Commentary: Accrediting colonoscopy services and colonoscopists for screening makes a difference

Valori, Roland; Thomas-Gibson, Siwan

doi:10.1111/codi.14374

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Additionally, there has been a national colonoscopy training programme since 2003 31. There is some evidence that these interventions have improved colonoscopy performance,32 33 34 particularly completion of the procedure and appropriate adenoma detection rates, but further work is required to confirm their impact. It is also noteworthy that providers outside the NHS, which have only recently engaged in JAG accreditation,35 had a higher overall rate of PCCRC-3yr than NHS providers.…”

Section: Discussionmentioning

confidence: 99%

Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study

Burr

Derbyshire

Taylor

et al. 2019

BMJ

118

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ObjectivesTo quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives.DesignPopulation based cohort study.SettingNational Health Service in England between 2005 and 2013.PopulationAll people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr).Main outcome measuresNational trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers.ResultsThe overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix.ConclusionsWide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes.

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Section: Discussionmentioning

confidence: 99%

Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study

Burr

Derbyshire

Taylor

et al. 2019

BMJ

118

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“…Ideally, surveillance of high-risk patients should be done by the best-performing colonoscopists (possibly on dedicated lists as occurs in the English BCSP), 26 adopting longer withdrawal times and, where appropriate, using optimal techniques/technologies to identify precursor lesions. Long and difficult procedures may lead to inattention and failure to identify smaller precursor lesions.…”

Section: Patient Factors Associated With Pccrcmentioning

confidence: 99%

Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

2020

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Causes of Post-colonoscopy Colorectal Cancers Based on WorldEndoscopy Organization System of Analysis BACKGROUND & AIMS: Postcolonoscopy colorectal cancer (PCCRC) is CRC diagnosed after a colonoscopy in which no cancer was found. A consensus article from the World Endoscopy Organization (WEO) proposed an approach for investigating and categorizing PCCRCs detected within 4 years of a colonoscopy. We aimed to identify cases of PCCRC and the factors that cause them, test the WEO system of categorization, quantify the proportion of avoidable PCCRCs, and propose a target rate for PCCRCs detected within 3 years of a colonoscopy that did not detect CRC. METHODS: We performed a retrospective analysis of 107 PCCRCs identified at a single medical center in England from January 1, 2010, through December 31, 2017 using coding and endoscopy data. For each case, we reviewed clinical, pathology, radiology, and endoscopy findings. Using the WEO recommendations, we performed a root-cause analysis of each case, categorizing lesions as follows: possible missed lesion, prior examination adequate; possible missed lesion, prior examination inadequate; detected lesion, not resected; or likely incomplete resection of previously identified lesion. We determined whether PCCRCs could be attributed to the colonoscopist for technical or decision-making reasons, and whether the PCCRC was avoidable or unavoidable, based on the WEO categorization and size of tumor. The endoscopy reporting system provided performance data for individual endoscopists. RESULTS: Of the PCCRCs identified, 43% were in high-risk patients (those with

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“…Since a nationwide colonoscopy quality survey (performed in 1999 and reported in 2004) demonstrated poor results in the English NHS, there have been many quality improvement initiatives in the English NHS that might explain some of the differences [26]. A certification process for both newly independent screening colonoscopists and those screening fecal occult blood tests, a national training infrastructure, and participation of endoscopy services in a unit accreditation scheme that requires services to monitor colonoscopist key performance indicators and act on poor performance, are just some of the initiatives that have not occurred in Denmark [27,28]. A closer look into the colonoscopist background and training reveals differences that may also be relevant.…”

Section: Pccrcmentioning

confidence: 99%

Risk of post-colonoscopy colorectal cancer in Denmark: time trends and comparison with Sweden and the English National Health Service

et al. 2019

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Background The post-colonoscopy colorectal cancer (PCCRC) rate is a key quality indicator for colonoscopy. Previously published PCCRC rates have been difficult to compare owing to differences in methodology. The primary aim of this study was to compare Danish PCCRC rates internationally and to calculate Danish PCCRC rates using the World Endoscopy Organization (WEO) consensus method for future comparison. The secondary aim was to identify factors associated with PCCRC. Methods National registries were used to examine the risk of PCCRC. The Danish 3-year rate of PCCRC (PCCRC-3yr) was calculated using previously published methods from England, Sweden, and the WEO. Poisson regression analysis was performed to identify factors associated with PCCRC. Results The Danish PCCRC-3yr was significantly higher than the rate in the English NHS (relative risk [RR] 1.12, 95 % confidence interval [CI] 1.05 – 1.19) and Sweden (RR 1.15, 95 %CI 1.06 – 1.24). The Danish PCCRC-3yr based on the WEO consensus method fell from 22.5 % in 2001 to 7.9 % in 2012. The multivariable Poisson regression model found PCCRC to be significantly associated with diverticulitis (RR 3.25, 95 %CI 2.88 – 3.66), ulcerative colitis (RR 3.44, 95 %CI 2.79 – 4.23), hereditary cancer (age < 60 years: RR 7.39, 95 %CI 5.77 – 9.47; age ≥ 60 years: RR 3.81, 95 %CI 2.74 – 5.31), and location in the transverse (RR 1.57, 95 %CI 1.28 – 1.94) and ascending colon (RR 1.85, 95 %CI 1.64 – 2.08). Conclusions The PCCRC-3yr was higher in Denmark than in comparable countries. Differences in colonoscopist training, background, and certification are possible contributing factors. A review of colonoscopist training and certification in Denmark, and continuous audit and feedback of colonoscopist performance may reduce PCCRC-3yr.

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Commentary: Accrediting colonoscopy services and colonoscopists for screening makes a difference

Cited by 5 publications

References 7 publications

Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study

Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study

Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis

Risk of post-colonoscopy colorectal cancer in Denmark: time trends and comparison with Sweden and the English National Health Service

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