Clin Endosc.  2016 Jan;49(1):61-68. 10.5946/ce.2016.49.1.61.

The Colonoscopist's Expertise Affects the Characteristics of Detected Polyps

• Jung DK
• Kim TO
• Kang MS
• Kim MS
• Kim MS
• Moon YS

• KMID: 2166551
• DOI: http://doi.org/10.5946/ce.2016.49.1.61

Abstract

BACKGROUND/AIMS
The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist.
METHODS
We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist.
RESULTS
No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies.
CONCLUSIONS
Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.

Keyword

Colonic polyps; Colonoscopy; Experience

MeSH Terms

Colon
Colonic Polyps
Colonoscopy
Humans
Mass Screening
Polyps*

Figure

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  Fig. 1. The overall polyp detection rate (PDR) and adenoma detection rate (ADR) by summing all of the patients who had polyps in three fellows’ groups.

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  Fig. 2. The detection rate of polyps of methods (A) A and (B) B. The significant increase of polyp detection rate was observed with experience of >400 colonoscopies by method B (arrow).

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  Fig. 3. The detection rate of polyps less than 5 mm using methods (A) A and (B) B. The detection rate of polyps <5 mm increased in method B, significantly, with an accumulation of experience of >300 colonoscopies (arrow).

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  Fig. 4. The detection rate of flat polyps by methods (A) A and (B) B.

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  Fig. 5. The detection rate of polyps at proximal position by methods (A) A and (B) B. (A) The polyp detection rate (PDR) determined with method A began to increase steadily after 200 procedures, although it declined slightly after 700 procedures (arrows). (B) On the other hand, with method B, the PDR for proximal sites was increased steadily after 300 colonoscopies (arrow).

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