Browsing by Subject "Adenoma detection rate"

Now showing 1 - 4 of 4
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    Key quality indicators in colonoscopy
    (Oxford University Press, 2023-03-10) Rex, Douglas K.; Medicine, School of Medicine
    Many quality indicators have been proposed for colonoscopy, but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation rate. Use of proper screening and surveillance intervals is another accepted key indicator but it is seldom evaluated in clinical practice. Bowel preparation efficacy and polyp resection skills are areas that are emerging as potential key or priority indicators. This review summarizes and provides an update on key performance indicators for colonoscopy quality.
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    Natural language processing accurately categorizes findings from colonoscopy and pathology reports
    (Elsevier, 2013) Imler, Timothy D.; Morea, Justin; Kahi, Charles; Imperiale, Thomas F.; Medicine, School of Medicine
    Background & aims: Little is known about the ability of natural language processing (NLP) to extract meaningful information from free-text gastroenterology reports for secondary use. Methods: We randomly selected 500 linked colonoscopy and pathology reports from 10,798 nonsurveillance colonoscopies to train and test the NLP system. By using annotation by gastroenterologists as the reference standard, we assessed the accuracy of an open-source NLP engine that processed and extracted clinically relevant concepts. The primary outcome was the highest level of pathology. Secondary outcomes were location of the most advanced lesion, largest size of an adenoma removed, and number of adenomas removed. Results: The NLP system identified the highest level of pathology with 98% accuracy, compared with triplicate annotation by gastroenterologists (the standard). Accuracy values for location, size, and number were 97%, 96%, and 84%, respectively. Conclusions: The NLP can extract specific meaningful concepts with 98% accuracy. It might be developed as a method to further quantify specific quality metrics.
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    Should We Measure Adenoma Detection Rate for Gastroenterology Fellows in Training?
    (Elmer Press, 2018-08) El-Halabi, Mustapha M.; Barrett, Patrick R.; Mateo, Melissa Martinez; Fayad, Nabil F.; Medicine, School of Medicine
    Background: Adenoma detection rate (ADR) is a proven quality metric for colonoscopy. The value of ADR for the evaluation of gastroenterology fellows is not well established. The aim of this study is to calculate and evaluate the utility of ADR as a measure of competency for gastroenterology fellows. Methods: Colonoscopies for the purposes of screening and surveillance, on which gastroenterology fellows participated at the Richard L. Roudebush VAMC (one of the primary training sites at Indiana University), during a 9-month period, were included. ADR, cecal intubation rate, and indirect withdrawal time were measured. These metrics were compared between the levels of training. Results: A total of 591 screening and surveillance colonoscopies were performed by 14 fellows. This included six, four and four fellows, in the first, second and third year of clinical training, respectively. Fellows were on rotation at the VAMC for a mean of 1.9 months (range 1 to 3 months) during the study period. The average ADR was 68.8% (95% CI 65.37 - 72.24). The average withdrawal time was 27.59 min (95% CI 23.45 - 31.73). The average cecal intubation rate was 99% (95% CI 98-100%). There was no significant difference between ADRs, cecal intubation rates, and withdrawal times at different levels of training; however, a trend toward swifter withdrawal times with advancing training was noted. Conclusions: ADR appears not to be a useful measure of competency for gastroenterology fellows. Consideration should be given to alternative metrics that could avoid bias and confounders.
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    Variability in Adenoma Detection Rate in Control Groups of Randomized Colonoscopy Trials
    (Elsevier, 2022) Hassan, Cesare; Piovani, Daniele; Spadaccini, Marco; Parigi, Tommaso; Khalaf, Kareem; Facciorusso, Antonio; Fugazza, Alessandro; Rösch, Thomas; Bretthauer, Michael; Mori, Yuichi; Sharma, Prateek; Rex, Douglas K.; Bonovas, Stefanos; Repici, Alessandro; Medicine, School of Medicine
    Background: Adenoma Detection Rate (ADR) is still the main surrogate outcome parameter of screening colonoscopy, but most of the studies included mixed indications and basic ADR is quite variable. We therefore looked at the control groups in randomized ADR trials using advanced imaging or mechanical methods to find out whether indications or other factors influence ADR levels. Methods: Patients in the control groups of randomized studies on ADR increase using various methods were collected based on a systematic review; this control group had to use high-definition (HD) white-light endoscopy performed between 2008 and 2021. Random-effects meta-analysis was used to pool ADR in control groups and its 95% confidence interval [CI] according to the following parameters: clinical (indication and demographic), study setting (tandem/parallel, N° centres, sample size), and technical (type of intervention, withdrawal time). Inter-study heterogeneity was reported with I-squared statistic. Multivariable mixed-effects meta-regression was performed for potentially relevant variables. Findings: 25,304 patients from 80 studies in the respective control groups were included. ADR in control arms varied between 8.2% and 68.1% with a high degree of heterogeneity (I2 = 95.1%; random-effect pooled value: 37.5% [34.6‒40.5]). There was no difference in ADR levels between primary colonoscopy screening (12 RCTs, 15%), and mixed indications including screening/surveillance and diagnostic colonoscopy; however, FIT as an indication for colonoscopy was an independent predictor of ADR (OR: 1.6 [1.1‒2.4]). Other well known parameters were confirmed by our analysis such as age (OR: 1.038 [1.004‒1.074]) and sex (male sex: OR: 1.02 [1.01‒1.03) as well withdrawal time (OR: 1.1 [1.0‒1.1). The type of intervention (imaging vs. mechanical) had no influence, but methodological factors did: more recent year of publication and smaller sample size were associated with higher ADR. Interpretation: A high level of variability was found in the level of ADR in the controls of RCTs. With regards to indications, only FIT-based colonoscopy studies influenced basic ADR, primary colonoscopy screening appeared to be similar to other indications. Standardization for variables related to clinical, methodological, and technical parameters is required to achieve generalizability and reproducibility.