Performance of Endoscopists Associated With 10-Year Colorectal Cancer Risk

colon cancer, colorectal neoplasia, colon tumor
Researchers analyzed the impact of colonoscopists’ performance on colorectal cancer risk following adenoma removal.

Colorectal cancer (CRC) risk may be associated with not only polyp characteristics during endoscopy but also with the performance of endoscopists themselves. These findings were published in Gastroenterology.

Inhabitants of Poland aged between 50 and 66 years with no symptoms of CRC are offered colonoscopy screenings every 10 years. Individuals with a family history of CRC are eligible once aged 40 onward. This Polish National Colorectal Cancer Screening Program was established in 2000 and included 132 screening centers. All screenings (n=173,288) between 2000 and 2011 and their follow-up through 2017 performed by 262 endoscopists were included in this analysis of CRC risk predictors. A validation cohort (n=137,169) from the Austrian screening program (n=242 endoscopists) was used to independently confirm these findings.

Patients were aged mean 55.8±5.5 years, 62.2% were women, 19.8% had a first degree relative with CRC, and 82.2% had no adenoma identified during colonoscopy. Interval CRC was diagnosed in 443 individuals after a median of 5.9 (interquartile range [IQR], 4.0-7.9) years.

The median adenoma detection rate for each endoscopist was 17.9% (IQR, 13.1%-23.5%). The majority of colonoscopies (62.5%) were performed by low-performing endoscopists.

Among individuals who were at low-risk for CRC and examined by a low-performing endoscopist, the 10-year CRC incidence rate was 0.55% (95% CI, 0.40%-0.75%) compared with 0.22% (95% CI, 0.14%-0.34%) for their counterparts examined by high-performing clinicians (hazard ratio [HR], 2.35; 95% CI, 1.31-4.21; P =.004).

Among the individuals at high risk for CRC, incidence rates were 1.14% (95% CI, 0.87%-1.48%) and 0.43% (95% CI, 0.27%-0.69%) depending on whether they were examined by low or high performing endoscopists (HR, 2.69; 95% CI, 1.62-4.47; P <.001), respectively.

Among the validation cohort, 103 interval CRCs were diagnosed. CRC risk in individuals with low-risk adenomas was 2.51 per 100,000 person-years among those examined by low-performance clinicians compared with 1.14 per 100,000 person-years examined by high-performing clinicians (HR, 2.11; 95% CI, 0.61-7.28; P =.238). Among high-risk adenomas, CRC incidence was 9.77 and 4.31 per 100,000 person-years depending on low and high performing endoscopists (HR, 2.16; 95% CI, 0.92-5.08; P =.079), respectively.

A similar trend between CRC and endoscopists’ performance was observed among individuals with no adenoma identified during exam. Patients examined by low and high performing endoscopists corresponded with incidence rates of 2.51 and 1.49 per 100,000 person-years (HR, 1.65; 95% CI, 1.03-2.64; P =.038), respectively.

This study may have been limited by not including other predictors for CRC including BMI or tobacco use.

These data indicated that colonoscopy findings, family history, and endoscopists’ performance were important contributors to CRC risk at 10 years.


Wieszczy P, Waldmann E, Løberg M, et al. Colonoscopist performance and colorectal cancer risk after adenoma removal to stratify surveillance: two nationwide observational studies. Gastroenterol. 2021;160(4):1067-1074. doi: 10.1053/j.gastro.2020.10.009