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Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial
  1. Michal F Kaminski1,
  2. John Anderson2,
  3. Roland Valori3,
  4. Ewa Kraszewska1,
  5. Maciej Rupinski1,
  6. Jacek Pachlewski1,
  7. Ewa Wronska1,
  8. Michael Bretthauer4,5,
  9. Siwan Thomas-Gibson6,
  10. Ernst J Kuipers7,
  11. Jaroslaw Regula1
  1. 1Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
  2. 2Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
  3. 3Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
  4. 4Department of Health Economy and Health Management, University of Oslo, Oslo, Norway
  5. 5Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway
  6. 6Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK
  7. 7Departments of Gastroenterology and Hepatology, and Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to Dr Michal F Kaminski, Department of Gastroenterological Oncology, Institute of Oncology, Roentgen Street 5, Warsaw 02-781, Poland; mfkaminski{at}


Objective Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial.

Design 40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders’ ADR. Mixed effect models using ORs and 95% CIs were computed.

Results The study included 24 582 colonoscopies performed by 38 leaders and 56 617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p<0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017).

Conclusions Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy.

Trial registration number NCT01667198.


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