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ASSOCIATION OF ENDOSCOPIST-PATIENT SEX CONCORDANCE AND COLONOSCOPY OUTCOME

Felix Theunissen 1, David M. de Jong 1, Rob J.Th. Ouwendijk 2, Pieter ter Borg 2, Lydi van Driel 1, Marco J. Bruno 1, Peter D. Siersema 1, Manon C.W. Spaander 1

Affiliations

1 Erasmus MC Cancer Institute University Medical Center, Rotterdam, Netherlands

2 Ikazia Hospital, Rotterdam, Netherlands

Summary

AI Generated

A multicenter retrospective study of 235,101 colonoscopies found that sex discordance between endoscopists and patients was associated with worse outcomes in screening colonoscopies but had minimal impact on non-screening procedures.

In 44,944 colorectal cancer screening colonoscopies, sex discordance was associated with significantly more patient discomfort (aOR 1.19, 95%CI 1.04-1.37), lower adenoma detection rate (aOR 0.86, 95%CI 0.82-0.90), and lower polyp detection rate (aOR 0.84, 95%CI 0.80-0.88), but not with cecal intubation.
In 190,157 non-screening colonoscopies, sex discordance was associated only with lower polyp detection rate (aOR 0.95, 95%CI 0.92-0.98), with no significant associations for discomfort, cecal intubation, or adenoma detection rate.
Subgroup analyses by patient sex and endoscopist sex did not reveal specific subgroups driving the association.
The authors state that further studies are needed to confirm or invalidate these findings and assess clinical relevance.
This study may be relevant to gastroenterologists, endoscopists, and healthcare administrators involved in colonoscopy quality assurance and screening program design.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Recent data has suggested that discordance between surgeon sex and patient sex is associated with a negative postoperative outcome (1). It is as yet unknown whether this is also true for endoscopists’ performance in relation to endoscopist and patient sex. We aimed to assess if there is an association between endoscopist-patient sex discordance and colonoscopy outcome.

Aims & Methods

In a multicenter retrospective study all colonoscopy procedures performed between 2016 and 2020 in 17 hospitals were collected from a prospective endoscopy database. Coloscopies were categorized into colorectal cancer screening procedures and colonoscopies performed for other indications. Concordance sex was defined if endoscopist and patient had the same sex, discordance was defined if endoscopist and patient did not have the same sex. For each colonoscopy, patient discomfort (Gloucester comfort scale >4), cecal intubation, adenoma detection rate (ADR), and polyp detection rate (PDR) was recorded. We used generalized estimating equations accounting for endoscopist age and experience (years of experience), patient age, year of procedure, ASA classification, adequate bowel preparation (Boston bowel preparation score >6), type of hospital (academic vs. non-academic) and type of sedation. Random effects incorporated were patient ID, hospital and endoscopist.

Results

Out of 235,101 colonoscopies, 44,944 screening procedures were performed by 103 endoscopists, of which 23,990 were sex concordant and 20,954 were sex discordant. The other 190,157 colonoscopies were performed by 196 endoscopists, of which 95.662 were sex concordant and 94.495 were sex discordant. In screening colonoscopies, sex discordance was associated with significantly more discomfort (aOR: 1.19; 95%CI, 1.04-1.37), lower ADR (aOR: 0.86; 95%CI, 0.82-0.90), and lower PDR (adjusted Odds Ratio (aOR): 0.84; 95%CI, 0.80-0.88) but not with cecal intubation (aOR: 0.9; 95%CI, 0.76-1.07). In non-screening colonoscopies ,sex discordance was significantly associated with lower PDR (aOR: 0.95; 95%CI, 0.92-0.98) but not with discomfort (aOR: 0.99; 95%CI, 0.92-1.07), cecal intubation (aOR: 1.00; 95%CI, 0.94-1.06) and ADR (aOR: 1.00; 95% CI, 0.96-1.05). Subgroup analyses revealed no specific subgroup, and endoscopists’ sex and patients’ sex did not change this association (Table 1).

Table 1. Discordance vs concordance

		Colorectal Cancer Screening colonoscopies	Non-screening colonoscopy
	Outcome	OR (95% CI)	OR (95% CI)
Female patients	Significant discomfort	0.685 [0.446 – 1.052]	0.815 [0.604 – 1.100]
	Caecal intubation	0.992 [0.607 – 1.620]	1.219 [0.740 – 2.008]
	ADR	1.020 [0.875 – 1.188]	1.037 [0.742 – 1.450]
	PDR	1.040 [0.879 – 1.231]	0.916 [0.789 – 1.062]
Male patients	Significant discomfort	0.721 [0.441 – 1.177]	0.952 [0.673 – 1.348]
	Caecal intubation	0.965 [0.652 – 1.428]	1.250 [0.711 – 2.196]
	ADR	0.938 [0.804 – 1.095]	1.018 [0.696 – 1.488]
	PDR	0.976 [0.829 – 1.150]	0.870 [0.729 – 1.039]

Conclusion

Sex discordance between endoscopists and patients was associated with more discomfort, lower ADR, and lower PDR in screening colonoscopies, and lower PDR in non-screening colonoscopies. These findings do not seem to be driven by a specific subgroup or endoscopists’ sex, such as the case was in the study on the observed discordance between surgeon sex and patient sex and its associated negative postoperative outcome. Further studies are needed to confirm or invalidate these findings, as well as the clinical relevance.

References

Wallis CJD, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. Bmj. 2017;359:j4366.

Disclosure

R.J.T. Ouwendijk received grants from Janssen Netherlands, Norgine and the Coolsingel foundation. M.J. Bruno serves as a consultant and receives support for industry and investigator-initiated studies from Boston Scientific and Cook Medical and receives support for investigator-initiated studies from Pentax Medical, 3 M, Interscope, and Mylan. P.D. Siersema received research grants from Norgine, Pentax, Microtech, Yakult, Lucid Diagnostics and Motus GI (ongoing). P.D. Siersema is a member on the advisory board of Motus GI and Boston Scientific.The other authors declare that they have no conflicts of interest.

Conference

UEG Week Copenhagen 2023

Submission format

Abstract

Session

PP 10 Health economics / Digitalisation in GI / Education In GI / Gender and diversity (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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THE ROLE OF ENDOSCOPIST SKILL IN MALE AND FEMALE PATIENTS UNDERGOING COLONOSCOPY: FINDINGS FROM THE SCREESCO RANDOMIZED CONTROLLED TRIAL

Marcus Westerberg 1, Lars Holmberg 2,3, Anders Ekbom 4, Chris Metcalfe 5, Robert Steele 6, Anna Forsberg 7

Affiliations

1 Uppsala University, Uppsala, Sweden

2 Uppsala University Hospital, Uppsala, Sweden

3 King’s College London, London, United Kingdom

4 Clinical Epidemiology Unit, Karolinska Hospital M9:01, Stockholm, Sweden

5 University of Bristol, Bristol, United Kingdom

6 Surgery and Oncology, Dundee University, Dundee, United Kingdom

7 Karolinska Institutet, Stockholm, Sweden