Adenoma detection rates already as good as it gets

Dr Kumanan Nalankilli

Colonoscopists have increased their sessile serrated adenoma detection rates (SSADR) in recent years to levels that are already well above quality benchmarks, experience from an Australia tertiary centre shows.

Recertification standards set a minimum SSADR of 4% as a quality benchmark but levels at a Victorian gastroenterology network in 2018-19 were around 9% for all colonoscopy practitioners, according to findings presented at UEG 2020 virtual meeting.

This might explain why an additional brief educational intervention on SSA detection for colonoscopists implemented in 2019 had no significant effect to further increase detection rates, said investigator Dr Kumanan Nalankilli of the Western Health Department of Gastroenterology.

In his presentation he provided data from 1763 pre-intervention colonoscopies and 1843 post intervention colonoscopies in 2018/19 and compared the outcomes with a control group of 1562 colonoscopies at the same network done in 2015.

The colonoscopies analysed covered various indications including symptoms and personal history of cancer or polyps, as well as follow up of positive FOBT.

The overall detection rates for SSA improved from 6% in 2015 to 9.2% in 20189/19, with no significant change after the education intervention( 9.3%).

For adenoma the detection rates were 31% in 2015 and 40.5% in 2018/19 (p< 0.05), increasing slightly to 42.4% after the education session.

In 2018/19 the SSADR were 6.7% for non-interventional gastroenterologists, 17.7%  for interventional gastroenterologists, 9.9%  for nurse endoscopists 6.2% for colorectal surgeons and 5% for general surgeons.

Adenoma detection rates were 34.8% for non-interventional gastroenterologists, 50% for interventional gastroenterologists, 52.3% for nurse endoscopists, 32.1% for colorectal surgeons and 26.7% for general surgeons.

Dr Nalankilli said the significant increase seen in SSADR in the last four years was presumably due to greater awareness from the literature and also from accumulating experience in detecting SSA.

“The overall ADR and SSADR recorded at our health network are well above the recommended detection rates,” he concluded.

The lack of effect of education on SSA detection targeting colonoscopists might have been because the intervention was too brief (a 30 minute powerpoint presentation and posters) to induce behaviour change,  he said.

“Or maybe after a certain benchmark is reached it’s impossible to increase things further,” Dr Nalankilli suggested.

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