Video-Based Assessments of Colonoscopy Inspection Quality Correlate With Quality Metrics and Highlight Areas for Improvement

Duloy, Anna; Yadlapati, Rena; Benson, Mark; Gawron, Andrew J.; Kahi, Charles J.; Kaltenbach, Tonya; McClure, Jessica; Gregory, Dyanna L.; Keswani, Rajesh N.

doi:10.1016/j.cgh.2018.05.060

Cited by 12 publications

(13 citation statements)

References 23 publications

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“…One study investigator (AD) recorded > 28 consecutive de-identified screening or surveillance colonoscopies per colonoscopist (October 3, 2016-November 11, 2016) and randomly selected seven colonoscopies per colonoscopist for CIQ evaluation using a random number generator. CIQ was graded using a scale developed by Rex 10 and adapted by Lee et al 11 by six U.S. gastroenterologists (RY, MB, AG, CK, TK, RK) with previous experience in colonoscopy quality. The methods for video recording, video selection, and CIQ evaluation have been previously described 11 .…”

Section: Methodsmentioning

confidence: 99%

“…In the surgical field, assessing technical skill using video recordings has been utilized to identify variations in surgeon quality 9 and to provide individualized feedback to drive quality improvement efforts 10 . In gastrointestinal endoscopy, we and others have shown that assessments of technical skill via a structured review of videotaped colonoscopy procedures highly correlates with existing metrics of colonoscopy quality, including ADR and serrated polyp detection rates (SDR) 11 12 13 . However, it is unclear whether providing colonoscopists with structured feedback on technical skills is an effective method to improve colonoscopy quality.…”

Section: Introductionmentioning

confidence: 99%

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Individualized feedback on colonoscopy skills improves group colonoscopy quality in providers with lower adenoma detection rates

et al. 2022

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Background and study aims Colonoscopy inspection quality (CIQ) assesses skills (fold examination, cleaning, and luminal distension) during inspection for polyps and correlates with adenoma detection rate (ADR) and serrated detection rate (SDR). We aimed to determine whether providing individualized CIQ feedback with instructional videos improves quality metrics performance. Methods We prospectively studied 16 colonoscopists who already received semiannual benchmarked reports of quality metrics (ADR, SDR, and withdrawal time [WT]). We randomly selected seven colonoscopies/colonoscopist for evaluation. Six gastroenterologists graded CIQ using an established scale. We created instructional videos demonstrating optimal and poor inspection techniques. Colonoscopists received the instructional videos and benchmarked CIQ performance. We compared ADR, SDR, and WT in the 12 months preceding (“baseline”) and following CIQ feedback. Colonoscopists were stratified by baseline ADR into lower (≤ 34 %) and higher-performing (> 34 %) groups. Results Baseline ADR was 38.5 % (range 26.8 %–53.8 %) and SDR was 11.2 % (2.8 %–24.3 %). The proportion of colonoscopies performed by lower-performing colonoscopists was unchanged from baseline to post-CIQ feedback. All colonoscopists reviewed their CIQ report cards. Post-feedback, ADR (40.1 % vs 38.5 %, P = 0.1) and SDR (12.2 % vs. 11.2 %, P = 0.1) did not significantly improve; WT significantly increased (11.4 vs 12.4 min, P < 0.01). Among the eight lower-performing colonoscopists, group ADR (31.1 % vs 34.3 %, P = 0.02) and SDR (7.2 % vs 9.1 %, P = 0.02) significantly increased post-feedback. In higher-performing colonoscopists, ADR and SDR did not change. Conclusions CIQ feedback modestly improves ADR and SDR among colonoscopists with lower baseline ADR but has no effect on higher-performing colonoscopists. Individualized feedback on colonoscopy skills could be used to improve polyp detection by lower-performing colonoscopists.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Individualized feedback on colonoscopy skills improves group colonoscopy quality in providers with lower adenoma detection rates

et al. 2022

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“…-High-definition endoscopy, with the possibility of electronic chromoendoscopy -Good intestinal preparation: Boston Bowel Preparation Scale (BBPS) score > 2 in all segments (proximal, transverse and distal colon) [30] -Highly accurate polyp counting, dividing the colon into the following segments: cecum, ascending colon (from cecum to hepatic flexure); transverse colon; distal colon (from splenic flexure to upper rectum); rectum (15 cm from the anal verge) Level 2, Grade A A recorded video or thorough collection of electronic images of the whole colonoscopy should be available [31] .…”

Section: Endoscopic Diagnosismentioning

confidence: 99%

Definition and management of colorectal polyposis not associated with APC/MUTYH germline pathogenic variants: AIFEG consensus statement

Urso¹,

Leòn²,

Vitellaro³

et al. 2021

Digestive and Liver Disease

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An expert consensus panel convened by the Italian Association for Inherited and Familial Gastrointestinal Tumors ( Associazione Italiana per lo Studio della Familiarità ed Ereditarietà dei Tumori Gastrointestinali , AIFEG) reviewed the literature and agreed on a number of position statements regarding the definition and management of polyposis coli without an identified pathogenic mutation on the APC or MUTYH genes, defined in the document as NAMP (non-APC/MUTYH polyposis).

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“…6 Department of Gastroenterology, University of Colorado, Boulder, USA. 7 Division of Gastroenterology, University of California, San Diego School of Medicine, La Jolla, USA.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…To be effective, a RV should be performed to the hepatic flexure (HF) while circumferentially examining behind folds. However, in a prospective study evaluating the quality of colonoscopy inspection, we anecdotally noted that a RV was often performed in a brief, abbreviated manner [ 7 ]. Thus, endoscopists may be falsely reassured that they are performing an additional satisfactory second view of the right colon.…”

Section: Introductionmentioning

confidence: 99%

Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality

et al. 2021

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Background As right colon polyps are challenging to detect, a retroflexed view of right colon (RV) may be useful. However, cecal retroflexion (CR) without a RV to the hepatic flexure (HF) is inadequate. We aimed to determine the frequency of CR and quality of the RV in routine practice. Methods This prospective observational study performed at an academic medical center assessed colonoscopy inspection technique of endoscopists who had performed ≥ 100 annual screening colonoscopies. We video recorded ≥ 28 screening/surveillance colonoscopies per endoscopist and randomly evaluated 7 videos per endoscopist. Six gastroenterologists blindly reviewed the videos to determine if CR was performed and HF withdrawal time (cecum to HF time, excluding ileal/polypectomy time). Results Reviewers assessed 119 colonoscopies performed by 17 endoscopists. The median HF withdrawal time was 3 min and 46 s. CR was performed in 31% of colonoscopies. CR frequency varied between endoscopists with 9 never performing CR and 2 performing CR in all colonoscopies. When performed, nearly half (43%) of RVs did not extend to the HF with median RV duration of 16 s (IQR 9–30 s). Three polyps were identified in the RV (polyp detection rate of 8.1%), all identified prior to a forward view. Conclusions CR is performed infrequently in routine practice. When CR is performed, the RV is of low quality with a very short inspection duration and insufficient ascending colon examination. Further education is required to educate endoscopists in optimal technique to improve overall colonoscopy quality.

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Video-Based Assessments of Colonoscopy Inspection Quality Correlate With Quality Metrics and Highlight Areas for Improvement

Abstract: In a prospective observational study, we found CIQ and CIQ components to correlate with ADR and SDR. Colonoscopists with similar ADRs and SDRs differ in their performance of the 3 CIQ components-specific, actionable feedback might improve colonoscopy technique.

Cited by 12 publications

References 23 publications

Individualized feedback on colonoscopy skills improves group colonoscopy quality in providers with lower adenoma detection rates

Individualized feedback on colonoscopy skills improves group colonoscopy quality in providers with lower adenoma detection rates

Definition and management of colorectal polyposis not associated with APC/MUTYH germline pathogenic variants: AIFEG consensus statement

Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality

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