Associations between endoscopist feedback and improvements in colonoscopy quality indicators: a systematic review and meta-analysis - 06/11/20

Doi : 10.1016/j.gie.2020.03.3865

Kirles Bishay, MD ^1,^{^{∗
Drs Bishay and Causada-Calo contributed equally to this article.}}, Natalia Causada-Calo, MD, MSc ^1,^{^{∗
Drs Bishay and Causada-Calo contributed equally to this article.}}, Michael A. Scaffidi, MEd ¹, Catharine M. Walsh, MD, MEd, PhD ^2,³, John T. Anderson, MBChB, MMEd, MD ^4,⁵, Alaa Rostom, MD, MSc ^6,⁷, Catherine Dube, MD, MSc ^6,⁷, Rajesh N. Keswani, MD, MS ⁸, Steven J. Heitman, MD, MSc ^9,¹⁰, Robert J. Hilsden, MD, PhD ^9,¹⁰, Risa Shorr, MLS ¹¹, Samir C. Grover, MD, MEd ^1,¹², Nauzer Forbes, MD, MSc ^9,^10,^⁎
¹ Division of Gastroenterology, St. Michael’s Hospital, Toronto, Ontario
² Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute, and Research Institute, Hospital for Sick Children, Toronto, Ontario
³ The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
⁴ Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London
⁵ Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Gloucester, United Kingdom
⁶ Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Ontario
⁷ Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario
⁸ Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
⁹ Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta
¹⁰ Department of Community Health Sciences, University of Calgary, Calgary, Alberta
¹¹ Learning Services, The Ottawa Hospital, Ottawa, Ontario
¹² Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada

^∗Reprint requests: Nauzer Forbes, MD, MSc, Clinical Assistant Professor of Medicine, Division of Gastroenterology, University of Calgary, TRW 6D19, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.Clinical Assistant Professor of MedicineDivision of GastroenterologyUniversity of CalgaryTRW 6D193280 Hospital Drive NWCalgaryABT2N 4Z6Canada

Abstract

Background and Aims

Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. It is unclear whether endoscopist feedback on these indicators improves performance. We performed a meta-analysis to determine whether associations exist between endoscopist feedback and colonoscopy performance.

Methods

We conducted a search through May 2019 for studies reporting on endoscopist feedback and associations with ADR or other colonoscopy quality indicators. Pooled rate ratios (RRs) and weighted mean differences were calculated using DerSimonian and Laird random effects models. Subgroup, sensitivity, and meta-regression analyses were performed to assess for potential methodological or clinical factors associated with outcomes.

Results

From 1326 initial studies, 12 studies were included in the meta-analysis for ADR, representing 33,184 colonoscopies. Endoscopist feedback was associated with an improvement in ADR (RR, 1.21; 95% confidence interval [CI], 1.09-1.34). Low performers derived a greater benefit from feedback (RR, 1.62; 95% CI, 1.18-2.23) compared with moderate performers (RR, 1.19; 95% CI, 1.11-1.29), whereas high performers did not derive a significant benefit (RR, 1.06; 95% CI, 0.99-1.13). Feedback was not associated with increases in withdrawal time (weighted mean difference, +0.43 minutes; 95% CI, −0.50 to +1.36 minutes) or improvements in cecal intubation rate (RR, 1.00; 95% CI, 0.99-1.01).

Conclusion

Endoscopist feedback is associated with modest improvements in ADR. The implementation of routine endoscopist audit and feedback should be considered alongside other quality improvement interventions in institutions dedicated to the provision of high-quality screening-related colonoscopy.

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Graphical abstract

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Abbreviations : ADR, ANDR, CI, CIR, GRADE, NOS, PDR, PRISMA, RCT, RR, WT

Plan

	If you would like to chat with an author of this article, you may contact Dr Forbes at nauzer.forbes@ucalgary.ca.
	DISCLOSURE: Dr Keswani is a consultant for Boston, Scientific. Dr Hilsden has a research contract with Freenome Holdings Inc. and Exact Sciences Co. Dr Grover receives research funding from Abbvie, Janssen, Takeda and Olympus; receives consulting fees from Ferring; and owns shares of Volo Healthcare. All other authors disclosed no financial relationships.
	See CME section; p. 1122.