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DOI: 10.1055/a-1477-2963
Weekend and evening planned colonoscopy activity: a safe and effective way to meet demands
Abstract
Background and study aims Colonoscopy is the “gold standard” investigation for assessment of the large bowel that detects and prevents colorectal cancer, as well as non-neoplastic conditions. The Joint Advisory Group (JAG) on Gastrointestinal Endoscopy recommends monitoring key performance indicators such as cecal intubation rate (CIR) and adenoma detection rate (ADR). We aimed to investigate the quality of colonoscopies carried out during evening and Saturday lists in our unit and compare them against JAG standards of quality for colonoscopies.
Patients and methods We retrospectively collected and analyzed demographical and procedure-related data for non-screening colonoscopies performed between January 2016 and November 2018. Evenings and Saturdays were defined as the out-of-hour (OOH) period. We compared the outcomes of the procedures done in these against the working hours of the weekdays. We also wanted to explore whether the outcomes were different among certain endoscopists. Other factors that could affect the KPIs, such as endoscopist experience and bowel preparation, were also analyzed.
Results There were a total of 17634 colonoscopies carried out; 56.9 % of the patients (n = 10041) < 70 years old. Key Performance Indicators (KPIs) of weekday, evening, and Saturday colonoscopies regarding the CIR and ADR met the JAG standards as they were above 93 % and 24 %, respectively. Advanced colonoscopists had better KPIs when compared to the non-advanced colonoscopists, with CIR at 97.6 % vs. 93.2 % and ADR at 40.8 % vs. 26 %, respectively.
Conclusions JAG standards were maintained during colonoscopies done on weekdays, evenings, and Saturdays. Advanced colonoscopists had higher CIR and ADRs.
Publikationsverlauf
Eingereicht: 29. Mai 2020
Angenommen: 08. März 2021
Artikel online veröffentlicht:
17. Juni 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
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References
- 1 Rex DK, Cutler CS, Lemmel GT. et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997; 112: 24-28
- 2 Bowles CJ, Leicester R, Romaya C. et al. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?. Gut 2004; 53: 277-283
- 3 Atia MA, Ramirez FC, Gurudu SR. Quality monitoring in colonoscopy: Time to act. World J Gastrointest Endosc 2015; 7: 328-335
- 4 Sint Nicolaas J, de Jonge V, de Man RA. et al. The Global Rating Scale in clinical practice: a comprehensive quality assurance programme for endoscopy departments. Dig Liver Di 2012; 44: 919-924
- 5 Arora G, Mannalithara A, Singh G. et al. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 2009; 69: 654-664
- 6 Iqbal CW, Cullinane DC, Schiller HJ. et al. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 2008; 143: 701-707
- 7 Korman LY, Overholt BF, Box T. et al. Perforation during colonoscopy in endoscopic ambulatory surgical centers. Gastrointest Endosc 2003; 58: 554-557
- 8 Rabeneck L, Paszat LF, Hilsden RJ. et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008; 135: 1899-1906.e1
- 9 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
- 10 Al-Rifaie A, El-Feki M, Al-Talib I. et al. Does the withdrawal time affect adenoma detection in non-screening colonoscopies?. Frontline Gastroenterol 2020; 11: 5-10
- 11 Aranda-Hernández J, Hwang J, Kandel G. Seeing better--Evidence based recommendations on optimizing colonoscopy adenoma detection rate. World J Gastroenterol 2016; 22: 1767-1778
- 12 Burr NE, Derbyshire E, Taylor J. et al. Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study. BMJ 2019; 367: 16090
- 13 Thoufeeq MH, Rembacken BJ. Meticulous cecal image documentation at colonoscopy is associated with improved polyp detection. Endosc Int Open 2015; 3: E629-E633
- 14 Wong MC, Ching JY, Chan VC. et al. Determinants of bowel preparation quality and its association with adenoma detection: a prospective colonoscopy study. Medicine (Baltimore) 2016; 95: e2251
- 15 Widjaja D, Bhandari M, Loveday-Laghi V. et al. Withdrawal time in excellent or very poor bowel preparation qualities. World J Gastrointest Endosc 2014; 6: 186-192
- 16 Lee TJ, Blanks RG, Rees CJ. et al. Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy 2013; 45: 20-26
- 17 Rees CJ, Thomas Gibson S, Rutter MD. et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65: 1923-1929
- 18 Shenbagaraj L, Thomas-Gibson S, Stebbing J. et al. Endoscopy in 2017: a national survey of practice in the UK. Frontline Gastroenterol 2019; 10: 7-15
- 19 Murchie B, Tandon K, Zackria S. et al. Can polyp detection rate be used prospectively as a marker of adenoma detection rate?. Surg Endosc 2018; 32: 1141-1148
- 20 Gavin DR, Valori RM, Anderson JT. et al. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK [published correction appears in Gut 2013; 62: 249. Gut 2013; 62: 242-249
- 21 Rutter MD, Chattree A, Barbour JA. et al. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut 2015; 64: 1847-1873
- 22 Vavricka SR, Sulz MC, Degen L. et al. Monitoring colonoscopy withdrawal time significantly improves the adenoma detection rate and the performance of endoscopists. Endoscopy 2016; 48: 256-262
- 23 Ford JA, Jones AP, Wong G. et al. Weekend opening in primary care: analysis of the General Practice Patient Survey. Br J Gen Pract 2015; 65: e792-e798
- 24 Sanaka MR, Shah N, Mullen KD. et al. Afternoon colonoscopies have higher failure rates than morning colonoscopies. Am J Gastroenterol 2006; 101: 2726-2730
- 25 Subramanian S, Psarelli EE, Collins P. et al. Colonoscopy performance is stable during the course of an extended three-session working day. Endosc Int Open 2015; 3: E494-E500
- 26 British Society of Gastroenterology. BSG guidance on recommencing GI endoscopy in the deceleration & early recovery phases of the COVID-19 pandemic. 03 Mar 2021. https://www.bsg.org.uk/covid-19-advice/bsg-guidance-on-recommencing-gi-endoscopy-in-the-deceleration-early-recovery-phases-of-the-covid-19-pandemic/
- 27 British Society of Gastroenterology. Endoscopy activity and COVID-19: BSG and JAG guidance. 03 Mar 2021. https://www.bsg.org.uk/covid-19-advice/endoscopy-activity-and-covid-19-bsg-and-jag-guidance/
- 28 Gulamhussein MA, Chaudhry S, Noor S. et al. Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital. Ann R Coll Surg Engl 2017; 99: 347-350
- 29 Mothey MP, Schembri J, Thoufeeq M. PTU-054. Out of hours colonoscopy-are we compromising on quality? . Gut 2017; 66: A77-A78