Search

Objective: Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial., Design: 40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤ 25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders' ADR. Mixed effect models using ORs and 95% CIs were computed., Results: The study included 24,582 colonoscopies performed by 38 leaders and 56,617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017)., Conclusions: Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy., Trial Registration Number: NCT01667198., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background and Study Aims: The aim of this study was to evaluate prospectively the long-term outcomes of using argon plasma coagulation (APC) as an adjunct to piecemeal polypectomy of large sessile colorectal adenomas., Patients and Methods: A total of 77 patients with 82 sessile colorectal adenomas (median size 2.9 cm, range 1.5 - 8.0 cm) underwent snare piecemeal polypectomy. Patients in whom polypectomy was complete received no further treatment (polypectomy group; n = 14). When polypectomy was incomplete, additional treatment with APC was started either immediately or 1 - 3 months after the last polypectomy session (polypectomy + APC group; n = 63). Patients were followed (by endoscopy and biopsy) at regular intervals., Results: Histologically proven adenoma eradication was achieved in 100 % of patients (14/14) in the polypectomy group and in 90 % of patients (57/63) in the polypectomy + APC group (two patients died of unrelated causes before adenoma was eradicated, two underwent operation because cancer was detected in the polyp treated, and two underwent operation because of endoscopic treatment failure). The adenoma recurrence rate was 14 % in both the polypectomy and polypectomy + APC groups. All recurrences except one occurred during the first year of follow-up and all were successfully re-treated endoscopically. A total of 69 patients in whom long-term follow-up data are available are free from adenoma at a median follow-up of 37 months (range 12 - 80). No major complications of endoscopic treatment occurred. In seven cases (9 %) the polyp was eventually shown to be malignant; in two of these patients the diagnosis of cancer was delayed as a result of unsuccessful endoscopic treatment., Conclusions: APC used in combination with piecemeal polypectomy of large colorectal adenomas is an effective and safe method of therapy, provided patient selection is careful and follow-up close.