Gastroenterologists are largely meeting quality indicators for colonoscopies related to bowel cancer, according to an audit of colonoscopists who underwent recertification during the initial voluntary period.

However more surgeons could lift their game, according to data presented at AGW 2019 in Adelaide.

Associate Professor Peter Katelaris told that meeting that 619 colonoscopists had logged more than 100 procedures each during the first two years. Most had logged more than the 150 procedures required in each three-year recertification cycle.

About two thirds of the doctors were gastroenterologists and a third were surgeons.

Overall, the adenoma detection rate was 40.1% in patients from 50 years of age with an intact colon and no IBD – comfortably higher than the bar of 25%. Physicians had a rate of 43.0% compared to 34.2% for surgeons.

The caecal intubation rate was 99.2% – again, above the target of 95%. Physicians had a rate of 99.3% compared to 98.6% for surgeons.

Sessile serrated polyp detection rate was 11% – well above the fairly modest target of 4%. Physicians had a detection rate twice that of surgeons (13.2% v 6.6%).

Associate Professor Katelaris said the data was not to be used as a big stick however people whose performance fell below the bar required remediation.

And there was evidence that annual feedback and quality benchmark indicators can improve colonoscopy performance, he said.

“We picked a target adenoma detection rate of 25% because around the world that has been shown to be the bar above which you do better in terms of patient outcomes. Below 25% is associated with an increased risk of interval cancer.”

“So aspirationally, you want it to be as high as possible – we want the average to climb. But mostly we want to people below the 25% metric to be well above it because that seems to be the pivotal detection rate for which you can improve outcomes the most.”

He said the Colonoscopy Recertification Committee currently send a letter to people who could improve their performance inviting them to participate a variety of activities such as engaging colleagues to help them or formal courses.

“Now there is a discussion about whether that needs to be more formalised but we are in the infancy of recertification and we are working that out.”

He said the difference in performance between physicians and surgeons was “completely in accord with international data”.

“There are many, many papers that show exactly the same thing. I think we showed there was a greater proportion of surgeons who were below the metrics we want and we don’t know what sort of surgeons they were. That’s another question for another day.”

“But irrespective of what College, everybody below the bar needs remediation. Now if there is a signal that there are more surgeons below the bar than physicians, that’s a message to surgical training that there is an issue with a proportion of their people.”

He acknowledged the first people to commit to recertification may not be a representative group however it was a start.

“Recertification is ongoing every three years. We have got the systems in place now with a big database and we will now have the ability to capture data in a rolling way and watch the variation and hopefully shrink the proportion below the bar.”