Endoscopist specialty is associated with colonoscopy quality

BMC Gastroenterology

Robert J Hilsden²  Lawrence Joseph³  Alan N Barkun³  Maida J Sewitch³  Mengzhu Jiang¹ 

[1] Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, 687 Pine Avenue West, V Building, Room V2.15, Montreal, QC, H3A 1A1, Canada;Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada;Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

关键词: Specialty;    Adenoma detection rate;    Polypectomy;    Colonoscopy quality;   

Others  :  858012
DOI  :  10.1186/1471-230X-13-78

 received in 2012-08-07, accepted in 2013-04-22,  发布年份 2013

【 摘 要 】

Background

Some studies have shown that endoscopist specialty is associated with colorectal cancers missed by colonoscopy. We sought to examine the relationship between endoscopist specialty and polypectomy rate, a colonoscopy quality indicator. Polypectomy rate is defined as the proportion of colonoscopies that result in the removal of one or more polyps.

Methods

A cross-sectional study was conducted of endoscopists and their patients from 7 Montreal and 2 Calgary endoscopy clinics. Eligible patients were aged 50–75 and covered by provincial health insurance. A patient questionnaire assessed family history of colorectal cancer, history of large bowel conditions and symptoms, and previous colonoscopy. The outcome, polypectomy status, was obtained from provincial health administrative databases. For each city, Bayesian hierarchical logistic regression was used to estimate the odds ratio for polypectomy comparing surgeons to gastroenterologists. Model covariates included patient age, sex, family history of colorectal cancer, colonoscopy indication, and previous colonoscopy.

Results

In total, 2,113 and 538 colonoscopies were included from Montreal and Calgary, respectively. Colonoscopies were performed by 38 gastroenterologists and 6 surgeons in Montreal, and by 31 gastroenterologists and 5 surgeons in Calgary. The adjusted odds ratios comparing surgeons to gastroenterologists were 0.48 (95% CI: 0.32–0.71) in Montreal and 0.73 (95% CI: 0.43–1.21) in Calgary.

Conclusions

An association between endoscopist specialty and polypectomy was observed in both cities after adjusting for patient-level covariates. Results from Montreal suggest that surgeons are half as likely as gastroenterologists to remove polyps, while those from Calgary were associated with a wide, non-significant Bayesian credible interval. However, residual confounding from patient-level variables is possible, and further investigation is required.

【 授权许可】

   
2013 Jiang et al.; licensee BioMed Central Ltd.

【 图 表 】

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