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Initiatives to increase colonoscopy capacity - is there an impact on polyp detection? A UK National Endoscopy Database analysis

Lookup NU author(s): Dr Liya Lu, Dr Jamie Catlow, Professor Matt Rutter, Professor Linda Sharp



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2023 Georg Thieme Verlag. All rights reserved.Background Mismatch between routine endoscopy capacity and demand means centres often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). There are concerns about whether increasing workload to meet demand could negatively impact quality. We investigated polyp detection, a key quality metric, in weekend vs weekday and insourced vs standard procedures using data from the UK National Endoscopy Database (NED). Methods We conducted a national retrospective cross-sectional study of diagnostic colonoscopies undertaken 01/01-04/04/2019. The primary outcome was mean number of polyps (MNP) and the secondary, polyp detection rate (PDR). Multi-level mixed-effect regression, fitting endoscopist as a random effect, was used to examine associations between procedure day (weekend/weekday) and type (insourced/standard) and these outcomes, adjusting for patient age, sex and indication. Results 92,879 colonoscopies (weekends: 19,977 (21.5%); insourced: 9,909 (10.7%)) were performed by 2,496 endoscopists. For weekend colonoscopies, patients were more often female and less often having screening-related procedures; for insourced colonoscopies, patients were younger and less often attending for screening-related procedures (all p<0.05). Case-mix adjusted MNP was significantly lower for weekend vs weekday (IRR=0.86, (95%CI 0.83-0.89)) and for insourced vs standard procedures (IRR=0.91, (95%CI 0.87-0.95)). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures, but there was no interaction between procedure day and type. Similar associations were found for PDR. Conclusions Strategies to increase colonoscopy capacity may have adverse effects on polyp detection. Routine quality monitoring should be undertaken following such initiatives. Meantime, reasons for this unwarranted variation require investigation.

Publication metadata

Author(s): Lu L, Catlow J, Rutter MD, Sharp L

Publication type: Article

Publication status: Published

Journal: Endoscopy

Year: 2023

Issue: ePub ahead of Print

Online publication date: 21/11/2023

Acceptance date: 26/10/2023

Date deposited: 15/01/2024

ISSN (print): 0013-726X

ISSN (electronic): 1438-8812

Publisher: Georg Thieme Verlag


DOI: 10.1055/a-2214-9840

PubMed id: 37989199


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