Quality indicators in colonoscopy: observational study in a supplementary health system

Abstract

Purpose: Colorectal cancer is responsible for 9.4% of cancer deaths, and low polyp detection rate and cecal intubation rate increase the risks of interval colorectal cancer. Despite several population studies that address colonoscopy quality measures, there is still a shortage of these studies in Latin America. The aim of this study was to assess quality indicators in colonoscopy, enabling future strategies to improve colorectal cancer prevention. Methods: An observational retrospective study, in which all colonoscopies performed in 11 hospitals were evaluated through a review of medical records. Information such as procedure indication, colorectal polyp detection rate, cecal intubation rate, quality of colonic preparation, and immediate adverse events were collected and analyzed. Results: In 17,448 colonoscopies performed by 86 endoscopists, 57.9% were in patients aged 50 to 74 years old. Colon preparation was adequate in 94.4% procedures, with rates of cecal intubation and polyp detection of 94 and 36.6%, respectively. Acute adverse events occurred in 0.2%. In 53.9%, high-definition imaging equipment was used. The procedure location, colon preparation and high-definition equipment influenced polyp detection rates (p < 0.001). Conclusions: The extraction and analysis of electronic medical records showed that there are opportunities for improvement in colonoscopy quality indicators in the participating hospitals.

Development, quality, and influencing factors of colonoscopy in China: results from the national census in 2013 and 2020

“…Second, the overall quality of colonoscopy was imbalanced. The cecal intubation rate grew from 75.8% to 94.4%, which was catch up with or even surpass some developed countries, such as the UK (92.3%), Netherlands (92.4%), and Italy (83.0%) ( 7 , 27 , 28 ), and developing countries, such as Brazil (94.0%) ( 13 ). However, the huge gap of ADR is still visible.…”

“…However, the huge gap of ADR is still visible. The ADR was 38.1% in the United States ( 11 ), 28.7% in Japan ( 10 ), 32.1% in UK ( 7 ), 39.1% in Italy ( 9 ), and 36.6% in Brazil ( 13 ). Next, measures should be taken to improve adenoma detection, such as the deployment of a registry system collecting uniform data for measurements of endoscopy quality index ( 29 , 30 ), effective bowel preparation, and incorporation of artificial intelligence and novel technique ( 31 , 32 ).…”

“…In developed countries, colonoscopy behaves better in service accessibility and quality ( 7 – 10 ), which largely benefits from their adequate resource and rigorous quality improvement ( 11 , 12 ). But in developing countries, the capacity of the colonoscopy and its role in screening for CRC is still prominently limited, such as Brazil ( 13 ), Indonesia ( 14 ), and some African countries ( 15 – 17 ). The insufficient capacity to perform colonoscopy including infrastructure, utilization, and quality could be adverse to clinical practice and limit the efficacy of endoscopic screening for the reduction of the CRC burden ( 18 ).…”

Challenges of Colorectal Screening in Developing Countries

“…However, in developing countries, the capacity for colonoscopy screening for CRC remains severely limited, as observed in Brazil, Indonesia, and several African nations. Insufficient capacity to conduct colonoscopies, including infrastructure, utilization, and quality, could adversely affect clinical practice and restrict the effectiveness of endoscopic screening in reducing the burden of Colorectal Cancer [47][48][49]. Currently, the standard imaging technique for staging CRC is a Computed Tomography scan.…”