Substantial and sustained improvement of serrated polyp detection after a simple educational intervention: results from a prospective controlled trial

Arne G C Bleijenberg, Monique E van Leerdam, Marloes Bargeman, Jan Jacob Koornstra, Yasmijn J van Herwaarden, Manon Cw Spaander, Silvia Sanduleanu, Barbara A J Bastiaansen, Erik J Schoon, Niels van Lelyveld, Evelien Dekker, Joep E G IJspeert, Arne G C Bleijenberg, Monique E van Leerdam, Marloes Bargeman, Jan Jacob Koornstra, Yasmijn J van Herwaarden, Manon Cw Spaander, Silvia Sanduleanu, Barbara A J Bastiaansen, Erik J Schoon, Niels van Lelyveld, Evelien Dekker, Joep E G IJspeert

Abstract

Objective: Serrated polyps (SPs) are an important cause of postcolonoscopy colorectal cancers (PCCRCs), which is likely the result of suboptimal SP detection during colonoscopy. We assessed the long-term effect of a simple educational intervention focusing on optimising SP detection.

Design: An educational intervention, consisting of two 45 min training sessions (held 3 years apart) on serrated polyp detection, was given to endoscopists from 9 Dutch hospitals. Hundred randomly selected and untrained endoscopists from other hospitals were selected as control group. Our primary outcome measure was the proximal SP detection rate (PSPDR) in trained versus untrained endoscopists who participated in our faecal immunochemical test (FIT)-based population screening programme.

Results: Seventeen trained and 100 untrained endoscopists were included, who performed 11 305 and 51 039 colonoscopies, respectively. At baseline, PSPDR was equal between the groups (9.3% vs 9.3%). After training, the PSPDR of trained endoscopists gradually increased to 15.6% in 2018. This was significantly higher than the PSPDR of untrained endoscopists, which remained stable around 10% (p=0.018). All below-average (ie, PSPDR ≤6%) endoscopists at baseline improved their PSPDR after training session 1, as did 57% of endoscopists with average PSPDR (6%-12%) at baseline. The second training session further improved the PSPDR in 44% of endoscopists with average PSPDR after the first training.

Conclusion: A simple educational intervention was associated with substantial long-term improvement of PSPDR in a prospective controlled trial within FIT-based population screening. Widespread implementation of such interventions might be an easy way to improve SP detection, which may ultimately result in fewer PCCRCs.

Trial registration number: NCT03902899.

Keywords: colonic polyps; colonoscopy; colorectal cancer.

Conflict of interest statement

Competing interests: ED: took endoscopic equipment on loan of Olympus and FujiFilm, received a research grant from FujiFilm, received a honorarium for consultancy from FujiFilm, Tillots, Olympus, JEGI Supply and Cancer Prevention Pharmaceuticals and a speakers' fee from Olympus, Roche and JEGI Supply. EJS: received consultancy and speakers honorarium for FujiFilm.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
(A) PSPDR before and after training; (B) ADR before and after training. ADR, adenoma detection rate; PSPDR, proximal serrated polyp detection rate.
Figure 2
Figure 2
Effect of training sessions 1 and 2 per endoscopist, stratified according to their PSPDR at baseline, after the first training and after the second training. For example, of the seven endoscopists with average PSPDR at baseline, four (57%) moved up to ‘above-average PSPDR’ after training session 1, while three remained in the ‘average PSPDR’ group. PSPDR, proximal serrated polyp detection rate.
Figure 3
Figure 3
PSPDR before and after training. PSPDR, proximal serrated polyp detection rate.

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