State of the Science on Quality Indicators for Colonoscopy and How to Achieve Them

Abstract

Colonoscopy is a safe and effective tool, but operator dependent. Room for improvement in the quality of colonoscopy is the impetus for the development and measurement of colonoscopy quality indicators and the focus of many efforts to improve colonoscopy quality indicator prevention and control in provider practices and health systems. We present the preprocedural, intraprocedural, and postprocedural quality indicators and benchmarks for colonoscopy. Every provider and practice must make a commitment to performing high-quality colonoscopy and implement and monitor quality metrics. There are a variety of tools available to assist in improving quality indicators that range from distal attachment devices to education and feedback. Although technology can help, it is not a substitute for proper technique. The commitment also requires provider feedback through audits and report cards. The impact of these efforts on patient outcomes is an important area of further research.

Predictive factors for adenoma detection rates: a video study of endoscopist practices

“…There has been much interest in variables that can increase ADR, and some experts propose that endoscopist-related variables are still the most important [16]. Technical expertise not only prevents adverse events, but also increases the detection of colorectal adenomas [17,18].…”

Artificial intelligence-based assessments of colonoscopic withdrawal technique: a new method for measuring and enhancing the quality of fold examination

“…The lack of mucosal fold examination, poor bowel preparation, inadequate luminal distension, and rapid colonoscopy withdrawal time have been con-sidered among the most common factors leading to colonoscopic blind spots [12]. A variety of tools are available to assist endoscopists in exposing more mucosa during the inspection, including distal attachment exposure devices and new types of colonoscopes [13][14][15]. However, adequate inspection of all mucosal folds and flexures by rotating the endoscope is one of the basic and most common colonoscopic withdrawal techniques for reducing missed diagnoses [16].…”

Time to Add the “Q” (Quality) Factor to Postpolypectomy Surveillance?

“…In this issue of Gastroenterology, results are presented from a Norwegian RCT including almost 140,000 participants that was designed to directly compare, for the first time, the effectiveness of FIT-based screening (4 biennial rounds of FIT) with once-only FS screening with respect to reduction of CRC mortality. 5 This Norwegian trial will provide most welcome and long-awaited evidence on the comparative performance of these 2 widely used screening strategies for CRC. In the design and sample size calculation, a decrease in CRC mortality (the primary end point) was assumed to be twice as great in the FS arm (30%) than in the FIT arm (15%).…”

“…[2][3][4] Thus, high-quality screening colonoscopy is a priority, to improve the detection of colorectal polyps and prevent CRC. 5 The adenoma detection rate (ADR) is a valid measure of colonoscopy quality that is associated with subsequent neoplasia and PCCRC. 6,7 Current postpolypectomy guidelines use adenoma features (ie, size, number, histology) to determine colonoscopy surveillance intervals 8 and assume the colonoscopy was high quality (complete to cecum, with adequate bowel preparation and a physician ADR of 25%).…”

“…As a result, endoscopy quality improvement programs have incorporated ADR as a quality metric with a benchmark of 25% overall (30% for men and 20% for women) for individuals 50 years of age undergoing screening colonoscopy. 5,14,15 A variety of tools can help to optimize the ADR, including feedback and monitoring of colonoscopists, endoscopic devices, and the use of artificial intelligence software and other technologies. 2,[16][17][18][19] Several studies evaluating CRC risk for various surveillance intervals prospectively are in the planning or currently underway and should consider the impact of colonoscopy quality on CRC risk.…”