 
Low Endoscopy Completion Rate Linked to Missed CRCs
Patients whose colonoscopies were performed by endoscopists with high completion rates were less likely to receive a diagnosis of colorectal cancer 6-36 months later, compared with patients whose colonoscopies were done by endoscopists with lower completion rates, reported Dr. Nancy N. Baxter and colleagues in the January issue of Gastroenterology.
The study drew on five databases comprising virtually all residents of Ontario, wrote Dr. Baxter of the department of surgery at the University of Toronto. A total of 1,260 patients were considered to have a postcolonoscopy colorectal cancer (PCCRC), defined as a "CRC within 3 years following a colonoscopy in which the cancer was not detected," wrote the authors.
"After controlling for patient and endoscopy factors, patients undergoing colonoscopy performed by an endoscopist with a completion rate of 95% or greater were less likely to have a PCCRC than if performed by an endoscopist with a less than 80% completion rate for proximal [odds ratio, 0.72; 95% confidence interval, 0.53-0.97] and distal [OR, 0.73; 95% CI, 0.54-0.97] cancers."
Polypectomy rate was also associated with PCCRCs, at least in the proximal colon. Endoscopists with polypectomy rates greater than 30% had an OR of 0.61 for proximal PCCRC, compared with endoscopists whose polypectomy rates were less than 10% (95% CI, 0.42-0.89).
Endoscopist specialty appeared to play a role as well. Compared with gastroenterologists, endoscopists who were identified as "other" specialties (excluding surgeons) had an OR of 1.87 for proximal PCCRCs (95% CI, 1.34-2.60), and 1.67 for distal cancers (95% CI, 1.13-2.46).
Setting was apparently important too: Colonoscopies performed in a nonhospital setting had an OR of 1.88 for proximal PCCRCs (95% CI, 1.2-2.92), and an OR of 1.67 for distal PCCRCs (95% CI, 1.13-2.46). There was no significant relationship between the endoscopist's procedure volume and PCCRC.
The authors conceded several limitations to their study, including the possibility of errors in coding (from which their data were derived). "Additionally, we could not assess a number of other aspects of care that are likely to have an impact on colonoscopy performance and effectiveness, including factors such as quality of preparation and sedation," they wrote.
The authors stated that they have no conflicts of interest relative to this study, which was funded by an American College of Gastroenterology Cancer Prevention Action Plan Grant, as well as the Ontario Institute for Cancer Research, and Cancer Care Ontario.
Vol. 5 No. 1, January 2011: GI & Hepatology News: The official Newspaper of the AGA Institute |
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