title: Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3).
abstract: BACKGROUND
  Screening colonoscopy (SC) outcome quality is best determined by the adenoma detection rate (ADR). The substantial variability in the ADRs between endoscopists may reflect different skills, experience and/or equipment.
  
  
  OBJECTIVE
  To analyse the potential factors that may influence ADR variance, including case volume.
  
  
  METHODS
  12,134 consecutive SCs (mean age 64.5 years, 47% men) from 21 Berlin private-practice colonoscopists were prospectively studied during 18 months. The data were analysed using a two-level mixed linear model to adequately address the characteristics of patients and colonoscopists. The ADR was regressed after considering the following factors: sex, age, bowel cleanliness, NSAID intake, annual SC case volume, lifetime experience, instrument withdrawal times, instrument generations used, and the number of annual continuing medical education (CME) meetings attended by the physician. The case volume was also retrospectively analysed from the 2007 national SC registry data (312,903 colonoscopies and 1004 colonoscopists).
  
  
  RESULTS
  The patient factors that correlated with the ADR were sex, age (p<0.001) and low quality of bowel preparation (p=0.005). The factors that were related to the colonoscopists were the number of CME meetings attended (p=0.012) and instrument generation (p=0.001); these factors accounted for approximately 40% of the interphysician variability. Within a narrow range (6-11 min), the withdrawal time was not correlated with the ADR. Annual screening case volume did not correlate with the ADR, and this finding was confirmed by the German registry data.
  
  
  CONCLUSIONS
  The outcome quality of screening colonoscopies is mainly influenced by individual colonoscopist factors (ie, CME activities) and instrument quality.
  
  
  BACKGROUND
  Clinical Trial Gov Registration number: NCT00860665.
authors.affiliation: Central Interdisciplinary Endoscopy, Charité Medical University, Campus Virchow Hospital, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Adler
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: David
authors.initials: D
authors.lastname: Lieberman
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminalai
authors.forename: Jens
authors.initials: J
authors.lastname: Aschenbeck
authors.forename: Rolf
authors.initials: R
authors.lastname: Drossel
authors.forename: Michael
authors.initials: M
authors.lastname: Mayr
authors.forename: Michael
authors.initials: M
authors.lastname: Mroß
authors.forename: Mathias
authors.initials: M
authors.lastname: Scheel
authors.forename: Andreas
authors.initials: A
authors.lastname: Schröder
authors.forename: Katharina
authors.initials: K
authors.lastname: Gerber
authors.forename: Gabriela
authors.initials: G
authors.lastname: Stange
authors.forename: Stephanie
authors.initials: S
authors.lastname: Roll
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gauger
authors.forename: Bertram
authors.initials: B
authors.lastname: Wiedenmann
authors.forename: Lutz
authors.initials: L
authors.lastname: Altenhofen
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosch
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000188:drug therapy; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001604:Berlin; D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D055088:Early Detection of Cancer; D019723:Endoscopes / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal