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Colon polypectomy report card improves polypectomy competency: results of a prospective quality improvement study (with video) - 17/05/19

Doi : 10.1016/j.gie.2019.02.024 
Anna M. Duloy, MD 1, , Tonya R. Kaltenbach, MD, MS 2, , Mariah Wood, BA 3, Dyanna L. Gregory, BS 3, Rajesh N. Keswani, MD, MS 3
1 Department of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA 
2 Department of Gastroenterology, University of California, San Francisco, San Francisco, California, USA 
3 Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA 

Reprint requests: Anna Duloy, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Aurora, CO 80045.University of Colorado Anschutz Medical CenterMail Stop F7351635 Aurora CtAuroraCO80045

Abstract

Background and Aims

Polypectomy competency varies significantly among providers. Poor polypectomy technique may lead to interval cancer and/or adverse events. Our aim was to determine the effect of a polypectomy skills report card on subsequent polypectomy performance.

Methods

We conducted a 3-phase, prospective, single-blinded study. In phase 1 (“baseline”), we graded 10 polypectomies per endoscopist using the Direct Observation of Polypectomy Skills (DOPyS) tool (scores 1-4); mean overall scores ≥3 are competent. In phase 2 (“pre–report card”), we selected 10 additional polypectomies per endoscopist. We subsequently gave endoscopists a report card with baseline scores and instructional videos demonstrating optimal polypectomy technique. In phase 3 (“post–report card”), 10 additional polypectomies per endoscopist were selected. Raters, blinded to study phase, graded 10 pre– and 10 post–report card polypectomies per endoscopist. We compared mean DOPyS scores and rate of competent polypectomy in the pre– and post–report card phases.

Results

We graded 110 pre– and 110 post–report card polypectomies performed by 11 endoscopists. The mean DOPyS score increased between the pre– and post–report card phases (2.7 ± .9 vs 3.0 ± .8, P = .01); this improvement was seen for diminutive (P < .0001) but not for small-to-large polyps. Rate of competent polypectomy significantly improved from the pre– to post–report card phase (56% vs 69%, P = .04); this improvement was seen for diminutive (57% vs 81%, P = .001) but not for small-to-large polyps (55% vs 36%, P = .2).

Conclusions

Report cards with educational videos effectively improved polypectomy technique, primarily because of improvements in resecting diminutive polyps. The improved competency and decreased piecemeal resection may reduce the risk of polyp recurrence. Further education is needed to improve larger polyp resection.

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Graphical abstract




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Abbreviations : CRC, DOPyS


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 DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: T. Kaltenbach: Consultant for Olympus America and Aries Pharmaceutical. R.N. Keswani: Consultant for Boston Scientific and Medtronic. All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by The Digestive Health Foundation of Northwestern Memorial Hospital.


© 2019  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 89 - N° 6

P. 1212-1221 - giugno 2019 Ritorno al numero
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