26 // THE NEW GASTROENTEROLOGIST: INSIGHTS FOR FELLOWS & YOUNG GIS WINTER 2015
SNAPSHOTS FROM THE
Snapshots From the AGA Journals
Dr. Sameer D. Saini is assistant professor of internal medicine at
the University of Michigan Health System, Ann Arbor. He has no
conficts of interest.
In this well-planned study by Dr. Shaukat and her colleagues, the authors retrospectively examined the association between an endos- copist’s mean withdrawal time, adenoma detection rate (ADR),
and interval cancer rate by using data
from a large community gastroenterology practice and a state cancer registry. Prior studies have examined the
association between mean withdrawal
time and ADR, and ADR and interval
cancer, but no study has examined the
association between withdrawal time
(a process measure of colonoscopy
quality) and interval cancer (an outcome measure of colonoscopy quality). In this study, the authors found
a statistically significant association
between mean withdrawal time and
ADR, and mean withdrawal time and
interval cancer. Specifically, for mean
withdrawal times less than 8 minutes,
lower withdrawal times were associated with higher rates of interval cancer.
Compared to physicians with mean
withdrawal times greater than 6 minutes, those with withdrawal times less
than 6 minutes were 2. 3 times more
likely to have a patient develop an interval cancer.
The authors did not find a statistically significant association between
ADR and interval cancers, which they
attributed to confounding related to
the increased risk of cancer in populations with higher adenoma prevalence and the increased likelihood of
early cancer detection related to more
frequent surveillance examinations.
These data provide clear evidence of
a link between a modifiable physician characteristic (mean withdrawal
time), a readily measurable intermediate outcome measure (ADR), and an
important clinical outcome (interval
cancer). Such data should prove useful
to those who seek not only to measure, but also to improve, the quality
of colonoscopy. n
Key clinical point: Colonoscope
withdrawal times less than 6 minutes are associated with significantly higher rates of interval colorectal
Major finding: Rates of interval
CRC were 2. 3 times higher when
physicians’ average withdrawal
times were less than 6 minutes vs.
greater than 6 minutes (P less than
Data source: Retrospective study of
76,810 colonoscopies performed by
Disclosures: A Veterans Affairs
Career Development program and
the Center for Chronic Disease Outcomes Research funded the study.
The authors reported having no
conflicts of interest.
Short Colonoscopy Procedures Tied to Higher CRC Rates
October Gastroenterology (doi: 10.1053/ j.gastro.2015.06.001)