10A Assan.ppt [Sola lettura]

Valutazione
performance degli
endoscopisti
Variability in colonoscopy efficacy Cohort studies Author Population Endpoint Person-years Follow up
of follow up duration
(years) Winawer Post-Polypectomy Citarda Post-Polypectomy Robertson Post-Polypectomy Incidence Singh H Negative colon. Lakoff J Negative colon. Brenner H Negative colon. Incidence Rex Screening CRC
endpoint
reduction 8,401 14,211 10,786 5.9 10.5 3.7 76% 66% 5% Incidence 147,781 110,402§ 6,581 4.6 14 11.9 31% 55% 100% Incidence 10,492 14.7 48% Incidence Incidence Mortality Variability in colonoscopy efficacy Case-­‐control studies Author Population Endpoint CRC
cases NoCRC endpoint
CRC
reduction controls Brenner H Brenner H Colonoscopy Incidence Neg. colonoscopy Incidence 1,688 380 Muller AD Baxter N Colonoscopy Colonoscopy 16,351 16,351 10,292 51,460 Incidence Mortality 1,932 485 77% 74% 45-49% 31% OPEN ISSUES What are the main reasons of this variability in efficacy of colonoscopy? HR 10 95% CI 1.4-­‐87 Predictors o f interval CRC Author Kaminsky M Study design Cohort Brenner H Case-­‐control Cooper GS Cohort Baxter N Cohort Population Screening Endoscopy
Biology
predictors Predictors Adenoma DR (<20%) NA Colonoscopy Incompleteness,
FOBT+ Medicare Polyp DR (<24%),
non-GI, OC Volume Colonoscopy Incompleteness, Polyp DR (<24%), non-­‐GI specialty, Female sex,
G3-G4 Proximal
location Female sex OPEN ISSUES Is the variability in efficacy related with the quality of colonoscopy? 18 endoscopists 3 462 colonoscopies 25 endoscopists 2 664 colonoscopies 30 centres (144 endoscopists) 3 150 colonoscopies 80%
70%
60%
50%
40%
30%
20%
10%
0%
real
adjusted
30 centres (144 endoscopists) 3 150 colonoscopies Table 2. Multivariate analysis for the detection of polyps and neoplastic lesions. OR: odds ratio.
30 centres (144 endoscopists) Variable
Patients with
polyps
3 150 colonoscopies Patients with
neoplasia
Patients with
advanced
neoplasia
OR (95% CI)
Patient characteristics
Age
BMI
Male sex
Smoking history
Alcohol history
Alarm symptoms
Surveillance
Endoscopic setting
Withdrawal time
measurement
2.2 (1.8-2.6) *
1.2 (1.1-1.4) *
1.5 (1.3-1.8) *
1.5 (1.2-1.7) *
1.2 (1.1-1.5) *
-
2.2 (1.9-2.7) *
1.6 (1.3-1.9) *
1.3 (1.1-1.6) *
1.3 (1.1-1.5) *
-
2.1 (1.7-2.7) *
1.6 (1.3-2) *
1.4 (1.1-1.8) *
1.4 (1.1-2) **
0.5 (0.4-0.7) *
1.3 (1.1-1.5) *
1.3 (1.1-1.6)* **
36%
22%
6%
93%
93%
60% 50% 40% 30% 20% 10% 0% 0 10 20 30 40 50 60 Progetto EQuIPE
(Evaluation of Quality Indicators
of the Performance of
Endoscopy)
ADR in FIT+
E di conseguenza •  SistemaOca rilevazione (“ricostruzione”) della ADR individuale nei tracciaO di screening •  Performance individuale / seWng struXurale •  Performance individuale / seWng extrastruXurale ? (Patologo?) •  Gli altri indicatori (completezza, toileXe…) •  AudiOng in relazione ai CI •  -­‐-­‐-­‐