Quality is very important in colonoscopy. There are various methods to assess the quality of colonoscopy (colonoscopists). One of these is the percentage of patients in whom one or more abnormal (pre cancerous) polyp(s) is detected. This is called the adenoma detection rate (ADR).
The current (scientifically supported) evidence suggests polyps become bowel cancer. Even small polyps may progress to advanced lesions in a short timeframe (Dekker et al). It therefore makes sense that the greater number of polyps detected the greater the reduction in colon cancer. However is was not until 2014 that a study published in the New England journal of Medicine (Quesenberry et al) proved this. This study showed that for every 1% increase in ADR there was a 5% decrease in bowel cancer death.
Dr Kostalas believes that quality colonoscopy is supremely important. Dr Kostalas has an extremely high adenoma detection rate (p 4 D Rex). For more details on what the adenoma detection rate means and what the proposed targets should be please click this link (Ponchon et al). In consecutive symptomatic/surveillance patients (over 1000 colonoscopies in 2016) aged 50 years or older his ADR is over 87%. During the same time period his sessile serrated ADR (ssADR) was 49% (p 3 D Rex).
It is extremely important for quality metrics to be monitored, recorded and proof of up- to-date practice be detailed / logged. With recognition that colonoscopic training needs to be constant, updated and lifelong "The Gastroenterological Society of Australia (GESA) has introduced a voluntary program that provides for recertification every three years. The program aims to encourage practitioners to maintain and develop their expertise in colonoscopy and to increase safety standards and the quality of care being delivered to patients. The Gastroenterological Society of Australia introduced recertification with the aim "to assist practitioners, referring doctors, and users of colonoscopy services (patients) in determining which colonoscopy practitioners are currently recertified by the GESA Colonoscopy Recertification Program" Dr Kostalas was one of the first practitioners to undertale this process and was first recertified in 2016 (GESA recertification).
The recertification process provides data comparing the colonoscopist to the minimum standard and the peer mean. Dr Kostalas and Dr Sundaralingam have provided their metrics below.
Dr Stuart Kostalas
Dr Praka Sundaralingam
In many large international centres decisions on the treatment of advanced polyps and early cancers are made after review by a multidisciplinary team. This process is intended to encourage a wide range of opinions and perspectives with the goal of providing the best outcome for the patient. This process is not mandatory in Australia.
Dr Kostalas has a particular interest and further training in gastroenterological endoscopic surgery. He is happy to provide advice or a second opinion on whether early cancers or (advanced) polyps could be treated endoscopically or require conventional surgery.
It is important to note that all medical procedures have inherent risk. These risks, along with the benefits and limitations of procedures need to be discussed with both the referring doctor and Dr Kostalas. Information contained on this website is NOT a subsitute for a medical consultation.