Quality indicators for colonoscopy

Rex, Douglas K.; Petrini, John L.; Baron, Todd H.; Chak, Amitabh; Cohen, Jonathan; Deal, Stephen E.; Hoffman, Brenda J.; Jacobson, Brian C.; Mergener, Klaus; Petersen, Bret T.; Safdi, Michael; Faigel, Douglas O.; Pike, Irving M.

doi:10.1016/j.gie.2014.07.058

Cited by 1,159 publications

(1,063 citation statements)

References 184 publications

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“…There should have been at least 150 examinations performed in the preceding 12 months by each endoscopist. [1][2][3][4][5] Three of the staff performing the procedure worked in the colorectal service and easily met this requirement, suggesting that we have an adequate caseload for the training of colorectal specialists. The remaining procedures were preformed by a variety of endoscopists from different services.…”

Section: Discussionmentioning

confidence: 99%

“…Inadequate bowel preparation makes the procedure technically more challenging and increases the risk of an incomplete study and of complications. [1][2][3]8,9] 3. Rate of complete colonoscopy.…”

Section: Quality Of Bowel Preparation the Asgementioning

confidence: 99%

“…The rate of complete colonoscopy should be >90% for diagnostic colonoscopy and >95% for screening colonoscopy; these rates are being achieved in our endoscopy service. [1][2][3] Both endoscopists with more than a year's experience with the procedure had significantly higher completion rates than the first-year trainee. 4.…”

Section: Quality Of Bowel Preparation the Asgementioning

confidence: 99%

“…[1][2][3] However, colonoscopy is technically difficult to master and is associated with a significant number of complications. There has therefore been considerable interest in attempts to standardise the teaching of the procedure and in the accreditation of endoscopists, and several regulatory bodies and societies have developed norms and quality markers for endoscopists.…”

mentioning

confidence: 99%

“…There has therefore been considerable interest in attempts to standardise the teaching of the procedure and in the accreditation of endoscopists, and several regulatory bodies and societies have developed norms and quality markers for endoscopists. [1][2][3] The advent of dedicated colonoscopic screening programmes around the world has focused attention on the sensitivity and specificity of colonoscopy, and the endoscopist must provide proof of competency based on detailed logbooks. Logbooks are also required for training purposes.…”

mentioning

confidence: 99%

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An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service

2015

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Background. Competence in colonoscopy, which is a technically difficult procedure, requires adequate exposure to it and the maintenance of a detailed logbook. Without an electronic record this is difficult to achieve. By implementing an electronic medical record system we aimed to perform a detailed quality assessment audit of colonoscopy, to benchmark our results and generate accurate logbooks for individual endoscopists. Methods. We reviewed the prospectively maintained Hybrid Electronic Medical Registry (HEMR). Colonoscopies performed betweenMarch 2013 and March 2014 were reviewed, and for competency, quality metrics were derived from the guidelines of the American Society of Gastroenterology. Results. A total of 843 colonoscopies were performed. Seven hundred and seventy procedures were performed by three staff endoscopists who each performed over the required 150 procedures annually (n=197, 338 and 235). The remaining 73 (8.7%) were performed by other staff. In 105 cases (12.5%), bowel preparation was deemed to be inadequate, which caused the procedure to be abandoned in 34 cases. A total of 64 cases were deemed to be incomplete because of obstructing lesions (n=26), extensive diverticulosis (n=4), technical difficulty (n=31) and patient discomfort (n=3). There were two complications recorded: perforation (n=1) and bleeding (n=1). Conclusions. The HEMR system enabled the audit of experiences with colonoscopy in our institution. Our results are broadly compatible with the international literature and with a number of guidelines. The development of an electronic record system is a major advance, as it enables meaningful benchmarking and the generation of accurate procedural logbooks.

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Section: Discussionmentioning

confidence: 99%

Section: Quality Of Bowel Preparation the Asgementioning

confidence: 99%

Section: Quality Of Bowel Preparation the Asgementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service

2015

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Variation in Adenoma Detection Rate and the Lifetime Benefits and Cost of Colorectal Cancer Screening

Meester

Doubeni

Lansdorp–Vogelaar

et al. 2015

JAMA

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IMPORTANCE Colonoscopy is the most commonly used colorectal cancer screening test in the United States. Its quality, as measured by adenoma detection rates (ADRs), varies widely among physicians, with unknown consequences for the cost and benefits of screening programs.OBJECTIVE To estimate the lifetime benefits, complications, and costs of an initial colonoscopy screening program at different levels of adenoma detection. DESIGN, SETTING, AND PARTICIPANTS Microsimulation modeling with data from a community-based health care system on ADR variation and cancer risk among 57 588 patients examined by 136 physicians from 1998 through 2010.EXPOSURES Using modeling, no screening was compared with screening initiation with colonoscopy according to ADR quintiles (averages 15.3%, quintile 1; 21.3%, quintile 2; 25.6%, quintile 3; 30.9%, quintile 4; and 38.7%, quintile 5) at ages 50, 60, and 70 years with appropriate surveillance of patients with adenoma.MAIN OUTCOMES AND MEASURES Estimated lifetime colorectal cancer incidence and mortality, number of colonoscopies, complications, and costs per 1000 patients, all discounted at 3% per year and including 95% confidence intervals from multiway probabilistic sensitivity analysis. RESULTSIn simulation modeling, among unscreened patients the lifetime risk of colorectal cancer incidence was 34.2 per 1000 (95% CI, 25.9-43.6) and risk of mortality was 13.4 per 1000 (95% CI, 10.0-17.6). Among screened patients, simulated lifetime incidence decreased with lower to higher ADRs (26.6; 95% CI, 20.0-34.3 for quintile 1 vs 12.5; 95% CI, 9.3-16.5 for quintile 5) as did mortality (5.7; 95% CI, 4.2-7.7 for quintile 1 vs 2.3; 95% CI, 1.7-3.1 for quintile 5). Compared with quintile 1, simulated lifetime incidence was on average 11.4% (95% CI, 10.3%-11.9%) lower for every 5 percentage-point increase of ADRs and for mortality, 12.8% (95% CI, 11.1%-13.7%) lower. Complications increased from 6.0 (95% CI, 4.0-8.5) of 2777 colonoscopies (95% CI, 2626-2943) in quintile 1 to 8.9 (95% CI, 6.1-12.0) complications of 3376 (95% CI, 3081-3681) colonoscopies in quintile 5.

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Adenoma Detection Rate and Colorectal Cancer Prevention by Colonoscopy

Rex

2022

JAMA

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Colonoscopy has played a pivotal role in the declining US incidence of colorectal cancer in persons older than 50 years observed over the past 2 decades. 1 However, outside the gastroenterology community, physicians may not understand that colonoscopy performance is highly operator dependent. On a per-lesion basis, colonoscopists with the worst performance miss more than 90% of precancerous colorectal lesions. 2 A report in this issue of JAMA suggests that on a per-patient basis, colonoscopists with the worst performance, in terms of their adenoma detection rate (ADR), diagnose more than half of patients who harbor precancerous colorectal lesions as normal. 3 As early as 1997, evidence of variable detection 4 started a movement to improve colonoscopy quality, 5-7 including development of national quality registries reporting performance of individual endoscopists. 8 However, there is currently no regulatory mandate or compelling financial incentive to measure colonoscopy quality. According to a 2019 survey of 250 US gastroenterologists who performed more than 80 colonoscopies per month, 20% responded that they did not measure their detection skills. 9 In response to evidence of variable and poor detection, the US Multi-Society Task Force on colorectal cancer proposed the ADR as a quality indicator in 2002. 5 The definition of ADR and targets for ADR were modified by a joint task force of the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy in 2006 and 2015. 6,7 The most recent definition of ADR is the fraction of patients aged 50 years and older undergoing first-time screening colonoscopy who have at least 1 conventional adenoma detected by a colonoscopist. 7 The minimum threshold recommended for acceptable performance is 30% for men, 20% for women, or 25% for a patient population that includes men and women. 7 ADR was first validated as a predictor of postcolonoscopy colorectal cancer (PCCRC) in 2010, 10 followed by other validations. Currently, ADR is considered the most important measure of colonoscopy quality, although variable efficacy of polyp resection has emerged as an important problem. 11 It is likely that the ADR definitions and targets will soon be updated, as evidence supporting modifications has emerged.In this issue of JAMA, Schottinger and colleagues 3 from 3 large Kaiser health care systems in California and Washington evaluated the association between physician ADR value and risk of PCCRC and related deaths. In this study, among 735 396 patients who underwent 852 624 colonoscopies that did not detect cancer, 619 cases of PCCRC were detected, and 36 related deaths occurred during a median follow-up of 3.5 years (>2.4 million person-years of follow-up). The investiga-

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Quality indicators for colonoscopy

Cited by 1,159 publications

References 184 publications

An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service

An electronic colonoscopy record system enables detailed quality assessment and benchmarking of an endoscopic service

Variation in Adenoma Detection Rate and the Lifetime Benefits and Cost of Colorectal Cancer Screening

Adenoma Detection Rate and Colorectal Cancer Prevention by Colonoscopy

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