Manuel Zorzi1, Carlo Senore2, Filippo Da Re3, Alessandra Barca4, Luigina Ada Bonelli5, Renato Cannizzaro6, Renato Fasoli7, Lucia Di Furia8, Emilio Di Giulio9, Paola Mantellini10, Carlo Naldoni11, Romano Sassatelli12, Douglas Rex13, Cesare Hassan14, Marco Zappa15. 1. Registro Tumori del Veneto, Padova, Italy. 2. CPO Piemonte and San Giovanni Battista University Hospital, Turin, Turin, Italy. 3. Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venice, Italy. 4. Regione Lazio, Rome, Italy. 5. SS Prevenzione Secondaria e Screening, IRCCS AOU San Martino-IST, Genova, Italy. 6. Department of Oncological Gastroenterology, National Cancer Institute, IRCCS, Centro di Riferimento Oncologico, Aviano, Italy. 7. U.O. multizonale di Gastroenterologia, Ospedale S. Chiara, Trento, Italy. 8. Agenzia Regionale Sanitaria, Regione Marche, Ancona, Italy. 9. Endoscopia Digestiva, Università di Roma "Sapienza", Azienda Ospedaliera Sant'Andrea, Rome, Italy. 10. Department of Clinical Epidemiology, Cancer Prevention and Research Institute (ISPO), Florence, Italy. 11. Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy. 12. Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. 13. Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA. 14. Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy, Rome, Italy. 15. SS Valutazione Screening, Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy.
Abstract
OBJECTIVES: To assess variation in the main colonoscopy quality indicators in organised colorectal cancer (CRC) screening programmes based on faecal immunochemical test (FIT). DESIGN: Data from a case-series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected. The adenoma detection rate (ADR) and caecal intubation rate (CIR) were assessed for the whole population and the individual endoscopists. To explore variation in the quality indicators, multilevel analyses were performed according to patient/centre/endoscopist characteristics. RESULTS: We analysed 75 569 (mean age: 61.3 years; men: 57%) colonoscopies for positive FIT performed by 479 endoscopists in 79 centres. ADR ranged from 13.5% to 75% among endoscopists (mean: 44.8%). ADR was associated with gastroenterology specialty (OR: 0.87 for others, 95% CI 0.76 to 0.96) and, at the endoscopy centre level, with the routine use of sedation (OR: 0.80 if occasional (<33%); 95% CI 0.64 to 1.00) and availability of screening-dedicated sessions (OR: 1.35; 95% CI 1.11 to 1.66). CIR ranged between 58.8% and 100% (mean: 93.1%). Independent predictors of CIR at the endoscopist level were the yearly number of screening colonoscopies performed (OR: 1.51 for endoscopists with >600 colonoscopies; 95% CI 1.11 to 2.04) and, at the endoscopy centre level, screening-dedicated sessions (OR: 2.18; 95% CI 1.24 to 3.83) and higher rates of sedation (OR: 0.47 if occasional; 95% CI 0.24 to 0.92). CONCLUSIONS: The quality of colonoscopy was affected by patient-related, endoscopist-related and centre-related characteristics. Policies addressing organisational issues should improve the quality of colonoscopy in our programme and similar programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: To assess variation in the main colonoscopy quality indicators in organised colorectal cancer (CRC) screening programmes based on faecal immunochemical test (FIT). DESIGN: Data from a case-series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected. The adenoma detection rate (ADR) and caecal intubation rate (CIR) were assessed for the whole population and the individual endoscopists. To explore variation in the quality indicators, multilevel analyses were performed according to patient/centre/endoscopist characteristics. RESULTS: We analysed 75 569 (mean age: 61.3 years; men: 57%) colonoscopies for positive FIT performed by 479 endoscopists in 79 centres. ADR ranged from 13.5% to 75% among endoscopists (mean: 44.8%). ADR was associated with gastroenterology specialty (OR: 0.87 for others, 95% CI 0.76 to 0.96) and, at the endoscopy centre level, with the routine use of sedation (OR: 0.80 if occasional (<33%); 95% CI 0.64 to 1.00) and availability of screening-dedicated sessions (OR: 1.35; 95% CI 1.11 to 1.66). CIR ranged between 58.8% and 100% (mean: 93.1%). Independent predictors of CIR at the endoscopist level were the yearly number of screening colonoscopies performed (OR: 1.51 for endoscopists with >600 colonoscopies; 95% CI 1.11 to 2.04) and, at the endoscopy centre level, screening-dedicated sessions (OR: 2.18; 95% CI 1.24 to 3.83) and higher rates of sedation (OR: 0.47 if occasional; 95% CI 0.24 to 0.92). CONCLUSIONS: The quality of colonoscopy was affected by patient-related, endoscopist-related and centre-related characteristics. Policies addressing organisational issues should improve the quality of colonoscopy in our programme and similar programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER SCREENING
Authors: Joaquín Cubiella; Antoni Castells; Montserrat Andreu; Luis Bujanda; Fernando Carballo; Rodrigo Jover; Ángel Lanas; Juan Diego Morillas; Dolores Salas; Enrique Quintero Journal: United European Gastroenterol J Date: 2016-07-20 Impact factor: 4.623
Authors: Reinier G S Meester; Chyke A Doubeni; Ann G Zauber; Marjolein van Ballegooijen; Douglas A Corley; Iris Lansdorp-Vogelaar Journal: Int J Cancer Date: 2017-08-31 Impact factor: 7.396
Authors: Shashank Sarvepalli; Ari Garber; Michael B Rothberg; Gautam Mankaney; John McMichael; Gareth Morris-Stiff; John J Vargo; Maged K Rizk; Carol A Burke Journal: JAMA Surg Date: 2019-07-01 Impact factor: 14.766