Introduction
Detection rates of adenoma (ADR) and sessile serrated adenoma (SSRA) during colonoscopy are key quality indicators linked to the reduction of post-procedure colorectal cancer rates. The detection rate of for sessile serrated adenomas and adenomas can vary by endoscopist gender, experience and can be improved by the monitoring of key procedural metrics and education (1-3). In addition, variation of ADR and SSRA can occur among pathologists (4,5). This variation among pathologists can potentially explain variation in ADR and SSRA of endoscopists. As part of routine end-to-end quality assurance, we identified significant variation among pathologists in relation to ADR and SSRA. Subsequently feedback was provided to the pathologists and an education program initiated.
This research examines whether these measures reduced the variation in pathologist detection rates for ADR and SSRA and if there is a subsequent impact on rates of detection of endoscopist. This requires determining if detection rates were linked to pathologists, if pathologist rates were linked to endoscopists and whether any detectable differences were maintained over time.
Aims & Methods
This retrospective quality improvement project reviewed the pathology results of all patients who underwent a colonoscopy procedure during three periods at a single tertiary site servicing a diverse population in Brisbane, Australia (HREC EX/2023/QMS/95516). Data was collected via the Endoscopy Services Information System Solution database and pathology results were collated from Pathology Queensland, Australia. The three periods examined were Quarter 3 (Jul-Sep) in 2020, 2021 and 2022.
Pearson Chi2 test was used to determine if ADR and SSADR for pathologists were independent, and if endoscopists and pathologists are independent. Finally, one-way ANOVA, factorial ANOVA and t-tests were used to determine if there was a change in detection rates for pathologists and endoscopists over time. In all tests, a p ≤ 0.05 is significant.
Results
A total of 3,813 colonoscopies were analysed during the three periods, of which 2,972 were had submitted material for histologic assessment. Procedures were performed by 25 endoscopists and a total of 16 pathologists examined the biopsied samples across the three periods. 17 endoscopists and 11 pathologists were involved in all three periods.
Significant variation in ADR was observed in Period 1 (p < 0.05). However, for subsequent time periods (after the variation was identified as part of our quality assurance measures), no significant relationship was observed between the pathologist and ADR and SSRA in subsequent years. Furthermore, in subsequent years there was a significant increase (p<0.05) of the rate of SSRA but not ADR.
Conclusion
This study suggests that not only the ADR and SSAR of endoscopists should be monitored but monitoring of variation in ADR and SSAR between pathologists can reveal substantial variations. With appropriate measures this unwarranted variation in key quality indicators of colonoscopy can be avoided.
References
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5. Lam, A. Y., Duloy, A. M., & Keswani, R. N. (2022). Quality Indicators for the Detection and Removal of Colorectal Polyps and Interventions to Improve Them. Gastrointestinal Endoscopy Clinics, 32(2), 329-349.
Disclosure
No conflicts of interest to declare
