Colonoscopist Performance and Colorectal Cancer Risk After Adenoma Removal to Stratify Surveillance: Two Nationwide Observational Studies

Background and AimsColonoscopy surveillance after adenoma removal is an increasing burden in many countries. Surveillance recommendations consider characteristics of removed adenomas, but not colonoscopist performance. We investigated the impact performance on colorectal cancer risk removal.MethodsWe compared high-risk low-risk negative colonoscopy for all colonoscopies performed by colonoscopists with low vs high quality (adenoma detection rate <20% ?20%) Polish screening program between 2000 2011, follow-up until 2017. Findings were validated Austrian program.ResultsA total 173,288 included study. Of 262 colonoscopists, 160 (61.1%) performers, 102 (38.9%) performers; 11.1% individuals had 6.6% adenomas at screening; 82.2% no adenomas. During 10 years follow-up, 443 cancers diagnosed. For individuals, incidence was 0.55% (95% confidence interval [CI] 0.40–0.75) low-performing 0.22% CI 0.14–0.34) high-performing (hazard ratio [HR] 2.35; 95% 1.31–4.21; P = .004). 1.14% 0.87–1.48) 0.43% 0.27–0.69) (HR 2.69; 1.62–4.47; < .001). After colonoscopy, 0.30% 0.27–0.34) examined 0.15% 0.11–0.20) 2.10; 1.52–2.91; The observed trends reproduced validation cohort.ConclusionsOur results suggest that endoscopist may be important contributor addition to polyp determining screening. Colonoscopy removal. program. A cohort. Our