Survey-based Analysis of Colonoscopy Quality Among Ukrainian Endoscopists

Aims Screening colonoscopy is an effective strategy to prevent and provide early diagnosis for colorectal cancer (CRC). In order to optimize the quality of colonoscopy, performance measures (PM) have been identified and published by major international gastrointestinal societies. This study aimed to evaluate adherence to colonoscopy PMs among Ukrainian endoscopists and investigate factors related to suboptimal polyp management.

Methods A survey was created utilizing quality PMs proposed by international guidelines (including ESGE) and disseminated via email to members of EndoAcademy, one of the largest societies for endoscopists in Ukraine. Suboptimal polyp management was defined as performing a biopsy or photo documentation of a premalignant polyp rather than complete removal. Descriptive analysis was performed followed by multivariate logistic regression analysis to identify factors associated with suboptimal polyp management.

Results The survey was emailed to 540 endoscopists. There were 122 respondents (22.6%), including 31 women (25.4%). Most endoscopists work in public hospitals (59.8%), are contracted with National Health Services of Ukraine (NHSU) (68.6%), and perform 300-1000 colonoscopies per year (36.9%). Recording cecal intubation rate was reported by 61.5% of endoscopists and measuring adenoma detection rate by 59.8%. Fewer endoscopists record withdrawal time (38.5%), adequate bowel preparation rate (38.5%), measure polyp detection rate (30.3%), tattooing resection sites (15.6%), and complication rates (13.9%). 20.5% of endoscopists reported not recording any PMs.

In terms of polypectomy techniques utilized, cold snare polypectomy was reported by 86.9% of endoscopists, cold forceps polypectomy by 67.2%, hot snare polypectomy by 76.2%, endoscopic mucosal resection by 54.0%, endoscopic submucosal dissection by 19.7%. Suboptimal polyp management was reported by 31.1% of endoscopists. This group was less likely to record PMs (p<0.05). Sex, age, experience, and number of colonoscopies per year were not associated with suboptimal management. Optimal polyp management was reported by 68.9% of endoscopists. It was associated with using ESGE guidelines as a main additional educational resource (p<0.001).

Conclusions The results of this survey distributed to the largest group of endoscopists in Ukraine indicate the importance of recording and monitoring quality PMs for colonoscopy in daily practice. A significant proportion of Ukrainian endoscopists do not record key PMs.

Wide adoption and auditing of quality PMs in Ukraine will be an important step towards implementing a national colorectal cancer screening program.

Publication History

Article published online:
15 April 2024