Impact of Changeover to Newer Endoscopic Systems on Quality and Efficiency of Screening and Surveillance Colonoscopy: Equipment or Endoscopist

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Abstract

Goals:

The goal of this study is to assess whether changeover to newer endoscopic systems impacts quality or efficiency, and quantify the relation between increased withdrawal time and detection rates of sessile serrated polyps (SSPDR) and adenomas (ADR) in real-world practice.

Study:

Beginning 2 months after new endoscopic systems were implemented at 2 endoscopy units, we included all outpatients undergoing screening/surveillance colonoscopy for 4 months. Outpatients during the same 4-month period 1 year earlier comprised the control group. Quality endpoints included ADR, advanced ADR, SSPDR, polyp detection rate (PDR), and withdrawal time. The efficiency endpoint was procedure time. Statistical adjustment for potential confounding factors was performed with multivariable analysis.

Results:

Significant increases occurred in postchangeover (N=1122) versus prechangeover (N=1131) procedure time (difference=2.6 minutes; 1.6 to 3.6) and withdrawal time (difference=1.6 minutes; 0.8 to 2.5). Significant increases also occurred in ADR [435 (39%) vs. 380 (34%)], advanced ADR [82 (7%) vs. 50 (4%)], and PDR [664 (59%) vs. 611 (54%)], but these differences lost significance when withdrawal time was added to the multivariable model. For every minute increase in withdrawal time a significant increase was seen in ADR (OR=1.09; 1.08 to 1.11), advanced ADR (OR=1.10; 1.08 to 1.13), SSPDR (OR=1.07; 1.06 to 1.09), and PDR (OR=1.16; 1.14 to 1.18).

Conclusions:

After changeover to newer endoscopy systems withdrawal times lengthened, resulting in increased procedure time, ADR, and advanced ADR. Regardless of endoscopic system, lengthening withdrawal time increased SSPDR, ADR, and advanced ADR: odds of detection increased 7% to 10% with every additional minute of withdrawal time. Greater attention to withdrawal time and endoscopist examination may be more productive than upgrading endoscopic systems.

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