Gastroenterologist focus of clinical practice affects adenoma detection in screening colonoscopy

Abstract

Our objective was to determine whether the clinical focus of gastroenterology practice would affect screening colonoscopy quality metrics, specifically adenoma detection (AD). In a retrospective study of screening colonoscopies, gastroenterologists were categorized based on their clinical subspecialty focus into general/motility, hepatology, inflammatory bowel disease (IBD), and interventional endoscopy. The primary outcome was AD with a secondary outcome of adenoma and/or sessile serrated polyp (SSP) detection (AD + SSP). A total of 5271 (male: 49.1%) complete colonoscopies were performed between 2010 and 2020 by 16 gastroenterologists (male: 62.5%, general/motility specialists: 3, hepatologists: 3, IBD specialists: 4, interventional endoscopists: 6). The AD and AD + SSP rate between each specialty focus were 27.5% and 31.0% for general/motility, 31.4% and 35.5% for hepatology, 38.4% and 43.6% for IBD, and 37.5% and 43.2% for interventional endoscopy. In regression analysis, patient’s male gender (odds ratios [OR]: 1.81, 95% CI: 1.60–2.05, P < .001), longer withdrawal time (OR: 1.16, 95% CI: 1.14–1.18, P < .001), hepatologist (OR: 1.25, 95% CI: 1.02–1.53, P = .029), IBD subspecialist (OR: 1.60, 95% CI: 1.30–1.98, P < .001), and interventional endoscopist (OR: 1.36, 95% CI: 1.13–1.64, P < .001) were independently associated with AD. Moreover, patient’s male gender (OR: 1.64, 95% CI: 1.45–1.85, P < .001), acceptable bowel preparation (OR: 1.29, 95% CI: 1.06–1.56, P = .010), withdrawal time (1.20, 95% CI: 1.18–1.22, P < .001), hepatologist (OR: 1.30, 95% CI: 1.07–1.59, P = .008), IBD subspecialist (OR: 1.72, 95% CI: 1.39–2.12, P < .001), interventional endoscopist (OR: 1.44, 95% CI: 1.20–1.72, P < .001) were independent factors that improved detection of AD + SSP. Subspecialty focus of practice was an important factor in AD rate along with the male gender of the patient, bowel preparation, and withdrawal time.