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Bannert C.,Quality Assurance Working Group | Bannert C.,Medical University of Vienna | Reinhart K.,Quality Assurance Working Group | Reinhart K.,Medical University of Vienna | And 9 more authors.
American Journal of Gastroenterology

Objectives: Quality indicators including cecal intubation rate (CIR) and adenoma detection rate (ADR) are established. Sex differences of quality indicators are observed, but the influence of sedation has not been investigated so far. The objective of this study is to assess the impact of sedation on quality indicators, including CIR and ADR, according to sex.METHODS:We analyzed data of 52,506 screening colonoscopies performed by 196 endoscopists between November 2007 and April 2011 according to the Austrian quality management for colon cancer prevention program.Results: Sedation did not affect polyp detection rate (women P0.7972, men P0.3711) or ADR for both sexes (women P0.2773, men P0.8676). ADR was not significantly influenced by sedation (P0.1272), but by age and sex (both P0.0001), when the executing endoscopist was considered. Although women were more often sedated than men (90.70 vs. 81.83%; P0.0001), CIR was slightly lower in women than in men (94.69 vs. 96.58%; P0.0001). Sedation improved the CIR in women by 2.95% (94.96 vs. 92.01%; P0.0001), whereas in men it was just by 1.28% (96.81 vs. 95.53%; P0.0001). Sedated women only reached the CIR of unsedated men (94.96 vs. 95.53%; P0.1005). Accounting for the intra-observer influence of the endoscopist, the overall CIR was influenced by the interaction of sex and age (P0.0049), but not by sedation (P0.1435).CONCLUSIONS:Sedation does not increase adenoma or polyp detection, although it leads to an increase in CIR in men and women. This effect is more pronounced in women, yet CIR of men remains higher compared with women. Quality indicators are mainly influenced by the patient's age, sex, and the endoscopists individual performance, rather than the endoscopists subspeciality or procedural experience. © 2012 by the American College of Gastroenterology. Source

Ferlitsch M.,Quality Assurance Working Group | Ferlitsch M.,Medical University of Vienna | Reinhart K.,Quality Assurance Working Group | Reinhart K.,Medical University of Vienna | And 13 more authors.
JAMA - Journal of the American Medical Association

Context: Although some studies have shown that men are at greater age-specific risk for advanced colorectal neoplasia than women, the age for referring patients to screening colonoscopy is independent of sex and usually recommended to be 50 years. Objective: To determine and compare the prevalence and number needed to screen (NNS) for adenomas, advanced adenomas (AAs), and colorectal carcinomas (CRCs) for different age groups in men and women. Design, Setting, and Patients: Cohort study of 44 350 participants in a national screening colonoscopy program over a 4-year period (2007 to 2010) in Austria. Main Outcome Measures: Prevalence and NNS of adenomas, AAs, and CRCs in different age groups for men and women. Results: The median ages were 60.7 years (interquartile range [IQR], 54.5-67.5 years) for women and 60.6 years (IQR, 54.3-67.6 years) for men, and the sex ratio was nearly identical (51.0% [22 598] vs 49.0% [21 572]). Adenomas were found in 19.7% of individuals screened (95% CI, 19.3%-20.1%; n=8743), AAs in 6.3% (95% CI, 6.1%-6.5%; n=2781), and CRCs in 1.1% (95% CI, 1.0%-1.2%; n=491); NNS were 5.1 (95% CI, 5.0-5.2), 15.9 (95% CI, 15.4-16.5), and 90.9 (95% CI, 83.3-100.0), respectively. Male sex was significantly associated with a higher prevalence of adenomas (24.9% [95% CI, 24.3%-25.4%] vs 14.8% [95% CI, 14.3%-15.2%]; P < .001; unadjusted odds ratio [OR], 1.9 [95% CI, 1.8-2.0]), AAs (8.0% [95% CI, 7.6%-8.3%] vs 4.7% [95% CI, 4.4%-4.9%]; P < .001; unadjusted OR, 1.8 [95% CI, 1.6-1.9]), and CRCs (1.5% [95% CI, 1.3%-1.7%] vs 0.7% [95% CI, 0.6%-0.9%]; P < .001; unadjusted OR, 2.1 [95% CI, 1.7-2.5]). The prevalence of AAs in 50- to 54-year-old individuals was 5.0% (95% CI, 4.4%-5.6%) in men but 2.9% (95% CI, 2.5%-3.4%) in women (adjusted P=.001); the NNS in men was 20 (95% CI, 17.8-22.6) vs 34 in women (95% CI, 29.1-40; adjusted P=.001). There was no statistical significance between the prevalence and NNS of AAs in men aged 45 to 49 years compared with women aged 55 to 59 years (3.8% [95% CI, 2.3%-6.1%] vs 3.9% [95% CI, 3.3%-4.5%] and 26.1 [95% CI, 16.5-44.4] vs 26 [95% CI, 22.5-30.2]; P=.99). Conclusion: Among a cohort of Austrian individuals undergoing screening colonoscopy, the prevalence and NNS of AAs were comparable between men aged 45 to 49 years and women aged 55 to 59 years. ©2011 American Medical Association. All rights reserved. Source

Waldmann E.,Medical University of Vienna | Waldmann E.,Quality Assurance Working Group | Britto-Arias M.,Medical University of Vienna | Britto-Arias M.,Quality Assurance Working Group | And 14 more authors.
Surgical Endoscopy and Other Interventional Techniques

Background: An endoscopists adenoma detection rate (ADR) of less than 20 % correlates with high risk for occurrence of interval cancer. The impact of high-definition (HD) imaging on the ADR is discussed controversially. We aimed to investigate whether detection rates of individual endoscopists increase within 1 year before and 1 year after the switch from standard to HD endoscopy. Methods: This cohort study analyzed 6,330 screening colonoscopies (2,968 with standard and 3,362 with HD) performed by 42 endoscopists between November 2007 and March 2013 within a nationwide quality assurance program for screening colonoscopy. Results: The ADR of endoscopists with a low ADR (<20 %) increased significantly higher (from 11.8 to 18.1 %, p = 0.003) than of those with a high ADR (≥20 %) (from 28.6 to 30.7 %, p = 0.439) after switch from standard to HD colonoscopes (p = 0.0076). The proportion of endoscopists with an ADR < 20 % decreased from 45 to 42.9 % (p = 0.593). There was no significant increase in age- and sex-adjusted detection rates of adenomas (20.2 vs 23.7 %; p = 0.089), advanced adenomas (4.7 vs 5.5 %; p = 0.479), flat adenomas (2.7 vs 3.1 %; p = 0.515), polyps (38.8 vs 41.5 %; p = 0.305), proximal polyps (18.5 vs 20 %; p = 0.469) and hyperplastic polyps (15 vs 17.2 %; p = 0.243) of endoscopists after switch to HD colonoscopes. There was no difference in detection rates of flat polyps (5.5 vs 5.5 %; p = 0.987). Conclusions: The use of HD scopes is associated with marginal improvement in adenoma detection rates limited to those endoscopists with low adenoma detection rates prior to its introduction. © 2014, Springer Science+Business Media New York. Source

Britto-Arias M.,Medical University of Vienna | Britto-Arias M.,Quality Assurance Working Group | Waldmann E.,Medical University of Vienna | Waldmann E.,Quality Assurance Working Group | And 16 more authors.

Background and study aims: European guidelines for quality assurance in colorectal cancer screening recommend snare resection for polyps >5mm. The aim of this study was to investigate polypectomy technique according to lesion size and shape, and to assess adherence of endoscopists enrolled in the national quality assurance program to the European guidelines. Patients and methods: This cohort study included screening colonoscopies performed between 2007 and 2013 within a quality assurance program in Austria. Resection technique was analyzed according to lesion characteristics and endoscopy facility (private practices, hospitals, outpatient clinics) before publication of the EU guidelines (2007-2010) and adherence to the guidelines after publication (2011-2013). All surveillance colonoscopies and examinations with missing data were excluded. Results: A total of 128-969 screening colonoscopies performed by 278 endoscopy units were included. The polyp detection rate was 39.6% (n=47 797) and 95.6% of polyps were resected. Of polyps ≥5mm, 46.0% were resected using forceps and were therefore not treated in accordance with the guidelines. Forceps polypectomy of lesions 5-10mm and >10mm decreased significantly in hospitals after implementation of the guidelines (both P<0.0001). In private practices, there was no difference in forceps usage for polyps of 5-10mm (P=0.41) before and after the guidelines, and for polyps>10mm forceps usage even increased (P<0.0001). Endoscopists' forceps removal rates for polyps≥5mm correlated significantly with respective adenoma detection rates (P=0.0007, r p -0.187) and cecal intubation rates (P=0.0001, r p -0.303). Among endoscopists in private practices, internists had slightly lower forceps removal rates for polyps ≥5mm than surgeons, both before (47.2% vs. 50.7%; P=0.014) and after publication of the guidelines (51.9% vs. 53.5%; P=0.161). Conclusions: This study confirmed the importance of the European guidelines. The inclusion of adequate resection technique as a quality indicator in colorectal cancer screening programs is recommended. © Georg Thieme Verlag KG Stuttgart New York. Source

Ferlitsch M.,Quality Assurance Working Group | Ferlitsch M.,Medical University of Vienna | Heinze G.,Medical University of Vienna | Salzl P.,Quality Assurance Working Group | And 16 more authors.
Medical Oncology

Due to high costs and limited availability of screening colonoscopy, some screening programs require a positive fecal occult blood test (FOBT) before screening colonoscopy is remunerated. As male sex is a strong predictor of adenoma and advanced adenoma, we evaluated whether a positive FOBT or male sex is a stronger risk factor for adenoma and advanced adenoma. FOBT and screening colonoscopy results from 18.665 consecutive patients participating in a “national health check program” between 2009 and 2011 were included in this cohort study. Age-corrected adenoma detection rates (ADR), advanced adenoma detection rates (AADR) and carcinoma detection rates were calculated for men and women according to FOBT result separately. ADR and AADR in FOBT-positive men (34.6 and 11.8 %) and FOBT-negative men (29.1 and 7.6 %) were higher than ADR and AADR in FOBT-positive women (20 and 6.9 %) and in FOBT-negative women (17.6 and 4.4 %), (p = 0.0003). Men with negative FOBT were at higher risk of having an adenoma and advanced adenoma than women with positive FOBT (p < 0.0001). Odds ratios of a positive FOBT for ADR and AADR were 1.3 (1.1–1.5) (p = 0.0047) and 1.6 (1.2–2.1) (p < 0.0001), respectively. Odds ratios of male sex to predict ADR and AADR were significantly higher with 1.9 (1.8–2.1) and 1.8 (1.6–2), respectively (p < 0.001). Male sex is a stronger predictor for colorectal adenoma and advanced adenoma than positive FOBT. These results should be taken into account analyzing FOBT-based screening programs. © 2014, Springer Science+Business Media New York. Source

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