L’expertise alla polipectomia è associata alla qualità della colonscopia

 

Assessing Colon Polypectomy Competency and its Association with Established Quality Metrics.Duloy AM, Kaltenbach TR, Keswani RN. Gastrointest Endosc. 2017 Sep 4. [Epub ahead of print]

 

BACKGROUND & AIMS: Inadequate polypectomy leads to incomplete resection, interval colorectal cancer, and adverse events. However, polypectomy competency is rarely reported and quality metrics are lacking. The primary aims of this study were to (1) assess polypectomy competency among a cohort of gastroenterologists, and (2) measure the correlation between polypectomy competency and established colonoscopy quality metrics (adenoma detection rate [ADR] and withdrawal time [WT]).

METHODS:We conducted a prospective observational study to assess polypectomy competency amongst 13 high-volume screening colonoscopists at an academic medical center. Over 6 weeks, we video-recorded >28 colonoscopies per colonoscopist and randomly selected 10 polypectomies per colonoscopist for evaluation. Two raters graded the polypectomies using the Direct Observation of Polypectomy Skills (DOPyS), a polypectomy competency assessment tool, which assesses individual polypectomy skills and overall competency.RESULTS:We evaluated 130 polypectomies. A total of 83 (64%) polypectomies were rated as competent, more common for diminutive (70%) than small-large polyps (50%, P = .03). Overall DOPyS competency scores varied significantly among colonoscopists (P = .001) with overall polypectomy competency rates ranging between 30% to 90%. Individual skills scores, such as accurately directing the snare over the lesion (P = .02) and trapping an appropriate amount of tissue within the snare (P = .001) varied significantly between colonoscopists. Polypectomy competency rates did not significantly correlate with ADR (r=0.4, P = .2) or WT (r=0.2, P = .5).CONCLUSIONS:Polypectomy competency varies significantly among colonoscopists and does not sufficiently correlate with established quality metrics. Given the clinical implications of suboptimal polypectomy, efforts to educate in polypectomy techniques and develop a metric of polypectomy quality are needed.

 

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