title: Inter-endoscopist variation in polyp and neoplasia pick-up rates in flexible sigmoidoscopy screening for colorectal cancer.
abstract: BACKGROUND
  The Norwegian Colorectal Cancer Prevention study is an ongoing flexible sigmoidoscopy (FS) screening trial for colorectal cancer. Twenty-one thousand average-risk individuals, aged 50-64 years, living in two separate areas in Norway were randomly drawn from the Population Registry and invited to once-only screening flexible sigmoidoscopy. Examinations were performed over 3 years, at 2 centres, by 8 different endoscopists, using the same type of equipment. The aim of the present study was to investigate possible differences between endoscopists in detecting individuals with polyps, adenomas and advanced lesions (adenomas with severe dysplasia and/or villous components and/or size larger than 9 mm and carcinoma) in flexible sigmoidoscopy screening.
  
  
  METHODS
  The present trial comprises data from 8822 individuals, aged 55-64 years, who have undergone a flexible sigmoidoscopy. In the study period, all lesions detected by the different endoscopists were registered. Tissue samples were taken from all lesions detected.
  
  
  RESULTS
  Detection rates varied significantly between endoscopists, ranging from 36.4% to 65.5% for individuals with any polyp, from 12.7% to 21.2% for any adenoma and from 2.9% to 5.0% for advanced lesions. In a multiple logistic regression model, the performing endoscopist was a strong independent predictor for detection of individuals with polyps (P < 0.001 ), adenomas (P < 0.001) and advanced lesions (P = 0.01).
  
  
  CONCLUSIONS
  Detection rates for colorectal lesions vary significantly between endoscopists in colorectal cancer screening. Establishing systems for monitoring performance in screening programmes is important. Supervised training and re-certification for endoscopists with poor performance should be considered.
authors.affiliation: NORCCAP Centres of Telemark Hospital, Skien, Norway. michael.bretthauer@sthf.no
authors.forename: M
authors.initials: M
authors.lastname: Bretthauer
authors.forename: E
authors.initials: E
authors.lastname: Skovlund
authors.forename: T
authors.initials: T
authors.lastname: Grotmol
authors.forename: E
authors.initials: E
authors.lastname: Thiis-Evensen
authors.forename: G
authors.initials: G
authors.lastname: Gondal
authors.forename: G
authors.initials: G
authors.lastname: Huppertz-Hauss
authors.forename: P
authors.initials: P
authors.lastname: Efskind
authors.forename: B
authors.initials: B
authors.lastname: Hofstad
authors.forename: S
authors.initials: S
authors.lastname: Thorp Holmsen
authors.forename: T J
authors.initials: TJ
authors.lastname: Eide
authors.forename: G
authors.initials: G
authors.lastname: Hoff
mesh_terms: D002983:Clinical Competence; D003111:Colonic Polyps / Q000175:diagnosis* / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015588:Observer Variation; D015995:Prevalence; D012812:Sigmoidoscopy