The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK

Abstract

This is the first national audit of colonoscopy that has successfully captured the majority of adult colonoscopies performed across an entire nation during a defined time period. The data confirm that there has been a significant improvement in the performance of colonoscopy in the UK since the last study reported seven years ago (CIR 76.9%) and that performance is above the required national standards.

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…9 11-14 In a BSG audit of 20 085 colonoscopies in the UK, 52 (0.26%) haemorrhages were reported. 8 Thirty nine of these were self-limited, three (0.01%) required transfusion, and one required surgery. Data from the English National Bowel Cancer Screening Programme on 112 024 participants, of whom 69 028 underwent polypectomy, found an overall PPB rate of 1.14%.…”

Colonoscopy Quality Assessment

“…In the UK, the results of a 2011 nationwide audit were recently published 70 , and included two main quality metrics: cecal intubation rate and polyp detection rate. Compared to the previous audit results from 1999, the cecal intubation rate improved from 76.9% to 92.3%, and the polyp detection rate increased from 22.5% to 32.1%.…”

Magnetic Endoscopic Imaging: A Useful Ally in Colonoscopy

“…Some of the reasons for the differences in study outcomes not showing statistical differences is likely as a consequence of studies being underpowered, with an overestimate of the effect size of MEI which is likely to be less over recent years as the standard of colonoscopy has improved [1]. It is also not clear if endoscopist in the studies that were undertaking colonoscopy with MEI had received training on image and loop recognition and whether the process of loop reduction under direct vision was thoroughly understood.…”

“…Quality control requirements by endoscopy regulators, such as the joint advisory group in gastrointestinal endoscopy (JAG) in the UK, have mandated the need for institutions undertaking these procedures to record performance outcome measures. A marker of such performance is the caecal intubation rate, however, reports have shown considerable variation between individuals and institutions [1]. There have been several reasons given for failure to reach the caecum.…”

“…There have been several reasons given for failure to reach the caecum. One of the commonest factors elucidated in quality assurance audits is recurrent colonic looping leading to a consequent lack of advancement of the endoscope tip, and subsequent patient discomfort [1]. Measures to appreciate colonoscopic positioning in the past required fluoroscopy, however, its use was cumbersome, posed a radiation risk and views were suboptimal [2,3].…”