Quality assurance of colonoscopy within the Dutch national colorectal cancer screening program

Bronzwaer, Maxime; Depla, Annekatrien; Lelyveld, Niels van; Spanier, B.W.M.; Oosterhout, Yvonne H.; Leerdam, Monique E. van; Spaander, Manon C.W.; Dekker, Evelien; Haastert, M. van; Keller, Jutta; Koch, Arjun D.; Koornstra, Jan J.; Kouwen, M.C.A. van; Masclee, Ad; Mundt, Marco W.; Ridder, Rogier J. De; Sluys-Veer, A. van der; Wieren, M. van

doi:10.1016/j.gie.2018.09.011

Cited by 58 publications

(76 citation statements)

References 82 publications

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“…European guidelines for quality assurance in CRC screening have been set [3]. In the Netherlands, endoscopists have to be certified before being allowed to participate in the BCSP [11,12].…”

Section: Endoscopists and Equipmentmentioning

confidence: 99%

“…In addition, endoscopists are required to register 100 consecutive colonoscopies with corresponding quality indicators. Then, a theoretical e-learning module should be accomplished and colonoscopic skills are evaluated in live practice setting and via videos [12]. All endoscopists in this study fulfilled the quality measures for the screening program as described above but they received no specific additional training regarding optical diagnosis of colorectal polyps.…”

Section: Endoscopists and Equipmentmentioning

confidence: 99%

“…Several strengths of our study need to be acknowledged. First, we evaluated the efficacy of the optical diagnosis strategy within a) the structured setting of the nationwide Bowel Cancer Screening Program b) regular endoscopy practices where all participating endoscopists were qualified and accredited for performing colonoscopies for the Dutch FIT-based BCSP [12], but without additional training or selection for competency in optical diagnosis. We prospectively collected data from four endoscopy units (both academic and regional) in South Limburg (the Netherlands).…”

Section: E260mentioning

confidence: 99%

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Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

et al. 2020

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w.vandewetering@maastrichtuniversity.nl ABSTR AC T Background and study aims Implementation of optical diagnosis of diminutive polyps may potentially increase the efficacy and cost-effectiveness of colonoscopies. To adopt such strategy in clinical practice, the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) thresholds provide the basis to be met: ≥ 90 % negative predictive value (NPV) for diagnosis of adenomatous histology and ≥ 90 % agreement on surveillance intervals. We evaluated this within the Dutch Bowel Cancer Screening Program (BCSP). Patients and methods Endoscopic and histological datawere collected from participants of the national bowel cancer screening program with an unfavorable fecal immunochemical test referred for colonoscopy between February 2014 and August 2015 at four endoscopy centers. The "resect and discard" scenario was studied, resecting diminutive polyps without histological evaluation. Agreement between optical diagnosis and histological diagnosis was measured for surveillance intervals according to Dutch, European and American post-polypectomy surveillance guideline.Results Fifteen certified endoscopists participated in this study and included 3028 diminutive polyps. In 2,330 patients both optical and histological diagnosis were available. Optical diagnosis of diminutive polyps showed NPV of 84 % (95 % CI 80-87) for adenomatous histology in the rectosigmoid. Applying the 'resect and discard' strategy resulted in 90.6 %, 91.2 %, 90.9 % agreement on surveillance intervals for the Dutch, European and American guideline respectively.Conclusion Our data representing current clinical practice in the Dutch BCSP practice on optical diagnosis of diminutive polyps showed that accuracy of predicting histology remains challenging, and risk of incorrect optical diagnosis is still significant. Therefore, it is too early to safely implement these strategies.

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Section: Endoscopists and Equipmentmentioning

confidence: 99%

Section: Endoscopists and Equipmentmentioning

confidence: 99%

Section: E260mentioning

confidence: 99%

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Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

et al. 2020

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“…[9] Colonoscopy is the recommended diagnostic follow-up test for a positive FIT result. [10] To assure high quality of colonoscopy within this screening program, a specific accreditation and auditing system was developed and implemented. [10] Quality indicators that are monitored are ADR, CIR, adequate bowel preparation and withdrawal time.…”

Section: Introductionmentioning

confidence: 99%

Impact of sedation on the Performance Indicator of Colonic Intubation

et al. 2020

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Background: Performance Indicator of Colonic Intubation (PICI) has been introduced as new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. In a UK national audit, adequate PICI was achieved in 54.1% of colonoscopies and associated with higher polyp detection rates. In this study, achievement of PICI was assessed within the Dutch colorectal cancer (CRC) screening program and the association between PICI and the adenoma detection rate (ADR) was determined. Furthermore, we assessed the achievement of the performance indicator using the Dutch median midazolam dose. Methods: This retrospective study was conducted within the Dutch FIT-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between 01-01-2016 and 01-01-2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) between 1 - 3 and use of ≤ 2.5 mg midazolam. Results: During the study period, 107.328 colonoscopies were performed. Adequate PICI was achieved in 49.500 (46.1%) colonoscopies. In the colonoscopies with inadequate PICI, this was due to higher sedation dosages in 87.8%. Adequate PICI was associated with higher ADR (OR: 1.16; 95%CI: 1.12-1.20). When using a cut-off of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95.410 colonoscopies (88.9%). Conclusion: PICI appears to be an indicator that is heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as quality indicator is limited.

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“…These changes have been designed to minimise the burden on the service while maximising their impact. With perhaps the exception of the Dutch approach5 to quality assurance of bowel cancer screening (much of which is based on JAG methodology), no other country or professional body has come close to what the JAG has achieved in the UK.…”

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confidence: 99%

Joint Advisory Group on Gastrointestinal Endoscopy (JAG) achieves enduring large-scale change

Valori

2019

Frontline Gastroenterol

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Quality assurance of colonoscopy within the Dutch national colorectal cancer screening program

Cited by 58 publications

References 82 publications

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?

Impact of sedation on the Performance Indicator of Colonic Intubation

Joint Advisory Group on Gastrointestinal Endoscopy (JAG) achieves enduring large-scale change

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