Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 9/2020

01-09-2020 | Endoscopy

Training interventions to improve adenoma detection rates during colonoscopy: a systematic review and meta-analysis

Authors: Stephanie Lim, Sydney Hammond, Jason Park, David Hochman, Mê-Linh Lê, Rasheda Rabbani, Ahmed Abou-Setta, Ryan Zarychanski

Published in: Surgical Endoscopy | Issue 9/2020

Login to get access

Abstract

Background

Colonoscopies are effective means of detecting and removing precancerous adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy quality and an independent predictor of colorectal cancer incidence. Focused training interventions may improve an endoscopist’s ADR, but the supporting research is limited. This systematic review and meta-analysis identified, critically appraised, and meta-analyzed data from randomized trials (RCTs) evaluating the effect of training interventions on ADRs.

Methods

Ovid Medline, EMBASE, CENTRAL, Eric, CINAHL, Scopus, Web of Science, and ClinicalTrials.gov were searched for RCTs investigating the effect of an educational intervention on ADRs. Two reviewers independently screened, identified, and extracted trial-level data. Internal validity was assessed in duplicate using the Risk of Bias tool. Our primary outcome was the ADR. Secondary outcomes were advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were post-polypectomy bleeding rate and colonoscopy-related perforation rate.

Results

From 2837 screened citations, we identified 3 trials (119 endoscopists) meeting our inclusion criteria. Training interventions were associated with a trend toward increased ADRs (odds ratio 1.16, 95% confidence interval (CI) 1.00–1.34; I2 83%; 3 trials; 119 endoscopists). When limited to screening colonoscopies, the odds ratio for ADRs associated with training interventions was 1.17 (95% CI 1.00–1.36; I2 80%; 3 trials; 119 endoscopists). There was a high level of heterogeneity between the trials’ training interventions. Training intervention improved the advanced ADR, adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety outcomes were not reported.

Conclusions

A focused training intervention was associated with a strong trend toward increased ADRs among certified endoscopists. While the described training interventions definitely show promise, further efforts around continuing professional developments activities are needed to more consistently improve ADRS among certified endoscopists.
Appendix
Available only for authorised users
Literature
1.
Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ (2017) Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 112:1016–1030CrossRef
2.
Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, Doubeni CA, Zauber AG, de Boer J, Fireman BH, Schottinger JE, Quinn VP, Ghai NR, Levin TR, Quesenberry CP (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370:1298–1306CrossRef
3.
Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E (2010) Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 362:1795–1803CrossRef
4.
Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG II, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS (2015) Quality indicators for colonoscopy. Gastrointest Endosc 81:31–53CrossRef
5.
Munroe CA, Lee P, Copland A, Wu KK, Kaltenbach T, Soetikno RM, Friedland S (2012) A tandem colonoscopy study of adenoma miss rates during endoscopic training: a venture into uncharted territory. Gastrointest Endosc 75:561–567CrossRef
6.
van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E (2006) Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 101:343–350CrossRef
7.
Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, Sautereau D, Boustiere C, Grimaud JC, Barthelemy C, See J, Serraj I, D’Halluin PN, Branger B, Ponchon T (2008) Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 40:284–290CrossRef
8.
Chen SC, Rex DK (2007) Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 102:856–861CrossRef
9.
Shaukat A, Oancea C, Bond JH, Church TR, Allen JI (2009) Variation in detection of adenomas and polyps by colonoscopy and change over time with a performance improvement program. Clin Gastroenterol Hepatol 7:1335–1340CrossRef
10.
Buchner AM, Shahid MW, Heckman MG, Diehl NN, McNeil RB, Cleveland P, Gill KR, Schore A, Ghabril M, Raimondo M, Gross SA, Wallace MB (2011) Trainee participation is associated with increased small adenoma detection. Gastrointest Endosc 73:1223–1231CrossRef
11.
Madhoun MF, Tierney WM (2012) The impact of video recording colonoscopy on adenoma detection rates. Gastrointest Endosc 75:127–133CrossRef
12.
Rex DK, Hewett DG, Raghavendra M, Chalasani N (2010) The impact of videorecording on the quality of colonoscopy performance: a pilot study. Am J Gastroenterol 105:2312–2317CrossRef
13.
Sawhney MS, Cury MS, Neeman N, Ngo LH, Lewis JM, Chuttani R, Pleskow DK, Aronson MD (2008) Effect of institution-wide policy of colonoscopy withdrawal time > or = 7 minutes on polyp detection. Gastroenterology 135:1892–1898CrossRef
14.
Coe SG, Crook JE, Diehl NN, Wallace MB (2013) An endoscopic quality improvement program improves detection of colorectal adenomas. Am J Gastroenterol 108:219–226CrossRef
15.
Kaminski MF, Anderson J, Valori R, Kraszewska E, Rupinski M, Pachlewski J, Wronska E, Bretthauer M, Thomas-Gibson S, Kuipers EJ, Regula J (2016) Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial. Gut 65:616–624CrossRef
16.
Wallace MB, Crook JE, Thomas CS, Staggs E, Parker L, Rex DK (2017) Effect of an endoscopic quality improvement program on adenoma detection rates: a multicenter cluster-randomized controlled trial in a clinical practice setting (EQUIP-3). Gastrointest Endosc 85:538–545.e534CrossRef
17.
Higgins J, Lasserson T, Chandler J, Tovey D, Churchill R (2016) Standards for the conduct of new Cochrane Intervention Reviews. In: Higgins J, Lasserson T, Chandler J, Tovey D, Churchill R (eds) Methodological expectations of cochrane intervention reviews (C1-75). Cochrane, London
18.
Lasserson T, Churchill R, Chandler J, Tovey D, Higgins J (2016) Standards for the reporting of protocols of new Cochrane Intervention reviews. In: Higgins J, Lasserson T, Chandler J, Tovey D, Churchill R (eds) Methodological expectations of cochrane intervention reviews (PR1-44). Cochrane, London
19.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Br Med J 339:2535CrossRef
20.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46CrossRef
21.
22.
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J 343:5928CrossRef
23.
24.
Ussui V, Coe S, Rizk C, Crook JE, Diehl NN, Wallace MB (2015) Stability of increased adenoma detection at colonoscopy. Follow-up of an endoscopic quality improvement program-EQUIP-II. Am J Gastroenterol 110:489–496CrossRef
25.
26.
27.
28.
Selber JC, Chang EI, Liu J, Suami H, Adelman DM, Garvey P, Hanasono MM, Butler CE (2012) Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg 130:550e–557eCrossRef
Metadata
Title
Training interventions to improve adenoma detection rates during colonoscopy: a systematic review and meta-analysis
Authors
Stephanie Lim
Sydney Hammond
Jason Park
David Hochman
Mê-Linh Lê
Rasheda Rabbani
Ahmed Abou-Setta
Ryan Zarychanski
Publication date
01-09-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07153-7

Other articles of this Issue 9/2020

Surgical Endoscopy 9/2020 Go to the issue

OriginalPaper

Long-term outcomes of endoscopically resected laterally spreading tumors with a positive histological lateral margin

OriginalPaper

“Peek port”: avoiding conversion during laparoscopic colectomy—an update

OriginalPaper

Short-term surgical morbidity and mortality of distal pancreatectomy performed for benign versus malignant diseases: a NSQIP analysis

New Technology

Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: a systemic review and meta-analysis

OriginalPaper

Teaching robotic rectal cancer surgery at your workplace: does the presence of visiting surgeons in the operating room have a detrimental effect on outcomes?

Correction

Correction to: Pathological impact of transanal colorectal tube for obstructive colorectal cancer