Endoscopist Quality Matters After Positive Stool Test


Higher endoscopist polyp detection rates are significantly associated with fewer negative colonoscopies after positive stool tests, suggesting the need for new detection benchmarks, researchers say.


  • Researchers evaluated the degree to which positive stool tests followed by negative colonoscopy (“false-positive” stool tests) vary with endoscopist quality.
  • They analyzed data from the New Hampshire Colonoscopy Registry on 864 patients with a positive multitarget stool DNA (mt-sDNA) test and 497 with a positive fecal immunochemical test (FIT) who underwent follow-up colonoscopy.
  • They compared the frequency of “false” negative colonoscopies and polyp detection across four quartiles of endoscopist adenoma detection rate (ADR) and clinically significant serrated polyp detection rate (CSSDR).


  • Negative colonoscopies were significantly less common among endoscopists with higher ADR and CSSDR, particularly in the top two quartiles.
  • After a positive mt-sDNA test, the rate of detection of any adenoma was 62.8% for endoscopists in the top quartile vs 48.7% in the lowest quartile (P < .001). For CSSDR, detection rates were 66.7% in the top quartile vs 46.9% in the lowest quartile (P < .001).
  • Results were similar after a positive FIT test. Detection of any adenoma was 63.3% in the top quartile vs 35.8% in the lowest quartile (P < .001). For CSSDR, detection rates were 54.6% in the top quartile vs 37.3% in the lowest quartile (P < .001).
  • Significant differences were also observed in the detection of any sessile serrated lesion (SSL) after a positive stool test, with higher detection rates in the top quartile than in the lowest quartile. Among endoscopists in the top quartile of CSSDR, SSLs were found in 29.2% of exams following a positive mt-sDNA test and in 13.5% of those following a positive FIT test.


Based on their findings from high-performing endoscopists, the researchers proposed, “benchmarks of at least 40% (with 60% aspirational detection) for adenoma detection following positive mt-sDNA or FIT, benchmarks of 20% (with 30% aspirational detection) for sessile serrated lesions detection following positive mt-sDNA, and a benchmark of 15% for serrated polyp detection following a positive FIT.”


The study, with first author Lynn F. Butterly, MD, of the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, was published online in The American Journal of Gastroenterology.


The study was limited to a relatively racially homogeneous population in New Hampshire, potentially affecting generalizability. The authors acknowledged the need for further validation of the proposed benchmarks in other populations.


This research was supported by a grant to the New Hampshire Colonoscopy Registry from Exact Sciences. One author is an employee of Exact Sciences.

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