1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
53,000 will die of colorectal cancer in 2022. In 2001, when colonoscopy was first approved, 57,000 died. Why, when colonoscopy done well prevents 90% of deaths are we seeing so little mortality reduction? And no reduction for African American males?
2. Why are you struggling with this issue?
The study published by Xirasagar and de Groen demonstrated that when comprehensive inspection and thorough polyp removal is assured, the promise of near elimination of deaths from colorectal cancer is realistic. Obtaining board certification or privileges to perform colonoscopy DO NOT require any demonstration of proficiency.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
It is clear that the quality of colonoscopy is strongly correlated with subsequent outcomes. Yet we have done nothing to improve training, techniques, quality monitoring or corrective actions. If the simple adenoma detection rate (ADR), the industry standard measure of quality, were employed universally, the 25,000 patient who die despite undergoing colonoscopy screening would be nearly eliminated and the 75,000 cases of CCdC would drop 85%. Yet we continue powerlessly to passively observe continued preventable tragedies. Hospitals and surgery centers should be required to get clear documentation of adequate ADR levels (above 25). Insurers should not compensate doctors who do not provide evidence of adequate polyp detection. Cases of CCdC (Colorectal cancer despite colonoscopy) should be examined by the local tumor boards.
4. When do you need the evidence report?
Saturday, 07/01/2023
5. What will you do with the evidence report?
Present to our hospital's surgical committee. Present to the health department. Ask medical boards to put teeth into the value of board certification. It appears that nearly half of the board-certified gastroenterologists are functioning below the minimum standard. The price innocent patients pay is 75,000 excess cancers and 25,000 excess deaths. We need teeth in demonstration of quality. I have many additional articles on the dramatic results of failure to demand minimal quality in colonoscopy.
Supporting Documentation
Colonoscopy Standards ADR Best Quality Measure (PDF, 124 KB)
Optional Information About You
What is your role or perspective? Colonoscopist
If you are you making a suggestion on behalf of an organization, please state the name of the organization. SC
May we contact you if we have questions about your nomination? Yes
