Performance measures for endoscopy services: A European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative

Valori, Roland; Cortas, George; Lange, Thomas de; Balfaqih, Omer Salem; Pater, Marjon de; Eisendrath, Pierre; Falt, Přemysl; Koruk, İrfan; Ono, Akiko; Rustemović, Nadan; Schoon, Erik J.; Veitch, Andrew; Senore, Carlo; Bellisario, Cristina; Bennett, Cathy; Bretthauer, Michael; Dinis-Ribeiro, Mário; Domagk, Dirk; Hassan, Cesare; Rees, Colin; Spada, Cristiano; Bisschops, Raf; Rutter, Matthew D.

doi:10.1177/2050640618810242

Cited by 25 publications

(23 citation statements)

References 35 publications

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“…However, the processes of quality assurance (QA) of both service and training remain integral to the overall JAG quality framework. The JAG QA process assesses endoscopy units on criteria specifically related to training and the training environment; engagement and benchmarking ensures that standards are maintained and improved 10…”

Section: Recommendation Statementsmentioning

confidence: 99%

“…The JAG QA process assesses endoscopy units on criteria specifically related to training and the training environment; engagement and benchmarking ensures that standards are maintained and improved. 10 …”

Section: Recommendation Statementsmentioning

confidence: 99%

“…Endoscopy training should ideally be provided by individuals with the requisite skills and behaviours to teach endoscopy effectively, including an awareness of the principles of adult education, best practices in procedural skills education and appropriate use of beneficial educational strategies such as feedback. 10 40 41 Trainers in OGD should have appropriate training for their role and undertake regular performance review. Ideally, all trainers will have completed an endoscopy-focused Train-the-Trainer’s (TTT) course.…”

Section: Recommendation Statementsmentioning

confidence: 99%

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JAG consensus statements for training and certification in oesophagogastroduodenoscopy

Siau

Beales

Haycock

et al. 2022

Frontline Gastroenterol

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IntroductionTraining and quality assurance in oesophagogastroduodenoscopy (OGD) is important to ensure competent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for OGD training and certification.MethodsUnder the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted with stakeholder representation from British Society of Gastroenterology, Association of Upper Gastrointestinal Surgeons, trainees and trainers. Recommendations on OGD training and certification were formulated following literature review and appraised using Grading of Recommendations Assessment, Development and Evaluation. These were subjected to electronic voting to achieve consensus. Accepted statements were incorporated into the updated certification pathway.ResultsIn total, 32 recommendation statements were generated for the following domains: definition of competence (4 statements), acquisition of competence (12 statements), assessment of competence (10 statements) and post-certification support (6 statements). The consensus process led to following certification criteria: (1) performing ≥250 hands-on procedures; (2) attending a JAG-accredited basic skills course; (3) attainment of relevant minimal performance standards defined by British Society of Gastroenterology/Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, (4) achieving physically unassisted D2 intubation and J-manoeuvre in ≥95% of recent procedures, (5) satisfactory performance in formative and summative direct observation of procedural skills assessments.ConclusionThe JAG standards for diagnostic OGD have been updated following evidence-based consensus. These standards are intended to support training, improve competency assessment to uphold standards of practice and provide support to the newly-independent practitioner.

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Section: Recommendation Statementsmentioning

confidence: 99%

Section: Recommendation Statementsmentioning

confidence: 99%

Section: Recommendation Statementsmentioning

confidence: 99%

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JAG consensus statements for training and certification in oesophagogastroduodenoscopy

Siau

Beales

Haycock

et al. 2022

Frontline Gastroenterol

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“…Possible reasons for a patient to undergo more than one baseline colonoscopy before surveillance can start may be suboptimal endoscopist performance or inadequate colonoscopy centre services. Examples of inadequate colonoscopy centre services include handling of patients with needs related to literacy, compliance or comorbidities resulting in poor bowel cleansing or anticoagulation therapy that is not discontinued before colonoscopy, or inappropriate time schedules, workflow or staff communication 7…”

Section: Introductionmentioning

confidence: 99%

“…There is limited evidence regarding clinical practice variation for treatment of patients with colorectal polyps to meet high-quality requirements for baseline colonoscopy as recommended in current guidelines 4 7. Thus, needs and opportunities for improvement are unknown.…”

Section: Introductionmentioning

confidence: 99%

Rates of repeated colonoscopies to clean the colon from low-risk and high-risk adenomas: results from the EPoS trials

Juul

Garborg

Nesbakken

et al. 2022

Gut

Self Cite

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ObjectiveHigh-quality colonoscopy (adequate bowel preparation, whole-colon visualisation and removal of all neoplastic polyps) is a prerequisite to start polyp surveillance, and is ideally achieved in one colonoscopy. In a large multinational polyp surveillance trial, we aimed to investigate clinical practice variation in number of colonoscopies needed to enrol patients with low-risk and high-risk adenomas in polyp surveillance.DesignWe retrieved data of all patients with low-risk adenomas (one or two tubular adenomas <10 mm with low-grade dysplasia) and high-risk adenomas (3–10 adenomas, ≥1 adenoma ≥10 mm, high-grade dysplasia or villous components) in the European Polyp Surveillance trials fulfilling certain logistic and methodologic criteria. We analysed variations in number of colonoscopies needed to achieve high-quality colonoscopy and enter polyp surveillance by endoscopy centre, and by endoscopists who enrolled ≥30 patients.ResultsThe study comprised 15 581 patients from 38 endoscopy centres in five European countries; 6794 patients had low-risk and 8787 had high-risk adenomas. 961 patients (6.2%, 95% CI 5.8% to 6.6%) underwent two or more colonoscopies before surveillance began; 101 (1.5%, 95% CI 1.2% to 1.8%) in the low-risk group and 860 (9.8%, 95% CI 9.2% to 10.4%) in the high-risk group. Main reasons were poor bowel preparation (21.3%) or incomplete colonoscopy/polypectomy (14.4%) or planned second procedure (27.8%). Need of repeat colonoscopy varied between study centres ranging from 0% to 11.8% in low-risk adenoma patients and from 0% to 63.9% in high-risk adenoma patients. On the second colonoscopy, the two most common reasons for a repeat (third) colonoscopy were piecemeal resection (26.5%) and unspecified reason (23.9%).ConclusionThere is considerable practice variation in the number of colonoscopies performed to achieve complete polyp removal, indicating need for targeted quality improvement to reduce patient burden.Trial registration numberNCT02319928.

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Quality of clinical guidelines: It matters as it impacts patient care

Levink,

Balduzzi,

Marafini

et al. 2024

UEG Journal

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Performance measures for endoscopy services: A European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative

Cited by 25 publications

References 35 publications

JAG consensus statements for training and certification in oesophagogastroduodenoscopy

JAG consensus statements for training and certification in oesophagogastroduodenoscopy

Rates of repeated colonoscopies to clean the colon from low-risk and high-risk adenomas: results from the EPoS trials

Quality of clinical guidelines: It matters as it impacts patient care

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