The Appropriateness of Surveillance Colonoscopy Intervals after Polypectomy

Schreuders, Eline H.; Nicolaas, Jerome Sint; Jonge, Vincent de; Kooten, H. van; Soo, Isaac; Sadowski, Daniel C.; Wong, Clarence; Leerdam, Monique E. van; Kuipers, Ernst J.; Zanten, S. J. O. Veldhuyzen Van

doi:10.1155/2013/279897

Cited by 28 publications

(30 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although explicit guidelines are available,51 52 there is good evidence that they are often not followed 53 54. There are potential harms to both the patient and healthcare system when surveillance colonoscopy is either repeated too soon or too late 55.…”

Section: Quality Assurance In Colonoscopymentioning

confidence: 99%

Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

Robertson

Kaminski

Bretthauer

2015

Gut

View full text Add to dashboard Cite

Screening for colorectal cancer has been proven to be effective in reducing colorectal cancer incidence and mortality. While the precise benefit of screening exclusively by colonoscopy is not yet known, unarguably, the exam is central to the success of any screening programme. The test affords the opportunity to detect and resect neoplasia across the entire large bowel and is the definitive examination when other screening tests are positive. However, colonoscopy is invasive and often requires sedation as well as extensive bowel preparation, all of which puts the patient at risk. Furthermore, the test can technically be demanding and, unarguably, there is variation in how it is performed. This variation in performance has now been definitively linked to important outcome measures. For example, interval cancers are more common in low adenoma detectors as compared with high adenoma detectors. This review outlines the most current thinking regarding the effectiveness of colonoscopy as a screening tool. It also outlines key concepts to optimise its performance through robust quality assurance programmes and high-quality training.

show abstract

Section: Quality Assurance In Colonoscopymentioning

confidence: 99%

Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

Robertson

Kaminski

Bretthauer

2015

Gut

View full text Add to dashboard Cite

show abstract

“…One limitation of the current study was that we defined early procedures as those undertaken at least 6 months earlier than intended, consistent with a recent Canadian study; 17 it would, however, be useful to apply shorter cut‐offs for shorter recall periods (eg, 3 months for one‐year recommendations, as applied in another study 8 ). A further limitation was that we did not examine reasons for specialists deviating from guideline recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…The scheduled and actual dates of all surveillance colonoscopies during the calendar year 2015 were assessed. Colonoscopies performed more than 6 months before the scheduled date were deemed early procedures 17 . Numbers of and reasons for early procedures were assessed.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

A nurse‐led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines

Symonds

Simpson

Coats

et al. 2018

Medical Journal of Australia

View full text Add to dashboard Cite

show abstract

“…Irrespective of quality improvements, PDRs would be expected to be lower in patients whose previous colonoscopy was only 1 year prior as compared with patients whose previous colonoscopy was 5 years ago [8]. Analysis of changes in PDRs as correlated with the time interval between colonoscopies would help to clarify the importance of this potentially under-appreciated variable on PDRs [9]. Physicians should resist the temptation to pursue more frequent surveillance colonoscopies, and rather focus on improving the quality of their colonoscopy procedures, for example, through increased withdrawal times and higher completion rates.…”

Section: To the Editormentioning

confidence: 99%

Challenges in improving quality in colonoscopy: timing is critical

Heching

Mazor

Lachter

2015

Evaluation Clinical Practice

View full text Add to dashboard Cite

guidelines for quality indicators for colonoscopy highlight the importance of implementing quality improvements in screening colonoscopy procedures [1]. Clinical evidence has demonstrated that the impact of colonoscopy on colorectal cancer prevention has been less than anticipated [2] in part because the effectiveness of colonoscopy depends on the skill of the gastroenterology specialist and the quality of examination [3]. Various medical bodies and gastroenterology professional societies have published guidelines for endoscopists to provide a clear set of quality standards and encourage consistency and effectiveness in endoscopic procedures [1,4,5].Although guidelines are helpful in providing direction for improvement, designing appropriate interventions that achieve meaningful improvements can be challenging. A meta-analysis of studies designed to measure the effectiveness of quality improvement interventions concluded that various interventions aimed at improving endoscopist performance have not been proven to be effective in increasing adenoma detection rates [6].We recently implemented quality control improvements in protocols for colonoscopy procedures and subsequently examined whether the implemented improvements had a statistically meaningful impact on polyp detection rates (PDRs). The interventions were implemented at an active gastroenterology department in a tertiary hospital. The interventions included (1) individualized educational efforts emphasizing increased commitment to quality improvement and conformance with benchmark standards; (2) changes in the electronic medical record designed to ensure that physicians recorded relevant quality control parameters and increase intra-procedural awareness of quality results; and (3) continuous monitoring of overall performance levels and updating of quality standards and performance data.After implementation of the quality interventions, we analysed 1023 consecutive colonoscopies (patient ages ≥50) performed by eight attending gastroenterology endoscopists over a 9-month period. The data were compared with the results for 700 consecutive colonoscopies performed by attending physicians in the same department prior to the interventions. PDRs were used in lieu of adenoma detection rates as studies have demonstrated a high degree of correlation between PDR and adenoma detection rates, such that PDR can be used as a proxy quality measure in place of adenoma detection rates [7].Our post-intervention results showed that polyps were detected in 33.3% of the colonoscopy examinations as compared with 31.2% prior to implementation of the interventions (P = 0.20). On a gender basis, PDR improved for men to 38.8% from 37.6% and for women to 27.6% from 24.2%, which, although representing a modest improvement, neither increase was statistically significant (P = 0.36 and P = 0.16, respectively, see Fig. 1).Our results highlight the potential gap between quality guidelines advocated by professional societies and published literature and the difficulty in achieving meaningful...

show abstract

The Appropriateness of Surveillance Colonoscopy Intervals after Polypectomy

Abstract: Only a minority of surveillance colonoscopies were performed according to guideline recommendations. Deviation from the guidelines did not improve the adenoma detection rate. Interventions aimed at improving adherence to surveillance guidelines are needed.

Cited by 28 publications

References 25 publications

Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

A nurse‐led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines

Challenges in improving quality in colonoscopy: timing is critical

Contact Info

Product

Resources

About