Quality of colonoscopy in an emerging country: A prospective, multicentre study in Russia

Abstract

Background: The quality of colonoscopy has been related to a higher risk of interval cancer, and this issue has been addressed extensively in developed countries. The aim of our study was to explore the main quality indicators of colonoscopy in a large emerging country. Methods: Consecutive patients referred for colonoscopy in 14 centres were prospectively included between July and October 2014. Before colonoscopy, several clinical and demographic variables were collected. Main quality indicators (i.e. caecal intubation rate, (advanced) adenoma detection rate, rate of adequate cleansing and sedation) were collected. Data were analysed at per patient and per centre level (only for those with at least 100 cases). Factors associated with caecal intubation rate and adenoma detection rate were explored at multivariate analysis. Results: A total of 8829 (males: 35%; mean age: 57 þ 14 years) patients were included, with 11 centres enrolling at least 100 patients. Screening (including non-alarm symptoms) accounted for 59% (5188/8829) of the indications. Sedation and split preparation were used in 26% (2294/8829) and 25% (2187/8829) of the patients. Caecal intubation was achieved in 7616 patients (86%), and it was !85% in 8/11 (73%) centres. Adenoma detection rate was 18% (1550/8829), and it was higher than 20% in five (45%) centres, whilst it was lower than 10% in four (33%) centres. At multivariate analysis, age (OR: 1.020, 95% CI: 1.015-1.024), male sex (OR: 1.2, 95% CI: 1.1-1.3), alarm symptoms (OR: 1.8, 95% CI: 1.7-2), split preparation (OR: 1.4, 95% CI: 1.2-1.6), caecal intubation rate (OR: 1.6, 95% CI: 1.3-1.9) and withdrawal time measurement (OR: 1.2, 95% CI: 1.6-2.1) were predictors of a higher adenoma detection rate, while adequate preparation (OR: 3.4: 95% CI: 2.9-3.9) and sedation (OR: 1.3; 95% CI: 1.1-1.6) were the strongest predictors of caecal intubation rate. Conclusions: According to our study, there is a substantial intercentre variability in the main quality indicators. Overall, the caecal intubation rate appears to be acceptable in most centres, whilst the overall level of adenoma detection appears low, with less than half of the centres being higher than 20%. Educational and quality assurance programs, including higher rates of sedation and split regimen of preparation, may be necessary to increase the key quality indicators.

Colonoscopy findings in patients with haematochezia in Benin (South-South Nigeria): A 9-year prospective study

“…This is similar to reports from other centres. [ 1 , 10 , 11 , 12 ] This age cluster may be due to the contribution of bleeding malignant colorectal diseases in our study.…”

“…It occurred in 95.6% of patients which is similar to that from most centres in Nigeria. [ 4 , 11 , 20 , 21 , 22 ]…”

Colorectal Cancer: A Systematic Review of the Current Situation and Screening in North and Central Asian Countries

“…A prospective, multicenter study involving 14 endoscopy centers, selected by the Russian Society of Endoscopy from different regions of the country had good adenoma detection and cecal intubation rate. At multivariate analysis, age, male sex, presence of alarm symptoms, split preparation, cecal intubation rate and withdrawal time measurement were predictors of a higher adenoma detection rate [ 47 ]. The surgical outcome of CRC was optimal especially amongst elderly with a 30-day mortality of 4.9%.…”

Preparation for Introduction of a National Screening Program for Colorectal Cancer

“…Об отсутствии консенсуса по диагностике КРР среди специалистов в России впервые заговорили в 2014 г., когда в свет вышло мультицентровое исследование, выполненное в 14 медицинских учреждениях, выполняющих эндоскопическую диагностику. По данным этого исследования, достаточный уровень подготовки к колоноскопии был достигнут только в 77% обследований, двухэтапный «сплит»-режим был использован лишь в 25% случаев [31]. Слепую кишку интубировали в 86% процедур, а показатель обнаружения полипов составил всего 18% [31].…”

“…По данным этого исследования, достаточный уровень подготовки к колоноскопии был достигнут только в 77% обследований, двухэтапный «сплит»-режим был использован лишь в 25% случаев [31]. Слепую кишку интубировали в 86% процедур, а показатель обнаружения полипов составил всего 18% [31]. Данные результаты в целом не соответствовали рекомендациям Европейского объединения гастроэнтерологов (англ.…”