Initiatives to increase colonoscopy capacity – is there an impact on polyp detection? A UK National Endoscopy Database analysis
Liya Lu, Jamie Catlow, Matthew D. Rutter, Linda Sharp, on behalf of the NED-APRIQOT study team
Endoscopy. 2024 Apr; 56(4): 302–310.
HIGHLIGHTS
- To address increasing endoscopy demand, centers often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). However, there are concerns that such initiatives may negatively impact quality.
- A national, retrospective, cross-sectional study of diagnostic colonoscopies performed during 01/01–04/04/2019 was conducted. The primary outcome was mean number of polyps (MNP) and the secondary outcome was polyp detection rate (PDR).
- 92 .879 colonoscopies (weekends: 19. 977 [21.5 %]; insourced: 9.909 [10.7 %]) were performed by 2496 endoscopists. For weekend colonoscopies, patients were less often male or undergoing screening-related procedures; for insourced colonoscopies, patients were younger and less often undergoing screening-related procedures (all P < 0.05). Fully adjusted MNP was significantly lower for weekend vs. weekday (incidence rate ratio [IRR] 0.86 [95 %CI 0.83–0.89]) and for insourced vs. standard procedures (IRR 0.91 [95 %CI 0.87–0.95]). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures; there was no interaction between procedure day and type. Similar associations were found for PDR.
- The authors concluded that strategies to increase colonoscopy capacity may negatively impact polyp detection and should be monitored for quality. Reasons for this unwarranted variation require investigation.