May 07, 2015
2 min read

Endoscopic training program improves adenoma detection rate long term

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Improvements in adenoma detection rates achieved through an endoscopic quality improvement training program had long-term stability, according to recent study data.

“In our first randomized controlled trial (EQUIP-1), we demonstrated that even very high adenoma detection rates (36%) could be improved (to 47%),” Michael B. Wallace, MD, MPH, from Mayo Clinic in Jacksonville, Florida, told Healio Gastroenterology. “We were not sure at that time if the improvement was just due to the physicians knowing they were being watched/studied (called the Hawthorne effect). To address this, we did a follow-up study (EQUIP-2) after the original research program ended and physicians were just practicing as normal.”

Michael B. Wallace

In EQUIP-1, 15 staff endoscopists at a single tertiary care center were randomly assigned to a supplemental education program or continue with usual practice. In the first phase of this initial study, adenoma detection rates were measured during a 3-month period in all endoscopists before any intervention, and in the second phase, adenoma detection rates were measured during another 3-month period after the educational program. In the EQUIP-2 follow-up study, or phase 3, the same endoscopists were followed for an additional 5 months, during which time they performed 1,200 screening and surveillance colonoscopies.

“In this follow-up study, we found that the physicians who had originally increased their adenoma detection rate to 47% maintained that very high level (46%),” Wallace said. “Thus, the EQUIP training appears to have a durable benefit of improving the quality of colonoscopy.”

The estimated OR for detection of an adenoma in phase 3 vs. phase 1 was 1.56 (95% CI, 1.1-2.2) for the trained group, which was similar to that of phase 2 vs. phase 1 (1.59; 95% CI, 1.12-2.25).

“It should be emphasized that this quality is very high — more than double the national guidelines (20% at the time of the study, now 25%),” Wallace said. “It has been shown by other groups that having a colonoscopy by a physician with high adenoma detection rate (especially those over 33%) is associated with a more than 50% reduction in the risk of colon cancer and death from colon cancer compared to physicians with low (< 20%) adenoma detection rate.”

The researchers also measured the number of adenomas per patient to evaluate for an “inadvertent ‘one and done’ phenomenon whereby examination is less intensive after the first suspected adenoma is found.” They observed an immediate increase in the trained group after the educational program, from 0.72 to 0.87 adenomas per patient, and also a further increase in phase 3 to 0.98 adenomas per patient.

“We are now completing a much larger national trial in private practices throughout the U.S. to see if these results can be reproduced outside of referral centers of excellence such as Mayo Clinic,” Wallace said. – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures.