Detection of easy-to-miss precancerous polyps improves with brief training class

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A 2-hour course designed to increase clinicians' adenoma detection rate (ADR) made a big difference, even for experienced endoscopists.

The ADR is a measure of success in detecting easy-to-miss polyps known as adenomas, and it has been linked to a reduced risk of developing new cancers after colonoscopy. The current recommended national benchmark is at least 20%, meaning that an endoscopist should be able to detect adenomas in at least one of five patients undergoing colonoscopy.

“Numerous studies have shown that increased detection and removal of potentially precancerous polyps lowers the incidence of colorectal cancer,” says Michael Wallace, MD, MPH, chair of the Division of Gastroenterology and Hepatology at Mayo Clinic in Florida. “We also know that there is a lot of variability in how proficient physicians are at finding those polyps.”

Wallace and colleagues developed a 2-hour course designed to increase a clinician's ADR in order to lower the incidence of colorectal cancer. The course describes polyps that can be difficult to see, such as flat lesions, but are often the most dangerous.

The research team studied whether the course helps by examining the adenoma detection rate of 15 physicians, which was found to be 35%. Then, seven endoscopists were randomly chosen to take the course, and the detection rates of the endoscopists—both those who took the course and the eight who did not—were measured again. Over the course of the study, these physicians performed 2,400 colonoscopies.

The endoscopists who took the course improved their adenoma detection rate to 47%, while the ADR remained at 35% among the doctors who did not take the course.

“This relatively simple education program substantially increased the proficiency of physicians who are already skilled,” Wallace says. “Many people in the field think it is hard to change an endoscopist's level of proficiency, but we show that is not the case.”

These findings were published in The American Journal of Gastroenterology (2013; doi:10.1038/ajg.2012.417).

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