14 - Endoscopist Aggregated Hot Snare Polypectomy Rate Is Associated With Increased Risk of Colonoscopy Adverse Events

Award: ACG Outstanding Research Award in the Colorectal Cancer Prevention Category

Seth Crockett, MD¹, Jennifer Holub, MA, MPH², Audrey H. Calderwood, MD, MS³, Rajesh N. Keswani, MD, MS^4
1Oregon Health & Science University, Portland, OR; ²GI Quality Improvement Consortium, Ltd., Bethesda, MD; ³Dartmouth Hitchcock Medical Center, Lebanon, NH; ⁴Northwestern Feinberg School of Medicine, Chicago, IL

Introduction: In addition to polyp detection, polypectomy is a critical component of effective screening and surveillance colonoscopy. Polypectomy method impacts both the completeness of polypectomy and risk of adverse events. In particular, hot snare polypectomy is associated with a higher risk of post-polypectomy bleeding, yet hot snare use varies widely among endoscopists. We aimed to determine whether an aggregate measure of an endoscopist’s polypectomy practice (hot snare polypectomy rate: HSPR) was associated with colonoscopy adverse events.

Methods: We included complete screening and surveillance colonoscopies with one or more small ( < 1 cm) polyp(s) removed in patients aged 40-80 in the GIQuIC registry between 2019-2022. Diagnostic procedures, those with larger polyps or colorectal cancer, and inadequate bowel prep were excluded. Polypectomy technique was available through pre-set fields. The HSPR, defined as the proportion of colonoscopies with ≥1 small polyp during which HSP was used for at least one polyp, was calculated for each endoscopist. We then assessed whether patients had a 2^nd colonoscopy within 30 days of the index exam for: A) any indication; or B) bleeding specifically. Bivariate proportions were compared by Chi-squared tests, and multivariable analysis was performed using logistic regression.

Results: We identified 1,572,414 unique patients who had ≥1 small polyp(s) removed. Among these, 291 patients had a 2^nd colonoscopy within 30 days, 110 of which were for bleeding. Among the performing endoscopists (n=3,372), the mean HSPR (± SD) was 10.3% (±13.3). On multivariable analysis, controlling for potential patient-level confounders including age, sex, ASA classification, and antithrombotic use, GI specialty training was inversely associated with repeat colonoscopy (aOR 0.52, 95% CI 0.38, 0.70). In contrast, high endoscopist HSPR ( > 10%) was associated with increased risk of a 2^nd colonoscopy both overall (aOR 1.54, 95% CI 1.19, 1.99) and for bleeding (aOR 2.29, 95% CI 1.53, 3.42) (Table).

Discussion: The risks of repeat colonoscopy and post-colonoscopy bleeding were higher for patients whose index colonoscopy was performed by endoscopists with high hot snare usage. Endoscopist-level training and quality improvement efforts directed at optimizing polypectomy practices may reduce the incidence of colonoscopy adverse events.



Disclosures:


Seth Crockett, MD¹, Jennifer Holub, MA, MPH², Audrey H. Calderwood, MD, MS³, Rajesh N. Keswani, MD, MS⁴, 14, Endoscopist Aggregated Hot Snare Polypectomy Rate Is Associated With Increased Risk of Colonoscopy Adverse Events, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.