Associations between endoscopist feedback and improvements in colonoscopy quality indicators: a systematic review and meta-analysis.

Kirles Bishay, Natalia Causada-Calo, Michael A Scaffidi, Catharine M Walsh, John T Anderson, Alaa Rostom, Catherine Dube, Rajesh N Keswani, Steven J Heitman, Robert J Hilsden, Risa Shorr, Samir C Grover, Nauzer Forbes

Journal: Gastrointestinal endoscopy 2021;92(5):1030-1040.e9

PMID: 32330506

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. It is unclear whether endoscopist feedback on these indicators improves performance. We performed a meta-analysis to determine whether associations exist between endoscopist feedback and colonoscopy performance.

METHODS

We conducted a search through May 2019 for studies reporting on endoscopist feedback and associations with ADR or other colonoscopy quality indicators. Pooled rate ratios (RRs) and weighted mean differences were calculated using DerSimonian and Laird random effects models. Subgroup, sensitivity, and meta-regression analyses were performed to assess for potential methodological or clinical factors associated with outcomes.

RESULTS

From 1326 initial studies, 12 studies were included in the meta-analysis for ADR, representing 33,184 colonoscopies. Endoscopist feedback was associated with an improvement in ADR (RR, 1.21; 95% confidence interval [CI], 1.09-1.34). Low performers derived a greater benefit from feedback (RR, 1.62; 95% CI, 1.18-2.23) compared with moderate performers (RR, 1.19; 95% CI, 1.11-1.29), whereas high performers did not derive a significant benefit (RR, 1.06; 95% CI, 0.99-1.13). Feedback was not associated with increases in withdrawal time (weighted mean difference, +0.43 minutes; 95% CI, -0.50 to +1.36 minutes) or improvements in cecal intubation rate (RR, 1.00; 95% CI, 0.99-1.01).

CONCLUSION

Endoscopist feedback is associated with modest improvements in ADR. The implementation of routine endoscopist audit and feedback should be considered alongside other quality improvement interventions in institutions dedicated to the provision of high-quality screening-related colonoscopy.

Address: Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario.; Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute, and Research Institute, Hospital for Sick Children, Toronto, Ontario; The Wilson Centre, University of Toronto, Toronto, Ontario, Canada.; Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London; Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Gloucester, United Kingdom.; Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Ontario; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario.; Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.; Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, University of Calgary, Calgary, Alberta.; Learning Services, The Ottawa Hospital, Ottawa, Ontario.; Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario; Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.

DOI: 10.1016/j.gie.2020.03.3865

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MeSH Terms: Cecum, Colonoscopy, Colorectal Neoplasms, Early Detection of Cancer, Feedback, Humans, Quality Indicators, Health Care