Quality of Colonoscopy Performance among Gastroenterologists and Surgeons in Single Tertiary Center in Quebec
Bibliographic record
Abstract
Purpose: High quality endoscopy is a prerogative for an optimal colorectal cancer screening. Adenoma detection rate (ADR), ceacal intubation rate, withdrawal time, and complication rate are objective mesures of colonoscopy performance. However, previous studies have shown variable colonoscopy performance among different endoscopy specialties. Therefore, we used endoscopy quality markers to compare gastroenterologists (GI) and surgeons (GS) in our institution. Methods: This study was conducted in a single tertiary care teaching hospital, in Sherbrooke, Quebec. Data were prospectively collected from June 2009 to June 2010 from 475 consecutive screening colonoscopies conducted by either gastroenterologists or general surgeons. Quality parameters data were recorded for each colonoscopy and subsequently compared between the two groups. Results: A total of 475 patients were included, 52% female, with a mean age of 58. Twelve gastroenterologists and ten surgeons performed respectively 228 (48%) and 247 (52%) colonoscopies. The completion rate was 98.2% for gastroenterologists and 94.3% for surgeons (p=0.03). Withdrawal time over 6 minutes was achieved in 86.1% of gastroenterologists and 71.7% of surgeons (p<0.001). The polyp detection rate was 44.4%. The adenoma detection rate (ADR) for gastroenterologists was 26.8% and for surgeons 23.5% (p=0.46). Endoscopist-specific ADR ranged between 5.9-50.0 % for GI and 11.4-41.2% for GS. Post-procedure complications rate was 0.4% for GI and GS (p=NS). There were 2 post-polypectomy bleedings treated with supportive care. No perforation occured. Per-procedure complications rate was 4.39% for GI and 9.72% for GS (p=0.02). Conclusion: Surgeons and gastroenterologists in this tertiary care teaching hospital performed equally well in regard to ADR. Gastroenterologists had a significantly better completion rate, less sedation related complication and an average longer withdrawal time. Regardless of these differences, both specialties offered quality colonoscopies, respecting the recommended standards of care. There is still a large inter-endoscopists variability in ADR in both specialty. This issue needs further study and a larger population to draw appropriate conclusion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".