Polypectomy techniques, endoscopist characteristics, and serious gastrointestinal adverse events.
BACKGROUND
A use of polypectomy techniques by endoscopist specialty (primary care, surgery, and gastroenterology) and experience (volume), and associations with serious gastrointestinal adverse events, were examined.


METHODS
A retrospective follow-up study with ambulatory surgery and hospital discharge datasets from Florida, 1999-2001, was used. Thirty-day hospitalizations due to colonic perforations and gastrointestinal bleeding were investigated for 323,585 patients.


RESULTS
Primary care endoscopists and surgeons used hot biopsy forceps/ablation, while gastroenterologists provided snare polypectomy or complex colonoscopy. Low-volume endoscopists were more likely to use simpler rather than complex procedures. For hot forceps/ablation and snare polypectomy, low- and medium-volume endoscopists reported higher odds of adverse events. For complex colonoscopy, higher odds of adverse events were reported for primary care endoscopists (1.74 [95% CI, 1.18-2.56]) relative to gastroenterologists.


CONCLUSIONS
Endoscopists regardless of specialty and experience can safely use cold biopsy forceps. For hot biopsy and snare polypectomy, low volume, but not specialty, contributed to increased odds of adverse events. For complex colonoscopy, primary care specialty, but not low volume, added to the odds of adverse events. Comparable outcomes were reported for surgeons and gastroenterologists. Cross-training and continuing medical education of primary care endoscopists in high-volume endoscopy settings are recommended for complex colonoscopy procedures.
Department of Healthcare Policy and Research, School of Medicine, Virginia Commonwealth University, Richmond, Virginia.
Askar
A
Chukmaitov
Cathy J
CJ
Bradley
Bassam
B
Dahman
Umaporn
U
Siangphoe
Doumit
D
BouHaidar
Joan L
JL
Warren
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D005762:Gastroenterology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D013502:General Surgery; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology*; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care; D012189:Retrospective Studies
endoscopist specialty; polypectomy techniques; serious gastrointestinal adverse events