title: Forceps versus snare polypectomies in colorectal cancer screening: are we adhering to the guidelines?
abstract: OBJECTIVE
  European guidelines for quality assurance in colorectal cancer screening recommend snare resection for polyps > 5 mm. The aim of this study was to investigate polypectomy technique according to lesion size and shape, and to assess adherence of endoscopists enrolled in the national quality assurance program to the European guidelines.
  
  
  METHODS
  This cohort study included screening colonoscopies performed between 2007 and 2013 within a quality assurance program in Austria. Resection technique was analyzed according to lesion characteristics and endoscopy facility (private practices, hospitals, outpatient clinics) before publication of the EU guidelines (2007 - 2010) and adherence to the guidelines after publication (2011 - 2013). All surveillance colonoscopies and examinations with missing data were excluded.
  
  
  RESULTS
  A total of 128 969 screening colonoscopies performed by 278 endoscopy units were included. The polyp detection rate was 39.6 % (n = 47 797) and 95.6 % of polyps were resected. Of polyps ≥ 5 mm, 46.0 % were resected using forceps and were therefore not treated in accordance with the guidelines. Forceps polypectomy of lesions 5 - 10 mm and > 10 mm decreased significantly in hospitals after implementation of the guidelines (both P < 0.0001). In private practices, there was no difference in forceps usage for polyps of 5 - 10 mm (P = 0.41) before and after the guidelines, and for polyps > 10 mm forceps usage even increased (P < 0.0001). Endoscopists' forceps removal rates for polyps ≥ 5 mm correlated significantly with respective adenoma detection rates (P = 0.0007, r p  - 0.187) and cecal intubation rates (P = 0.0001, r p  - 0.303). Among endoscopists in private practices, internists had slightly lower forceps removal rates for polyps ≥ 5 mm than surgeons, both before (47.2 % vs. 50.7 %; P = 0.014) and after publication of the guidelines (51.9 % vs. 53.5 %; P = 0.161).
  
  
  CONCLUSIONS
  This study confirmed the importance of the European guidelines. The inclusion of adequate resection technique as a quality indicator in colorectal cancer screening programs is recommended.
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Martha
authors.initials: M
authors.lastname: Britto-Arias
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Waldmann
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Philip
authors.initials: P
authors.lastname: Jeschek
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Irina
authors.initials: I
authors.lastname: Gessl
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Sallinger
authors.affiliation: Austrian Society of Gastroenterology and Hepatology (OEGGH) Quality Assurance Working Group, Vienna, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Bannert
authors.affiliation: Austrian Society of Gastroenterology and Hepatology (OEGGH) Quality Assurance Working Group, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.affiliation: Austrian Society of Gastroenterology and Hepatology (OEGGH) Quality Assurance Working Group, Vienna, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Weiss
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
authors.affiliation: Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
mesh_terms: D001317:Austria / Q000453:epidemiology; D002983:Clinical Competence; D020685:Colonoscopes / Q000592:standards*; D003113:Colonoscopy / Q000295:instrumentation / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013525:Surgical Instruments