Lancaster Gastroenterology Procedure Center’s New Technique Has “All Eyes on the Screen”

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According to the GIQuic national database, the typical adenoma detection rate (ADR) is only 26 percent, and the national average for flat polyp detection rate is 4.5 percent. While new technologies: sprays, dyes, etc. offer promise, one group of gastroenterologists and technicians at the Lancaster Gastroenterology Procedure Center are working on a new technique that is an inexpensive way to increase their ADR.   Their technique is called “All Eyes on the Screen.” Led by Dr. Frederick Saunders, they began this technique for improvement in the fall of 2011. “We measured our own experiences in two consecutive quarters, and we looked at what the ADR was for the whole group and each individual doctor,” Dr. Saunders said. They evaluated 1,000 patients between the ages of 50 and 60 who were getting screened for the first time. Their ADR was 34 percent and the flat polyp detection rate was 6 percent. “We noticed during this collection that some of our techs seemed to enjoy identifying polyps,” Dr. Saunders said. “And a few of them were quite good at it. So then the thought occurred to us, ‘why not tell everybody in the room to look for polyps in addition to the endoscopist who’s performing the procedure?’”   They spent six months training all of their techs. Each of them witnessed about 2,000 colonoscopies during the training period. “We gave them some lectures and reviewed several articles about the importance of polyps, the difference shapes and configurations, different subtypes and risk levels, and the impact that it had upon saving lives,” Dr. Saunders said. “They were enrolled in the idea that this was an important task and that they could contribute to the wellbeing of people who were having procedures done.”   After training, Dr. Saunders and his team collected data during the last quarter of 2011 through the first quarter of 2012. They re-measured their data and found that in those six months their ADR went up to 41.7 percent and their flat polyp detection rate was up to 7.7 percent. While there was a slight improvement in both detection rates, they continued to train and collect more data in 2012 and 2013. After those six months, they were shocked with the results. The ADR went up to 52 percent and the flat polyp rate went up to 13.8 percent. “The whole thing sort of matured,” said Dr. Saunders. “The techs got better and everybody got more comfortable with it. The dynamic seemed to work smoothly.”   Dr. Saunders believes that this data is extremely important because it’s an extraordinarily high ADR, particularly with flat polyps. “Statistical analysis over 3 different time frames: the right colon discovery rate, the overall ADR, flat polyp discover rate, were all significant to .001 levels, so it was a highly significant outcome,” Dr. Saunders said. “The second reason we think this data is really important, and why we published this in two different abstracts, is because colonscopists don’t prevent colon cancer nearly as well as we have been telling ourselves. Recent data from last fall’s meetings suggests that colonoscopy prevents 65 at the most 70 percent of cancers. It is not the 90 percent that we had thought, and particularly in the right colon. Right colon cancer death rates are not improved at all. We think that’s because of flat polyps that are just being missed. They are hard to see. And secondly polyps in general in the right colon are not being found as they should be and would be expected.”   Dr. Saunders believes that their study is likely to make a big impact on reducing right colon cancer. He would like to see this technique implemented across the country. “If 50 percent of right colon cancers are being missed, and that counts for probably 10 to 15,000 deaths per year, if those could be prevented by this technology, that’s huge. The only way we’ll know that is to look at the right colon cancer death rate and occurrence rate in our study compared to studies outside.”