September 2021 - Elisabeth Waldmann

Dr. Elisabeth Waldmann

MedUni Wien RESEARCHER OF THE MONTH September 2021

Post-screening colorectal cancer (PSCRC) is associated with endoscopists’ performance, measured by the adenoma detection rate (ADR) of an endoscopist, and characteristics of resected lesions. However, the relative impact of those two features needed further study.
The present cohort study included 352,685 individuals (51.0% women, median age 60 years) who underwent screening colonoscopy between 1/2008 and 12/2019 performed by 387 physicians participating in a quality assurance program in Austria. Data were linked with hospitalization data for the diagnosis of PSCRC, defined as CRC diagnosis >6 months after colonoscopy. During a median follow-up of 55.4 month, 241 (0.06%) PSCRC were identified. To characterize performance quality of an endoscopist, we introduced a novel, dynamic calculation of the ADR, which accounts for possible changes over time. Both adenoma characteristics (size, number, histological features) and ADR may play a similar role for the risk of PSCRC. Therefore, decision about surveillance intervals after screening colonoscopy may include endoscopists’ ADR, dynamically calculated, in addition to lesion characteristics.

However, the relative impact of those two features  characterize performance quality of an endoscopist, we introduced a novel, dynamic calculation of the adenoma detection rate (ADR), which accounts for the possible changes over time

• Using this dynamic ADR and a more liberal time definition of post-screening colorectal cancer, we confirmed that both were correlated. HR per 10% increase in ADR 0.7 (95% Confidence Interval 0.60-0.82)
• The impact of both adenoma parameters and endoscopist quality (ADR) appeared to be of similar importance.
• The rate of advanced adenomas showed a similar correlation and does not appear to be a superior quality parameter compared to overall ADR.
• Decision about surveillance intervals after screening colonoscopy may include endoscopists’ ADR in addition to lesion characteristics

Selected Literature

1. Waldmann E, Penz D, Sinkovec H, Heinze G, Rinner C, Jiricka L, Majcher B, Hinterberger A, Trauner M, Ferlitsch M. Interval cancer after colonoscopy in the Austrian National Screening Programme: influence of physician and patient factors. Gut oct 6:gutjnl-2019-319427 (2020) Online ahead of print.
2. Wieszczy P*, Waldmann E*, Loberg M, Regula J, Rupinski M, Bugajski M, Gray K, Kalager M, Ferlitsch M, Kaminski M*, Bretthauer M*. Colonoscopist Performance and colorectal cancer risk after adenoma removal to stratify surveillance: two nationwide observational studies. Gastroenterology 160, 1067-1074 (2021)
3. Waldmann E, Kammerlander A, Gessl I, Penz D, Majcher B, Hinterberger A, Bretthauer M, Trauner M, Ferlitsch M Association of Adenoma Detection Rate and Adenoma Characteristics with Colorectal Cancer Mortality after screening colonoscopy. Clinical Gastroenterology and Hepatology 17:S1542-3565(21)00457-2 (2021) Online ahead of print.
4. Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Paspatis G, Jover R, Langner C, Bronzwaer M, Nalankilli K, Fockens P, Gralnek I, Gschwantler M, Waldmann E, Jeschek P, Heresbach D, Moons L, Lemmers A, Paraskeva K, Pohl J, Ponchon T, Regula J, Repici A, Rutter M, Burgess NG, Bourke MJ.  Colorectal polypectomy and endoscopic mucosal resection (EMR) guideline of the European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 49, 270-297 (2017)
5. Waldmann E, Heinze G, Ferlitsch A, Gessl I, Sallinger D, Jeschek P, Britto-Arias M, Salzl P, Fasching E, Jilma B, Kundi M, Trauner M, Ferlitsch M. Risk factors cannot explain the higher prevalence rates of precancerous lesions in men. British Journal of Cancer 115, 1421-1429 (2016)
6. Waldmann E, Gessl I, Sallinger D, Jeschek P, Britto-Arias M, Heinze G, Fasching E, Weiss W, Gschwantler M, Trauner M, Ferlitsch M. Trends in quality of screening colonoscopy in Austria. Endoscopy 48, 1102-1109 (2016)