Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

Abstract

Background and study aims To compare the quality of colonoscopy in a population-based coordinated program of colorectal cancer screening according to type of hospital (academic or non-academic). Patients and methods Consecutive patients undergoing colonoscopy after positive FIT (≥ 20 ug Hb/g feces) between January 2009 and September 2016 were prospectively included at five academic and seven non-academic public hospitals. Screening colonoscopy quality indicators considered were adenoma detection rate, cecal intubation rate, complications and bowel preparation quality. Results A total of 48,759 patients underwent colonoscopy, 34,616 (80 %) in academic hospitals and 14,143 in non-academic hospitals. Among these cases, 19,942 (37.1 %) advanced adenomas and 2,607 (5.3 %) colorectal cancers (CRCs) were detected, representing a total of 22,549 (46.2 %) cases of advanced neoplasia. The adenoma detection rate was 64 %, 63.1 % in academic hospitals and 66.4 % in non-academic hospitals ( P < 0.001). Rates of advanced adenoma detection, cecal intubation and adequate colonic preparation were 45.8 %, 96.2 % and 88.3 %, respectively, and in all cases were lower (implying worse quality care) in academic hospitals (45.3 % vs 48.7 %; odds ratio [OR] 0.87, 95 % confidence interval [CI] 0.84 – 0.91; 95.9 % vs 97 %; OR 0.48, 95 % CI 0.38 – 0.69; and 86.4 % vs 93 %; OR 0.48, 95 % CI 0.45 – 0.5; respectively; P < 0.001 in all cases). In 13 patients, all in the academic hospital group, CRC was diagnosed after colonoscopy (0.26 cases × 1000 colonoscopies). Rates of CRC treated by endoscopy were similar in both types of hospital (30 %). The rate of severe complication was 1.2 % (602 patients), with no significant differences by hospital type: bleeding occurred in 1/147 colonoscopies and perforation in 1/329. One patient died within 30 days after screening colonoscopy. Conclusions The quality of colonoscopy was better in non-academic hospitals. The rate of detection of advanced neoplasia was higher in non-academic hospitals and correlated with the rate of post-colonoscopy CRC.

Adverse events of colonoscopy in a colorectal cancer screening program with fecal immunochemical testing: a population-based observational study

“…The harm caused by colonoscopies in our FIT program is in line with that recently reported by two other programs (▶ Table 5) [7,8,[15][16][17][18]. Their rates of 7.0 ‰ and 10.0 ‰, along with our 11.9 ‰ rate of complications requiring hospitalization, are notably higher than the maximum standard of 5 ‰ for 7day hospital admission/readmission rate recommended by the ESGE [9].…”

Colonoscopy quality in community hospitals and nonhospital facilities in Korea

“…Approximately one-third of colonoscopies were withdrawn within 6 minutes and had incomplete photo-documentation. Although the overall rate of cecal intubation exceeded 90%, the cecal intubation rate of non-board-certified According to previous studies conducted in Spain and the United States comparing the quality of colonoscopies between various practice settings, both academic and non-academic centers provided high-quality colonoscopies [14,15]. Our results, unlike previous studies, showed that the quality of colonoscopies in community hospitals and nonhospital facilities was suboptimal.…”

“…In Spain, all screening colonoscopy data are coded by the coordinating staff in the Basque Country CRC Screening Program. In this way, data on colonoscopy quality indicators including ADR, cecal intubation rate, complications, and bowel preparation quality can be collected [14,29].…”

Factors Related to Non-participation in the Basque Country Colorectal Cancer Screening Programme

“…The BCSP is based on Primary Health Care (PHC), where most of the preventive and health promotion activities are carried out. A full description of this programme can be found as reported by Portillo et al (7).…”