Polyp Detection Rate in Gastroenterologists Compared to Surgeons in an Academic Medical Center: A 10-Year Retrospective Review: 2138

Purpose: Screening colonoscopy (SC) remains the preferred screening method for colorectal cancer (CRC), however, studies have suggested that differences in SC quality are often responsible for uneven outcomes in CRC prevention and detection. 2006 guidelines included a goal adenoma detection (ADR) rate of 25% of men and 15% of women. Polyp detection rate (PDR) has been shown to highly correlate to ADR and is used as surrogate marker for ADR to facilitate data extraction. The goal of our study was to examine PDR in SC performed by gastroenterologists (GI) compared to surgeons over a 10-year span at our academic institution. Methods: We reviewed all SC done in the last 10 years at Rhode Island Hospital, from May 2003 through May 2013 for average risk screening. Colonoscopies done for other indication were excluded. We included 8 full-time current gastroenterology faculty and 4 current full-time colorectal surgery faculty. Data was extracted from our endoscopy report database, ProVation (Minneapolis, MN) and included both the total number of SC done by each proceduralist as well as the number of SC during which polyps were detected. This was then used to calculate a PDR for each proceduralist. PDR was then also pooled by specialty. Results: We identified a total of 6,006 colonoscopies which met our inclusion criteria. GI performed 5,100 and colorectal surgical faculty performed 906. We found that the PDR for GI as a group was higher than surgeons as a group, 44.1% compared to 30.9% (Chi square p<0.0001). There was variability within each group. GI PDR ranging from 33% to 73%, and surgeon PDR from 26% to 41%. We performed a “jack knife” statistical analysis to account for this wide variability. This analysis was run 12 times, dropping out one proceduralist each time, however, the difference between the two groups remained significant each time. Conclusion: We conclude that there is a significant difference in PDR between GI compared to surgeons. While previous studies have shown that SC performed by non-gastroenterologist endoscopists is associated with increased risk for missed CRC, few studies have specifically looked at PDR in non-GI proceduralists. Our study is limited because it is based on endoscopic reports, which could be incomplete or inaccurately filled out. Additionally, we do not have specific demographic information about each patient in terms of age or gender, which have been shown to impact PDR and may be different among GI compared to surgeons. Future work should be done to identify what variables are affecting the low PDR among surgeons which could then be addressed during endoscopic training or as part of ongoing quality assessments.