title: Endoscopists with low adenoma detection rates benefit from high-definition endoscopy.
abstract: BACKGROUND
  An endoscopists adenoma detection rate (ADR) of less than 20 % correlates with high risk for occurrence of interval cancer. The impact of high-definition (HD) imaging on the ADR is discussed controversially. We aimed to investigate whether detection rates of individual endoscopists increase within 1 year before and 1 year after the switch from standard to HD endoscopy.
  
  
  METHODS
  This cohort study analyzed 6,330 screening colonoscopies (2,968 with standard and 3,362 with HD) performed by 42 endoscopists between November 2007 and March 2013 within a nationwide quality assurance program for screening colonoscopy.
  
  
  RESULTS
  The ADR of endoscopists with a low ADR (<20 %) increased significantly higher (from 11.8 to 18.1 %, p = 0.003) than of those with a high ADR (≥ 20 %) (from 28.6 to 30.7 %, p = 0.439) after switch from standard to HD colonoscopes (p = 0.0076). The proportion of endoscopists with an ADR < 20 % decreased from 45 to 42.9 % (p = 0.593). There was no significant increase in age- and sex-adjusted detection rates of adenomas (20.2 vs 23.7 %; p = 0.089), advanced adenomas (4.7 vs 5.5 %; p = 0.479), flat adenomas (2.7 vs 3.1 %; p = 0.515), polyps (38.8 vs 41.5 %; p = 0.305), proximal polyps (18.5 vs 20 %; p = 0.469) and hyperplastic polyps (15 vs 17.2 %; p = 0.243) of endoscopists after switch to HD colonoscopes. There was no difference in detection rates of flat polyps (5.5 vs 5.5 %; p = 0.987).
  
  
  CONCLUSIONS
  The use of HD scopes is associated with marginal improvement in adenoma detection rates limited to those endoscopists with low adenoma detection rates prior to its introduction.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria, elisabeth.waldmann@meduniwien.ac.at.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Waldmann
authors.forename: Martha
authors.initials: M
authors.lastname: Britto-Arias
authors.forename: Irina
authors.initials: I
authors.lastname: Gessl
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.forename: Petra
authors.initials: P
authors.lastname: Salzl
authors.forename: Daniela
authors.initials: D
authors.lastname: Sallinger
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.forename: Werner
authors.initials: W
authors.lastname: Weiss
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000193:education; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000078329:Workforce