title: Endoscopist specialty is associated with colonoscopy quality.
abstract: BACKGROUND
  Some studies have shown that endoscopist specialty is associated with colorectal cancers missed by colonoscopy. We sought to examine the relationship between endoscopist specialty and polypectomy rate, a colonoscopy quality indicator. Polypectomy rate is defined as the proportion of colonoscopies that result in the removal of one or more polyps.
  
  
  METHODS
  A cross-sectional study was conducted of endoscopists and their patients from 7 Montreal and 2 Calgary endoscopy clinics. Eligible patients were aged 50-75 and covered by provincial health insurance. A patient questionnaire assessed family history of colorectal cancer, history of large bowel conditions and symptoms, and previous colonoscopy. The outcome, polypectomy status, was obtained from provincial health administrative databases. For each city, Bayesian hierarchical logistic regression was used to estimate the odds ratio for polypectomy comparing surgeons to gastroenterologists. Model covariates included patient age, sex, family history of colorectal cancer, colonoscopy indication, and previous colonoscopy.
  
  
  RESULTS
  In total, 2,113 and 538 colonoscopies were included from Montreal and Calgary, respectively. Colonoscopies were performed by 38 gastroenterologists and 6 surgeons in Montreal, and by 31 gastroenterologists and 5 surgeons in Calgary. The adjusted odds ratios comparing surgeons to gastroenterologists were 0.48 (95% CI: 0.32-0.71) in Montreal and 0.73 (95% CI: 0.43-1.21) in Calgary.
  
  
  CONCLUSIONS
  An association between endoscopist specialty and polypectomy was observed in both cities after adjusting for patient-level covariates. Results from Montreal suggest that surgeons are half as likely as gastroenterologists to remove polyps, while those from Calgary were associated with a wide, non-significant Bayesian credible interval. However, residual confounding from patient-level variables is possible, and further investigation is required.
authors: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, 687 Pine Avenue West, V Building, Room V2.15, Montreal, QC H3A 1A1, Canada.
authors: Mengzhu
authors: M
authors: Jiang
authors: Maida J
authors: MJ
authors: Sewitch
authors: Alan N
authors: AN
authors: Barkun
authors: Lawrence
authors: L
authors: Joseph
authors: Robert J
authors: RJ
authors: Hilsden
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D000416:Alberta; D002983:Clinical Competence; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005762:Gastroenterology / Q000592:standards* / Q000706:statistics & numerical data; D013502:General Surgery / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D011792:Quebec; D013038:Specialization
references: Stat Med. 1989 Oct;8(10):1225-30
references: 2814071
references: J Clin Epidemiol. 2004 Feb;57(2):131-41
references: 15125622
references: Br J Surg. 2012 Oct;99(10):1436-44
references: 22961527
references: N Engl J Med. 2006 Dec 14;355(24):2533-41
references: 17167136
references: CMAJ. 2011 Aug 9;183(11):E743-7
references: 21670107
references: Gastroenterology. 2011 Jan;140(1):65-72
references: 20854818
references: Endoscopy. 2011 Nov;43(11):935-40
references: 21997723
references: J Clin Gastroenterol. 2008 Jul;42(6):704-7
references: 18496392
references: Gastrointest Endosc. 2011 Mar;73(3):493-7
references: 21353846
references: Am J Gastroenterol. 2010 Dec;105(12):2588-96
references: 20877348
references: Gastrointest Endosc. 2011 Mar;73(3):498-506
references: 20970795
references: Gastrointest Endosc. 2013 Mar;77(3):381-389.e1
references: 23218945
references: Can J Gastroenterol. 2012 Jan;26(1):17-31
references: 22308578
references: Gastrointest Endosc. 2009 Jun;69(7):1288-95
references: 19481649
references: Gastrointest Endosc. 2008 Dec;68(6):1056-62
references: 18640675
references: Clin Gastroenterol Hepatol. 2010 Mar;8(3):275-9
references: 19879970
references: Am J Gastroenterol. 2007 Apr;102(4):856-61
references: 17222317
references: Endoscopy. 2013;45(1):20-6
references: 23254403
references: Gastrointest Endosc. 2006 Apr;63(4 Suppl):S16-28
references: 16564908
references: Can J Gastroenterol. 2007 Dec;21(12):843-6
references: 18080058
references: Am J Gastroenterol. 2002 Jun;97(6):1296-308
references: 12094842
references: Gastrointest Endosc. 2010 Feb;71(2):335-41
references: 19922930
references: Gastrointest Endosc. 2013 Mar;77(3):390-4
references: 23199647
references: Int J Epidemiol. 2000 Feb;29(1):158-67
references: 10750618
references: Best Pract Res Clin Gastroenterol. 2011 Jun;25(3):349-60
references: 21764003
references: Gut. 2013 Feb;62(2):236-41
references: 22442161
references: Can J Gastroenterol. 2011 Sep;25(9):479-81
references: 21912757
references: Best Pract Res Clin Gastroenterol. 2010 Aug;24(4):451-64
references: 20833349
references: N Engl J Med. 2010 May 13;362(19):1795-803
references: 20463339
references: Gastroenterology. 2007 Jan;132(1):96-102
references: 17241863