P1751 - A Comparison of Quality Metrics Between Gastroenterologists and Colorectal Surgeons Performing Screening Colonoscopy Within a Large Healthcare System

Monday, October 23, 2023

10:30 AM – 4:15 PM PT

Location: Exhibit Hall

Presenting Author(s)

Shuji Mitsuhashi, MBBS (he/him/his)

Thomas Jefferson University
Rochester, MN

Shuji Mitsuhashi, MBBS¹, Jade Azari, BS¹, Vincent Dioguardi, MD², Justin Bilello, MD², Marshall Tang, BS¹, Kashyap Chauhan, MBBS¹, David Kastenberg, MD¹
¹Thomas Jefferson University, Philadelphia, PA; ²Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Colorectal adenomas are precursors to colorectal cancer, making their detection and removal crucial for effective cancer prevention. The adenoma detection rate (ADR) serves as an essential quality metric to assess the effectiveness of endoscopists in identifying these lesions during colonoscopy. We previously evaluated whether ADR was equivalent in two age groups (45-49 vs. 50-54) undergoing screening within a large health care system in Philadelphia, PA. This study aims to compare the ADR between gastroenterologists (GIs) and colorectal surgeons (CRSs) performing screening colonoscopy.

Methods: This retrospective review analyzed average-risk patients aged 45-54 who underwent screening colonoscopy between 1/2018 and 08/2022, performed by 16 CRSs and 84 GIs. Demographics, co-morbidities, medical/surgical/family history, purgative, withdrawal time, and Boston score were collected. Exclusions were prior diagnoses of colorectal cancer or adenomatous polyps, inflammatory bowel disease, personal or family history of genetic cancer syndromes, incomplete colonoscopy, and inadequate bowel preparation. The primary outcome was ADR, comparing GI to CRS.

Results: 3,199 average-risk screening colonoscopies were performed, and 204 patients were subsequently excluded based on exclusion criteria, resulting in a final sample size of 2,995. Of these, 413 colonoscopies were performed by CRS and 2,582 colonoscopies were performed by GIs. The mean withdrawal time without endoscopic intervention was significantly longer in the GI group (10.4 min) compared to the CRS group (6.9 min) (P< 0.001) (Fig 1A). ADR for CRS was 16.7%, whereas ADR for GI was substantially higher at 33.8% (P< 0.001) (Fig. 1B). After adjusting for relevant co-variables, GI ADR remained significantly higher than CRS ADR (OR 2.58, 95% CI: 1.92 – 3.45, P< 0.001) (Table 1).

Discussion: Our study reveals a significant difference in ADR between the CRS and GIs, with GIs demonstrating a higher ADR. The longer withdrawal time observed among GIs may have contributed to their higher ADR. The ADR of the CRS group fell below the minimum standard of 25% for a mixed population as established by guidelines. Further research is warranted to confirm these findings and investigate the factors influencing these differences.

Figure: Figure 1. (A) Mean withdrawal times (minutes) between Colorectal Surgery (CRS) and Gastroenterology (GI). (B) Adenoma detection rate (percentage) between CRS and GI. Note that errors bars are 95% Confidence Intervals.

Table 1. Factors associated with adenoma detection rate in multivariate analysis.

	Adenoma detection rate
Variables	OR	95% CI	P-value
Gastroenterology	2.58	(1.92, 3.45)	< 0.001
Age (continuous variable)	1.04	(1.01, 1.08)	0.011
Male	1.78	(1.51, 2.11)	< 0.001
Race/ethnicity
White	1.00	Ref
Black	0.75	(0.61, 0.91)	0.004
Latino/Hispanic	0.65	(0.46, 0.93)	0.018
Asian	1.06	(0.81, 1.40)	0.672
Other	0.85	(0.55, 1.32)	0.480
BMI
Underweight/Normal	1.00	Ref
Overweight	1.36	(1.07, 1.71)	0.01
Obese	1.69	(1.34, 2.14)	< 0.001
Smoking status
Never smoker	1.00	Ref
Former smoker	1.29	(1.06, 1.58)	0.012
Current smoker	1.69	(1.32, 2.17)	< 0.001
Heart disease	1.32	(0.85, 2.05)	0.225
Kidney disease	0.97	(0.55, 1.71)	0.908
Diabetes	1.04	(0.81, 1.32)	0.764
Liver disease	0.87	(0.38, 1.98)	0.742
Family history of CRC	1.21	(0.87, 1.69)	0.258
BBPS (continuous variable)	0.93	(0.85, 1.01)	0.089
Preparation
PEG-ELS	1.00	Ref
PEG-Sports Drink	0.97	(0.79, 1.19)	0.752
Hyperosmotic	0.79	(0.60, 1.03)	0.083
Other	1.12	(0.73, 1.73)	0.585

Disclosures:

Shuji Mitsuhashi indicated no relevant financial relationships.

Jade Azari indicated no relevant financial relationships.

Vincent Dioguardi indicated no relevant financial relationships.

Justin Bilello indicated no relevant financial relationships.

Marshall Tang indicated no relevant financial relationships.

Kashyap Chauhan indicated no relevant financial relationships.

David Kastenberg indicated no relevant financial relationships.

Shuji Mitsuhashi, MBBS¹, Jade Azari, BS¹, Vincent Dioguardi, MD², Justin Bilello, MD², Marshall Tang, BS¹, Kashyap Chauhan, MBBS¹, David Kastenberg, MD¹. P1751 - A Comparison of Quality Metrics Between Gastroenterologists and Colorectal Surgeons Performing Screening Colonoscopy Within a Large Healthcare System, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.