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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1321-E1331
DOI: 10.1055/a-1221-4922
Original article

Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

Natalia S. Causada-Calo‡
 1   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Emmanuel I. Gonzalez-Moreno‡
 2   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
 3   Department of Community Health Sciences, University of Calgary, Calgary, Canada
,
Kirles Bishay
 1   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Risa Shorr
 4   Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Catherine Dube
 5   Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Canada
 6   Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
,
Steven J. Heitman
 2   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
 3   Department of Community Health Sciences, University of Calgary, Calgary, Canada
,
Robert J. Hilsden
 2   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
 3   Department of Community Health Sciences, University of Calgary, Calgary, Canada
,
Alaa Rostom
 5   Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Canada
 6   Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
,
Catharine Walsh
 7   Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute, and Research Institute, Hospital for Sick Children, Toronto, Canada
 8   The Wilson Centre, University of Toronto, Toronto, Canada
 9   Department of Pediatrics, University of Toronto, Toronto, Canada
,
John T. Anderson
10   Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Gloucester, UK
,
Rajesh N. Keswani
11   Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, USA
,
Michael A. Scaffidi
 1   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Samir C. Grover
 1   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
12   Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
,
Nauzer Forbes
 2   Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
 3   Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Abstract

Background and study aims The quality of screening-related colonoscopy depends on several physician- and patient-related factors. Adenoma detection rate (ADR) varies considerably between endoscopists. Educational interventions aim to improve endoscopists’ ADRs, but their overall impact is uncertain. We aimed to assess whether there is an association between educational interventions and colonoscopy quality indicators.

Methods A comprehensive search was performed through August 2019 for studies reporting any associations between educational interventions and any colonoscopy quality indicators. Our primary outcome of interest was ADR. Two authors assessed eligibility criteria and extracted data independently. Risk of bias was also assessed for included studies. Pooled rate ratios (RR) with 95 % confidence intervals (CI) were reported using DerSimonian and Laird random effects models.

Results From 2,253 initial studies, eight were included in the meta-analysis for ADR, representing 86,008 colonoscopies. Educational interventions were associated with improvements in overall ADR (RR 1.29, 95 % CI 1.25 to 1.42, 95 % prediction interval 1.09 to 1.53) and proximal ADR (RR 1.39, 95 % CI 1.29 to 1.48), with borderline increases in withdrawal time, ([WT], mean difference 0.29 minutes, 95 % CI – 0.12 to 0.70 minutes). Educational interventions did not affect cecal intubation rate ([CIR], RR 1.01, 95 % CI 1.00 to 1.01). Heterogeneity was considerable across many of the analyses.

Conclusions Educational interventions are associated with significant improvements in ADR, in particular, proximal ADR, and are not associated with improvements in WT or CIR. Educational interventions should be considered an important option in quality improvement programs aiming to optimize the performance of screening-related colonoscopy.

Supplementary material



Publication History

Received: 08 April 2020

Accepted: 25 June 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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