Study On Impact Of Training And Feedback On Colonoscopy Quality

Background:Colonoscopy quality is the key to detection of early-stage colorectal cancers and the removal of precursor polyps,which is highly operator-dependent.One classic representative of colonoscopic quality indicators is adenoma detection rate(ADR),defined as the proportion of screening colonoscopies in which at least one adenoma is detected.ADR was inversely associated with the risk of interval CRC and relative death.However there has been a considerable variation in ADR among various studies,which inspires attempts on improving ADR and other colonoscopic quality indicators.Feedback or training has been used as a kind of intervention to achieve the goal,yielding conflicting results.Recently it has been pointed out that certain sample size is required for a reliable assessment of endoscopists'quality indicators which was also taken into account in the latest guideline.Thus it is necessary to study the impact of feedback and training combined on quality indicators under the updated application requirements.On the other hand,the benchmark of ADR among Chinese population is unclear.We sought to measure the outcome of proving training and feedback on colonoscopy quality indicators,for the sake of future quality assurance and improvement program.Methods:All screening and diagnostic colonoscopies performed at an endoscopy unit between January 2018 and June 2018 were reviewed.Endoscopists who performed at least 300 procedures in that period on average-risk patients aged 50 years and older were recruited and underwent training on colonoscopy skills.Since September 2019,we provided feedback on individual performance and anonymous group performance to endosocpists each time they performed 100 procedures.Results:A total of 5270 colonoscopies(male 45.6%,mean age of 61.3±7.1 years)were performed during the study period by 9 endoscopists.After intervention,the adjusted ADR and polyp detection rate were significantly higher than that of baseline:13.5%vs 25.8%(P<0.01)and 16.5%vs.36.8%(P<0.01),respectively.Mean adenoma per patient and mean polyp per patient improved from 0.157 to 0.299(P=0.014)and 0.318 to 0.673(P=0.027)respectively.The proportion of endoscopists whose ADR reached the international threshold of 25%reached 44.4%(4/9)after intervention,and a high standard of ADR over 30%was achieved by two endoscopists.Conclusion:1.Training and feedback using colonoscopy volume as interval criteria was associated with improved ADR and polyp detection rate.2.Average detectors benefited the most from the intervention.