Quality indicators in colonoscopy: an evolving paradigm

Abstract

The year 1969 marked a revolution in the diagnosis of colorectal cancer (CRC). It is when Dr Wolff developed the colonoscope and quickly realized its potential in both diagnosis and treatment of colonic neoplasms. Over the past 50 years there has been exponential increase in utilization of colonoscopy with over 1 million colonoscopies performed annually throughout Australasia. Endoscopic removal of pre‐malignant lesions has been proven to reduce the incidence and mortality of colorectal. Although timing and frequency of surveillance colonoscopy plays a crucial role in risk reduction of CRC, this is dependent upon the findings of the index colonoscopy. The goal of screening colonoscopy is to detect CRC and identify and remove pre‐malignant neoplasms that risk progression to CRC. With increasing uptake of bowel screening throughout Australasia, there is increasing pressure to ensure all endoscopists and endoscopy units perform at a universal high‐quality. All too often high demand and constant delays compromise colonoscopy quality. Without clear and concise quality indicators with transparent measurement and audit, these flaws can quickly jeopardize screening goals and patient outcomes. This review aims to explore six key quality indicators and explore the evidence behind the current recommended standards. These key indicators include; rate of adequate bowel preparation, caecal intubation rate, adenoma detection rate, withdrawal time, complication rates and surveillance intervals.

Colonoscopy recognition of training and recertification: are they important for surgeons?

“…1 It has been estimated that by 2050, there will be 10 million deaths per year globally because of antimicrobial resistance. 2 There is good evidence that the liberal use of non-therapeutic antibiotics in the meat industry, to promote animal growth, is causing antibiotic resistance that is being handed on to humans. There has been links with the development of methicillin-resistant Staphylococcus aureus and vancomycinresistant Enterococcus to the use of non-therapeutic antibiotics in these industries.…”

“…In addressing quality indicators for colonoscopy, Shine et al ., in this issue of the journal, are looking at similar markers of performance and outcome to those we espouse for our operative work. And yet the introduction of mandatory recognition and recertification, within the national clinical care standard for colonoscopy, are both being questioned by fellows of our college.…”

Effect of Intestinal Cleaning Knowledge Training on Intestinal Cleaning Rate of Enteroscopy in Hospitalized Patients

“…Currently, colonoscopy has played an irreplaceable role in diagnosing and treating colon diseases, and more and more people have undergoed colonoscopy to screen for colon diseases [8,9]. Undoubtedly, intestinal preparation is a prerequisite for colonoscopy [10]. However, the rate of intestinal cleansing is still unsatisfactory because of insufficient knowledge of bowel preparation in patients, insufficient compliance, a long appointment waiting times, insensitivity to laxatives, a history of pelvic/abdominal surgery and so on [11][12][13][14].…”

The Impact of Patient Education Level on Split-Dose Colonoscopy Bowel Preparation for CRC Prevention

“…Although mixed results have been published, split preparation increases the quality of bowel preparation compared to whole dosing [5]. The application of split preparation closer to scoping of the bowel results in reduced interference of chyme in the colon [6] and has also been found to improve compliance, adenoma detection rate (ADR), and patient satisfaction [3,7]. Therefore, split dosing results in higher-quality preparation, but understanding instructions might be more difficult.…”