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Journal article

Association Between Endoscopist Specialty and Colonoscopy Quality: A Systematic Review and Meta-analysis

Abstract

BACKGROUND & AIMS: Colonoscopy quality indicators provide measurable assessments of performance, but significant provider-level variations exist. We performed a systematic review and meta-analysis to assess whether endoscopist specialty is associated with adenoma detection rate (ADR) - the primary outcome - or cecal intubation rate, adverse event rates, and post-colonoscopy colorectal cancer rates. METHODS: We searched EMBASE, Google Scholar, MEDLINE, and the Cochrane Central Registry of Controlled Trials from inception to December 14, 2020. Two reviewers independently screened titles and abstracts. Citations underwent duplicate full-text review, with disagreements resolved by a third reviewer. Data were abstracted in duplicate. The DerSimonian and Laird random effects model was used to calculate pooled odds ratios (ORs) with respective 95% confidence intervals (CIs). Risk of bias was assessed using Risk of Bias in Non-randomised Studies of Interventions. RESULTS: Of 11,314 citations, 36 studies representing 3,500,832 colonoscopies were included. Compared with colonoscopies performed by gastroenterologists, those by surgeons were associated with lower ADRs (OR, 0.81; 95% CI, 0.74-0.88) and lower cecal intubation rates (OR, 0.76; 95% CI, 0.63-0.92). Compared with colonoscopies performed by gastroenterologists, those by other (non-gastroenterologist, non-surgeon) endoscopists were associated with lower ADRs (OR, 0.91; 95% CI, 0.87-0.96), higher perforation rates (OR, 3.02; 95% CI, 1.65-5.51), and higher post-colonoscopy colorectal cancer rates (OR, 1.23; 95% CI, 1.14-1.33). Substantial to considerable heterogeneity existed for most analyses, and overall certainty in the evidence was low according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. CONCLUSION: Colonoscopies performed by surgeons or other endoscopists were associated with poorer quality metrics and outcomes compared with those performed by gastroenterologists. Targeted quality improvement efforts may be warranted.

Authors

Mazurek M; Murray A; Heitman SJ; Ruan Y; Antoniou SA; Boyne D; Murthy S; Baxter NN; Datta I; Shorr R

Journal

Clinical Gastroenterology and Hepatology, Vol. 20, No. 9, pp. 1931–1946

Publisher

Elsevier

Publication Date

September 1, 2022

DOI

10.1016/j.cgh.2021.08.029

ISSN

1542-3565

Associated Experts

Nancy Baxter

Dean and Vice-President, Faculty of Health Sciences
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Labels

Fields of Research (FoR)

32 Biomedical and Clinical Sciences3202 Clinical sciences

Sustainable Development Goals (SDG)

3 Good Health and Well Being

Medical Subject Headings (MeSH)

AdenomaCecumColonoscopyColorectal NeoplasmsGastroenterologistsHumans
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