Back to Program | 2010 Program and Abstracts Overview | 2010 Posters
Do Gastroenterologists Find More Adenomas On Colonoscopy Than Colorectal Surgeons?
Kevin Ollington*1, Daniel Brelian1, Edward J. Share1,3, Janet a. Morgan3, Daniel R. Margulies2, Phillip Fleshner2,3, Gil Y. Melmed1,3
1Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA; 2Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; 3Specialty Surgical Center, Los Angeles, CA
Background: Adenoma detection is increasingly used as a measure of quality for screening/surveillance colonoscopy. Both gastroenterologists (GIs) and colorectal surgeons (CRS) perform colonoscopy, and studies demonstrate equivalent safety between the two specialties. However, it is unknown whether there is there is variability in adenoma detection rates between GIs and CRS. The objective of this study was to assess differences in adenoma detection between GIs and CRS during screening/surveillance colonoscopy. Methods: We performed a retrospective analysis of colonoscopies performed by GIs and CRS over a one month period at an outpatient endoscopy center. Patients with prior colon cancer or resection, familial adenomatous polyposis or inflammatory bowel disease were excluded. Multiple factors were assessed, including patient demographics, procedure indication, family history of colorectal neoplasia, prep quality, cecal intubation rate, total procedure time, and procedure start time. Polyps were classified as hyperplastic, adenomatous, or cancer. Comparative statistics included Students’ T test, Wilcoxon rank-sum test, and chi-square analysis where appropriate. Poisson regression adjusting for non-independence and multivariable logistic regression were used to adjust for confounders.Results: Eight GIs and four CRS performed 180 and 119 colonoscopies respectively during the study period. 326 polyps including 157 adenomas and 2 cancers were found in 299 patients who met inclusion criteria. GIs found at least 1 polyp in a higher percentage of patients than CRS (56% vs. 40%; p=0.008), and GIs found more polyps per patient than CRS (1.27 vs. 0.75; p<0.007). These differences remained significant after adjusting for confounders. However, the percentage of patients in whom at least one adenoma was found was not different between GIs and CRS (33% vs. 29%; p=0.38). The mean number of adenomas per patient was also not significantly different among GIs relative to CRS (0.58 vs 0.44; p=0.24). Significant differences between GIs and CRS included patient age (55 yrs vs. 62 yrs; p<0.0001), percentage of patients undergoing first colonoscopy (9% vs. 20%; p<0.001), and total procedure time (21 min vs. 18 min; p<0.0001). After adjusting for potential confounders, there were no significant differences between GIs and CRS in the mean number of adenomas per patient (p=0.09), or in the mean number of patients in whom an adenoma was detected (p=0.26).Conclusions: Gastroenterologists may find more polyps than CRS, but adenoma detection rates are similar between GI and CRS. Patients should feel assured that adenoma detection during colonoscopy does not vary between GIs and CRS.
Back to Program | 2010 Program and Abstracts Overview | 2010 Posters
