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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(10): E1456-E1462
DOI: 10.1055/a-1486-6729
Original article

Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group

Cristiano Spada
 1   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
 2   Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
,
Anastasios Koulaouzidis 
 3   Pomeranian Medical University in Szczecin-Department of Social Medicine and Public Health, Faculty of Health Sciences, Szczecin, Zachodniopomorskie, Poland
,
Cesare Hassan 
 4   Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
,
Pedro Amaro
 5   Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
Anurag Agrawal
 6   Doncaster Royal Infirmary, Doncaster, UK
,
Lene Brink
 7   Herlev and Gentofte Hospital, Copenhagen University, Gastro Unit, Division of Endoscopy, Herlev, Denmark
,
Wolfgang Fischbach
 8   Gastroenterologie und Innere Medizin, Aschaffenburg, Germany
,
Matthias Hünger
 9   Private Practice for Internal Medicine, Würzburg, Germany
,
Rodrigo Jover
10   Hospital General Universitario de Alicante – Instituto de Investigación Sanitaria ISABIAL – Servicio de Medicina Digestiva, Alicante, Spain
,
Urpo Kinnunen
11   Tampere University Hospital-Gastroenterology, Tampere, Finland
,
Akiko Ono
12   Hospital Clínico Universitario Virgen de la Arrixaca-Gastroenterology, El Palmar, Murcia, Spain
,
Árpad Patai
13   Markusovszky University Teaching Hospital-Gastroenterology, Szombathely, Hungary
,
Silvia Pecere 
14   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Lucio Petruzziello
14   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Jürgen F. Riemann
15   LebensBlicke Foundation, Ludwigshafen, Germany
,
Bharat Amlani
16   Norgine Ltd-Medical Affairs, Harefield, UK
,
Harry Staines
17   Sigma Statistical Services Ltd, Saint Andrews, UK
,
Ann L. Stringer
18   ECQI Secretariat, Buckinghamshire, UK
,
Ervin Toth 
19   Skåne University Hospital, Lund University, Department of Gastroenterology, Malmö, Sweden
,
Giulio Antonelli
 4   Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
20   Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, Rome, Italy
21   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Lorenzo Fuccio
22   Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
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ESGE quality parameters in colonoscopy: How to ensure their adoption?Endosc Int Open 2021; 09(10): E1463-E1465
DOI: 10.1055/a-1486-6788

Abstract

Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires.

Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites.

Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received.

Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively.

Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing.

Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.

Supplementary material



Publication History

Received: 15 October 2020

Accepted: 10 March 2021

Article published online:
16 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62: 10-29
    CrossrefPubMedSearch in Google Scholar
  • 2 Edwards BK, Ward E, Kohler BA. et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010; 116: 544-573
    CrossrefPubMedSearch in Google Scholar
  • 3 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
    CrossrefPubMedSearch in Google Scholar
  • 4 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
    CrossrefPubMedSearch in Google Scholar
  • 5 Anderson JC, Butterly LF. Colonoscopy: quality indicators. Clin Transl Gastroenterol 2015; 6: e 77
    CrossrefPubMedSearch in Google Scholar
  • 6 Allen JI. Quality measures for colonoscopy: where should we be in 2015?. Curr Gastroenterol Rep 2015; 17: 10
    CrossrefPubMedSearch in Google Scholar
  • 7 Barclay RL, Vicari JJ, Doughty AS. et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
    CrossrefPubMedSearch in Google Scholar
  • 8 Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol 2007; 102: 856-861
    CrossrefPubMedSearch in Google Scholar
  • 9 Yabroff KR, Borowski L, Lipscomb J. Economic studies in colorectal cancer: challenges in measuring and comparing costs. J Natl Cancer Inst Monogr 2013; 2013: 62-78
    CrossrefPubMedSearch in Google Scholar
  • 10 Van Cutsem E, Borràs JM, Castells A. et al. Improving outcomes in colorectal cancer: where do we go from here?. Eur J Cancer 2013; 49: 2476-2485
    CrossrefPubMedSearch in Google Scholar
  • 11 von Karsa L, Patnick J, Segnan N. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45: 51-59
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Valori R, Cortas G, de Lange T. et al. Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50: 1186-1204
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Rembacken B, Hassan C, Riemann JF. et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2012; 44: 957-968
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Riemann JF, Demedts I, Agrawal A. et al. ECQI Group: Improving standards in colonoscopy through a practice level audit tool [PO160]. United European Gastroenterol J 2015; 3 (Suppl. 05) A191
    PubMedSearch in Google Scholar
  • 16 Jover R, Agrawal A, Amaro P. et al. Pilot results of the ECQI self-assessment questionnaire to evaluate quality in colonoscopy in Europe [PO165]. United European Gastroenterol J 2016; 05 (Suppl. 05) A213-A214
    PubMedSearch in Google Scholar
  • 17 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692
    CrossrefPubMedSearch in Google Scholar
  • 18 Pontone S, Hassan C, Maselli R. et al. Multiple, zonal and multi-zone adenoma detection rates according to quality of cleansing during colonoscopy. United European Gastroenterol J 2016; 4: 778-783
    CrossrefPubMedSearch in Google Scholar
  • 19 Radaelli F, Paggi S, Hassan C. et al. Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme. Gut 2017; 66: 270-277
    CrossrefPubMedSearch in Google Scholar
  • 20 Wang L, Sprung BS, DeCross AJ. et al. Split-dose bowel preparation reduces the need for early repeat colonoscopy without improving adenoma detection rate. Dig Dis Sci 2018; 63: 1320-1326
    CrossrefPubMedSearch in Google Scholar
  • 21 Murphy D, Jenks M, McCool R. et al. A systematic review and cost analysis of repeat colonoscopies due to inadequate bowel cleansing in five European countries. Expert Rev Pharmacoecon Outcomes Res 2019; 19: 701-709
    CrossrefPubMedSearch in Google Scholar
  • 22 Kaminski MF, Anderson J, Valori R. et al. Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial. Gut 2016; 65: 616-624
    CrossrefPubMedSearch in Google Scholar
  • 23 Coe SG, Crook JE, Diehl NN. et al. An endoscopic quality improvement program improves detection of colorectal adenomas. Am J Gastroenterol 2013; 108: 219-227
    CrossrefPubMedSearch in Google Scholar
  • 24 Corley DA, Jensen CD, Marks AR. Can we improve adenoma detection rates? A systematic review of intervention studies. . Gastrointest Endosc 2011; 74: 656-665
    CrossrefPubMedSearch in Google Scholar
  • 25 Brenner H, Altenhofen L, Kretschmann J. et al. Trends in adenoma detection rates during the first 10 years of the German screening colonoscopy program. Gastroenterology 2015; 149: 356-366
    CrossrefPubMedSearch in Google Scholar
  • 26 Adler A, Lieberman D, Aminalai A. et al. Data quality of the German screening colonoscopy registry. Endoscopy 2013; 45: 813-818
    Thieme ConnectPubMedSearch in Google Scholar