Prevalence of Forceps Polypectomy of Nondiminutive Polyps Is Substantial But Modifiable

التفاصيل البيبلوغرافية
العنوان: Prevalence of Forceps Polypectomy of Nondiminutive Polyps Is Substantial But Modifiable
المؤلفون: Caitlin C. Murphy, MinJae Lee, Amit G. Singal, Mark Cooper, David I. Fudman
المصدر: Clin Gastroenterol Hepatol
بيانات النشر: Elsevier BV, 2022.
سنة النشر: 2022
مصطلحات موضوعية: medicine.medical_specialty, Hepatology, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Forceps, Gastroenterology, Colonic Polyps, Colonoscopy, Odds ratio, Surgical Instruments, Incomplete Resection, Article, Polypectomy, Confidence interval, Surgery, Clinical Practice, Interquartile range, Prevalence, Humans, Medicine, Colorectal Neoplasms, business, Retrospective Studies
الوصف: BACKGROUND AND AIMS The use of forceps for removal of non-diminutive polyps is associated with incomplete resection compared to snare polypectomy. However, few studies have characterized the frequency of forceps polypectomy for non-diminutive polyps or identified strategies to improve this practice. To address this gap, we estimated prevalence and predictors of forceps polypectomy in clinical practice and examined the effectiveness of a multi-component intervention to reduce inappropriate forceps polypectomy. METHODS We retrospectively reviewed all colonoscopies with polypectomies performed at two U.S. health systems between 10/1/2017 and 9/30/2019. We used a mixed-effects logistic regression model to examine the effect of a multi-component intervention, including provider education and a financial incentive, to reduce inappropriate forceps polypectomy, defined as use of forceps polypectomy for polyps ≥5mm. RESULTS A total of 9968 colonoscopies with 25534 polypectomies were performed by 42 gastroenterologists during the study period. Overall, 8.5% (n=2176) of polyps were removed with inappropriate forceps polypectomy. Inappropriate forceps polypectomy significantly decreased after the intervention (OR 0.34, 95% CI 0.30-0.39), from 11.4% (n=1539) to 5.3% (n=637). Predictors of inappropriate forceps polypectomy included: inadequate bowel prep (OR 1.25, 95% CI 1.06 – 1.47), polyps in the right colon (vs. left: OR 1.29, 95% CI 1.09 – 1.51), and number of polyps removed (OR 0.96, 95% CI 0.94 – 0.97). Inappropriate forceps polypectomy also varied by gastroenterologist (median odds ratio 3.43). In a post-hoc analysis, the proportion of polyps >2mm removed with forceps decreased from 50.0% before the intervention to 43.0% after it (OR 0.62, 95% CI 0.58-0.68). CONCLUSIONS Inappropriate forceps polypectomy is common but modifiable. The proportion of non-diminutive polyps removed with forceps polypectomy should be considered as a quality measure.
تدمد: 1542-3565
DOI: 10.1016/j.cgh.2021.11.031
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::edc97e28fd15f7d16540fa34dbabfa23
https://doi.org/10.1016/j.cgh.2021.11.031
Rights: OPEN
رقم الانضمام: edsair.doi.dedup.....edc97e28fd15f7d16540fa34dbabfa23
قاعدة البيانات: OpenAIRE
الوصف
تدمد:15423565
DOI:10.1016/j.cgh.2021.11.031