Forceps versus snare polypectomies in colorectal cancer screening: are we adhering to the guidelines?
| Autor: | Martha Britto-Arias, Daniela Sallinger, Monika Ferlitsch, Michael Trauner, Elisabeth Waldmann, Michael Weber, Werner Weiss, Christina Bannert, Irina Gessl, Arnulf Ferlitsch, Philip Jeschek |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Quality Assurance Health Care medicine.medical_treatment Forceps medicine Humans Outpatient clinic Early Detection of Cancer Retrospective Studies Colonoscopes medicine.diagnostic_test business.industry Gastroenterology Cecal intubation Retrospective cohort study Colonoscopy Middle Aged Surgical Instruments Polypectomy Surgery Endoscopy Colorectal cancer screening Austria Female Clinical Competence Guideline Adherence Morbidity Colorectal Neoplasms business Follow-Up Studies Cohort study |
| Zdroj: | Endoscopy. 47:898-902 |
| ISSN: | 1438-8812 0013-726X |
| DOI: | 10.1055/s-0034-1392328 |
| Popis: | European guidelines for quality assurance in colorectal cancer screening recommend snare resection for polyps 5 mm. 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.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.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 ≥ 5 mm, 46.0 % were resected using forceps and were therefore not treated in accordance with the guidelines. Forceps polypectomy of lesions 5 - 10 mm and 10 mm 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 - 10 mm (P = 0.41) before and after the guidelines, and for polyps 10 mm forceps usage even increased (P 0.0001). Endoscopists' forceps removal rates for polyps ≥ 5 mm 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 ≥ 5 mm 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).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. |
| Databáze: | OpenAIRE |
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