Colonoscopy Quality Assurance in Ontario: Systematic Review and Clinical Practice Guideline

Abstract

Colonoscopy is fundamental to the diagnosis and management of digestive diseases and plays a key role in colorectal cancer (CRC) screening and diagnosis. Therefore, it is important to ensure that colonoscopy is of high quality. The present guidance document updates the evidence and recommendations in Cancer Care Ontario's 2007 Colonoscopy Standards, and was conducted under the aegis of the Program in Evidence-Based Care. It is intended to support quality improvement for colonoscopies for all indications, including follow-up to a positive fecal occult blood test, screening for individuals who have a family history of CRC and those at average risk, investigation for symptomatic patients, and surveillance of those with a history of adenomatous polyps or CRC. A systematic review was performed to evaluate the existing evidence concerning the following three key aspects of colonoscopy: physician endoscopist training and maintenance of competency; institutional quality assurance parameters; and colonoscopy quality indicators and auditable outcomes. Where appropriate, indicators were designated quality indicators (where there was sufficient evidence to recommend a specific target) and auditable outcomes (insufficient evidence to recommend a specific target, but which should be monitored for quality assurance purposes). The guidance document may be used to support colonoscopy quality assurance programs to improve the quality of colonoscopy regardless of indication. Improvements in colonoscopy quality are anticipated to improve important outcomes in digestive diseases, such as reduction of the incidence of and mortality from CRC.

Adenoma Detection Rates Decline with Increasing Procedural Hours in an Endoscopist’s Workload

“…Some studies suggest that operator fatigue, either as a function of the time of day (10), queue position (11,12) or performing emergency procedures the night before the colonoscopy (13), may affect quality (14) and the detection of polyps (15) and adenomas (16), while others have not found this association (17,18). These metrics, as well as others, have been stressed in the clinical practice guideline by Tinmouth et al (19) for colonoscopy quality assurance in Ontario.…”

Standards of diagnostic colonoscopy for early‐stage neoplasia: Recommendations by an Asian private group

“…Establishing a good doctor–patient relationship before any endoscopic procedure with realistic expectations can alleviate some of these stresses and help to provide improved clinical care when adverse events occur . Monitoring of complications has already become a standard quality indicator in many countries, and bleeding rate (<1%) and perforation rate (<0.1%) are often defined as the minimum threshold for assuring quality of endoscopic procedures …”

Endoscopy services and training: a national survey of general surgeons

“…6 To deliver high-quality endoscopy services, CCO guidelines published in 2014 recommend performance of a minimum of 200 colonoscopies per year before being granted access to the endosuite. 7 The Canadian Association of General Surgeons (CAGS) is committed to providing quality endoscopic services and training across the entire country. We invited all general surgeons in Canada to provide their opinions as to the importance of endoscopy in general surgical practice today and to comment further on their competence as endoscopists, their own training and the competence of current trainees.…”