. The Australian Colonoscopy Recertification Program recommends an SSADR of ≥4%. Therefore, educational programmes aiming to improve SSADR are highly relevant.

The current study analysed 1,763 colonoscopies from July 2018-January 2019 (pre-intervention) and 1,843 from March 2019-September 2019 (post-intervention). The overall detection rates were:

  • adenoma detection rate (ADR): 40.5% pre-intervention versus 42.4% post-intervention (P=0.25); and
  • SSADR: 9.2% pre-intervention versus 9.3% post-intervention (P=0.95).

The overall ADR detection rates pre-intervention and post-intervention for different healthcare professionals were respectively:

  • non-interventional gastroenterologists: 34.8% versus 38.8% (P=0.23);
  • interventional gastroenterologists: 50.0% versus 48.9% (P=0.82);
  • nurse endoscopists: 52.3% versus 53.8% (P=0.79);
  • colorectal surgeons: 32.1% versus 33.1% (P=0.76); and
  • general surgeons: 26.7% versus 25.5% (P=1).

No differences were found in bowel preparation quality, caecal intubation rate, or indications. Compared with the control cohort of 1,562 colonoscopies between 1 July 2015-31 December 2015, overall baseline SSADR improved significantly: 6.0% vs 9.3% (P<0.05). General surgeons significantly improved both their baseline ADR and SSADR, while colorectal surgeons and nurse endoscopists had a significantly improved baseline ADR.

The overall ADR and SSADR recorded at this Australian health network are well above the recommended detection rates. Overall SSADR improved significantly over 4 years between 2015 and 2019.

A brief educational intervention did not further improve SSADR. This may be because the intervention was too brief to induce behaviour change or because once an adequate benchmark is reached, it is difficult to further enhance detection rates.

  1. Nalankilli K. Sessile serrated adenoma/polyp (SSA/P) detection rates have improved over a 4-year period, but have not improved further after a targeted educational intervention at an Australian tertiary health network. UEG Week Virtual Symposium 2020, abstract LB07.

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