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CC BY 4.0 · Endosc Int Open 2025; 13: a25209965
DOI: 10.1055/a-2520-9965
Original article

Sustained success in endoscopic performance demonstrated by the Irish National Endoscopy Quality Improvement Programme

Eoin Keating 
1   Department of Gastroenterology, St James's Hospital, Dublin, Ireland (Ringgold ID: RIN58024)
2   School of Medicine, University College Dublin, Dublin, Ireland (Ringgold ID: RIN8797)
,
Eoin Slattery
3   Department of Gastroenterology, University Hospital Galway, Galway, Ireland (Ringgold ID: RIN58040)
4   School of Medicine, University College Galway, Galway, Ireland (Ringgold ID: RIN8799)
5   National Gastrointestinal Endoscopy Quality Improvement Programme, Royal College of Physicians of Ireland, Dublin, Ireland (Ringgold ID: RIN8867)
,
Karen Hartery
1   Department of Gastroenterology, St James's Hospital, Dublin, Ireland (Ringgold ID: RIN58024)
6   School of Medicine, Trinity College Dublin, Dublin, Ireland (Ringgold ID: RIN8809)
5   National Gastrointestinal Endoscopy Quality Improvement Programme, Royal College of Physicians of Ireland, Dublin, Ireland (Ringgold ID: RIN8867)
,
Glen Doherty
7   Department of Gastroenterology, St Vincent's University Hospital, Dublin, Ireland (Ringgold ID: RIN58038)
2   School of Medicine, University College Dublin, Dublin, Ireland (Ringgold ID: RIN8797)
5   National Gastrointestinal Endoscopy Quality Improvement Programme, Royal College of Physicians of Ireland, Dublin, Ireland (Ringgold ID: RIN8867)
,
Conor Canavan
5   National Gastrointestinal Endoscopy Quality Improvement Programme, Royal College of Physicians of Ireland, Dublin, Ireland (Ringgold ID: RIN8867)
,
Jan Leyden
8   Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland (Ringgold ID: RIN8881)
2   School of Medicine, University College Dublin, Dublin, Ireland (Ringgold ID: RIN8797)
5   National Gastrointestinal Endoscopy Quality Improvement Programme, Royal College of Physicians of Ireland, Dublin, Ireland (Ringgold ID: RIN8867)
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Abstract

Background and study aims

The National Gastrointestinal Endoscopy Quality Improvement (NEQI) Programme captures over 94% of endoscopic activity in the Republic of Ireland (ROI), accounting for > 120,000 colonoscopies per annum. The aim of this study was to assess temporal changes in colonoscopy Key Quality Indicators (KQIs) at a national level over a 5-year period among low-, intermediate-, and high-volume endoscopists.

Methods

A retrospective analysis of all NEQI colonoscopy episodes occurring between 2016 and 2022, collating colonoscopy KQIs (cecal intubation rate [CIR], comfort score [CS], polyp detection rate [PDR] and sedation use). Endoscopists with 5 consecutive years of activity were defined as low, intermediate, or high activity according to annual procedural volumes.

Results

Over 658,000 colonoscopies were completed by 1240 endoscopists. Workload is disproportionate, with 36% of endoscopists completing 66% of national colonoscopy volume. Low-, intermediate-, and high-activity endoscopists all demonstrated sustained improvements in KQI targets over the study period. Comparing experts (≥ 300 colonoscopies/year) vs non-experts, KQI plateaus were demonstrated for PDR at < 150 colonoscopies per year (34.2% vs 29.6%, P = 0.002), CS at < 200 procedures per year (97.5% vs 94.9%, P < 0.001), and CIR at < 250 colonoscopies per year (94.5% vs 93.4%, P = 0.048).

Conclusions

This study represents the first published endoscopist-level NEQI data demonstrating ongoing KQI improvements for endoscopists at all activity levels. Sustaining this improvement and continuing to capture national endoscopic performance will remain a core role of the Irish NEQI program. Workforce imbalances and minimum annual volumes continue to represent challenges for national endoscopy programs.

Keywords

Quality and logistical aspects - Quality management - Performance and complications - Endoscopy Lower GI Tract


Publication History

Received: 02 August 2024

Accepted after revision: 15 January 2025

Accepted Manuscript online:
20 January 2025

Article published online:
26 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Eoin Keating, Eoin Slattery, Karen Hartery, Glen Doherty, Conor Canavan, Jan Leyden. Sustained success in endoscopic performance demonstrated by the Irish National Endoscopy Quality Improvement Programme. Endosc Int Open 2025; 13: a25209965.
DOI: 10.1055/a-2520-9965
 

  • References

  • 1 Harewood GC, Petersen BT, Ott BJ. Prospective assessment of the impact of feedback on colonoscopy performance. Aliment Pharmacol Ther 2006; 24: 313-318
    Search in Google Scholar
  • 2 Lim S, Tritto G, Zeki S. et al. Regular feedback to individual endoscopists is associated with improved adenoma detection rate and other key performance indicators for colonoscopy. Frontline Gastroenterology 2022; 13: 509-516
    Search in Google Scholar
  • 3 Tinmouth J, Sutradhar R, Li Q. et al. A pragmatic randomized controlled trial of an endoscopist audit and feedback report for colonoscopy. Am J Gastroenterol 2021; 116: 2042-2051
    Search in Google Scholar
  • 4 Rutter MD, Senore C, Bisschops R. et al. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: Developing performance measures. United European Gastroenterol J 2016; 4: 30-41
    Search in Google Scholar
  • 5 JAG. Joint Advisory Group on GI Endoscopy. https://www.thejag.org.uk/
  • 6 Bretthauer M, Aabakken L, Dekker E. et al. Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement. United European Gastroenterol J 2016; 4: 172-176
    Search in Google Scholar
  • 7 Lee TJ, Siau K, Esmaily S. et al. Development of a national automated endoscopy database: The United Kingdom National Endoscopy Database (NED). United European Gastroenterol J 2019; 7: 798-806
    Search in Google Scholar
  • 8 Matsuda K, Tanaka K, Fujishiro M. et al. Design paper: Japan Endoscopy Database (JED): A prospective, large database project related to gastroenterological endoscopy in Japan. Dig Endosc 2018; 30: 5-19
    Search in Google Scholar
  • 9 de Neree Tot Babberich MPM, Ledeboer M, van Leerdam ME. et al. Dutch Gastrointestinal Endoscopy Audit: automated extraction of colonoscopy data for quality assessment and improvement. Gastrointest Endosc 2020; 92: 154-162 e151
    Search in Google Scholar
  • 10 NEQI. Guidelines for the Implementation of the National GI Endoscopy Quality Improvement Programme 2021. https://rcpi.access.preservica.com/uncategorized/IO_52f6c211-b7c6–49bc-a68a-5535a48ffe2a/
  • 11 NEQI. 8th NEQI National Data Report 2023. https://rcpi.access.preservica.com/download/file/IO_dc64d6da-aca6–40d5-bf94–1d41d3cc1d7a
  • 12 NEQI. 7th NEQI National Data Report - 2016 to 2021. 2022. https://rcpi.access.preservica.com/uncategorized/IO_a879050b-afaa-4356–9008–237237b4342b/
  • 13 Rees CJ, Thomas Gibson S, Rutter MD. et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65: 1923-1929
    Search in Google Scholar
  • 14 Saito Y, Kodashima S, Matsuda T. et al. Current status of diagnostic and therapeutic colonoscopy in Japan: The Japan Endoscopic Database Project. Dig Endosc 2022; 34: 144-152
    Search in Google Scholar
  • 15 Valori RM, Damery S, Gavin DR. et al. A new composite measure of colonoscopy: the Performance Indicator of Colonic Intubation (PICI). Endoscopy 2018; 50: 40-51
    Search in Google Scholar
  • 16 Catlow J, Sharp L, Wagnild J. et al. Nationally automated colonoscopy performance feedback increases polyp detection: The NED APRIQOT randomized controlled trial. Clin Gastroenterol Hepatol 2024; 22: 1926-1936
    Search in Google Scholar
  • 17 Beaton D, Sharp L, Trudgill NJ. et al. UK endoscopy workload and workforce patterns: is there potential to increase capacity? A BSG analysis of the National Endoscopy Database. Frontline Gastroenterol 2023; 14: 103-110
    Search in Google Scholar
  • 18 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
    Search in Google Scholar
  • 19 Løberg M, Kalager M, Holme Ø. et al. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med 2014; 371: 799-807
    Search in Google Scholar
  • 20 Atkin W, Wooldrage K, Brenner A. et al. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol 2017; 18: 823-834
    Search in Google Scholar
  • 21 Carter HE, Knowles D, Moroney T. et al. The use of modelling studies to inform planning of health services: case study of rapidly increasing endoscopy services in Australia. BMC Health Serv Res 2019; 19: 608
    Search in Google Scholar
  • 22 van Turenhout ST, Terhaar sive Droste JS, Meijer GA. et al. Anticipating implementation of colorectal cancer screening in The Netherlands: a nation wide survey on endoscopic supply and demand. BMC Cancer 2012; 12: 46
    Search in Google Scholar
  • 23 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. Gut 2013; 62: 242-249
    Search in Google Scholar
  • 24 Kaltenbach T, Gawron A, Meyer CS. et al. Adenoma detection rate (ADR) irrespective of indication is comparable to screening ADR: Implications for quality monitoring. Clin Gastroenterol Hepatol 2021; 19: 1883-1889 e1881
    Search in Google Scholar