American College of Gastroenterology Annual Meeting

American College of Gastroenterology Annual Meeting

Perspective from Kenneth R. DeVault, MD, FACG
Perspective from John R. Saltzman, MD, FACG
October 20, 2015
3 min read

EQUIP-3: Endoscopic quality improvement program increases ADR

Perspective from Kenneth R. DeVault, MD, FACG
Perspective from John R. Saltzman, MD, FACG
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HONOLULU — In the third trial of an endoscopic quality improvement program, adenoma detection rates were shown to increase after training in a multicenter clinical practice setting, but not significantly compared with a control intervention, according to data presented at ACG 2015.

“In our original trial … called EQUIP-1, … we performed a single-center, randomized, controlled trial at the Mayo Clinic in Florida,” Michael B. Wallace, MD, from the division of gastroenterology and hepatology at Mayo Clinic in Jacksonville, Fla., said during his presentation. “There was a significant increase in adenoma detection rate in the group of physicians … that received supplemental education that included regular feedback, lectures on detection of flat and otherwise subtle polyps, and showing both the individual and the group adenoma detection rate throughout the course of feedback, whereas the control group received no other feedback or intervention.

Michael B. Wallace

“In the current study design we performed a prospective, randomized, controlled clinical trial using the same EQUIP educational intervention,” he said. “The main hypothesis was that an endoscopic training program would increase adenoma detection rate. The methods were the same as in our single-center trial, although in this case we randomized by center.”

Wallace and colleagues randomly assigned five large clinical centers to receive supplemental, in-person EQUIP training with active feedback, and four control sites to receive no additional training and no active feedback.

Adenoma detection rates (ADRs) and other quality measures were evaluated during a 6-month baseline period, and during a 6-month post-training period using the GIQuIC quality monitoring system. All participants were unmasked to the evaluation of ADRs and other factors.

Overall, there were 22,316 patients, who underwent colonoscopy during the study period. ADRs increased significantly from 32% to 38% after training at the intervention centers compared with and insignificant increase of 35% to 39% at the control centers, but the difference between groups was not significant (OR = 1.03; 95% CI, 0.84-1.25).

“We observed that ADR increased significantly after training. There was a small but nonsignificant increase in the control group, but there was no significant difference between the intervention and control group,” Wallace said. “We saw the greatest gains in screening examinations in physicians who had baseline low ADR.

“In conclusion, we believe that there are beneficial gains in ADR for both groups. We speculate that there was a possible Hawthorne effect, meaning just by knowing that you are being monitored you improve your behaviors, and we believe that national efforts, particularly GIQuIC, are ongoing and encouraged.” – by Adam Leitenberger 


Wallace MB, et al. Abstract 10. Presented at: ACG 2015; Oct. 19-21, 2015; Honolulu, HI.

Disclosures: The researchers report no relevant financial disclosures.