Silvia Paggi1, Arnaldo Amato2, Andrea Anderloni3, Vito Annese4, Luca Barresi5, Andrea Buda6, Paola Cesaro7, Emilio Di Giulio8, Giuseppe Gullotti9, Carlo Fabbri10, Giancarla Fiori11, Lorenzo Fuccio12, Mauro Manno13, Alessandro Musso14, Emanuele Rondonotti2, Cristina Trovato11, Cesare Hassan15, Alessandro Repici16, Franco Radaelli2. 1. Division of Gastroenterology, Valduce Hospital, Como, Italy. Electronic address: silviapagg@gmail.com. 2. Division of Gastroenterology, Valduce Hospital, Como, Italy. 3. Istituto Clinico Humanitas, Gastroenterology and Endoscopy Unit, Milano, Italy. 4. Gastroenterology Unit, A.O. Universitaria Careggi, Firenze, Italy. 5. Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy. 6. Department of Oncological Gastrointestinal Surgery, Division of Gastroenterology, S. Maria del Prato Hospital, Feltre, Italy. 7. Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy. 8. Digestive Endoscopy Unit, Azienda Ospedaliera Sant'Andrea di Roma, Italy. 9. Endoscopy Unit, A.O.U. Policlinico G. Martino, Messina, Italy. 10. Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy. 11. Endoscopy Unit, Istituto Europeo di Oncologia, Milano, Italy. 12. Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Italy. 13. Digestive Endoscopy Unit, AUSL Modena Northern Area, Carpi-Mirandola Hospital, Italy. 14. Division of Gastroenterology, AOU Città della Salute e della Scienza, Torino, Italy. 15. Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy. 16. Istituto Clinico Humanitas, Gastroenterology and Endoscopy Unit, Milano, Italy; Humanitas University, Milano, Italy.
Abstract
BACKGROUND: The provision of high-quality colonoscopy can be assessed by evaluating technical aspects of the procedure and, at individual center level, by comparing structural indicators and institutional policies for managing peri-procedural issues with guideline recommendations. AIM: To assess the colonoscopy quality (CQ) in Italy at center level. METHODS: Gastroenterologists participating in a nationwide colonoscopy education initiative provided information on structural indicators of their centers and on institutional policies by answering 10 multiple-choice clinical scenarios. Practice variation across centers and compliance with guidelines were analyzed. RESULTS: Data from 282 Italian centers were evaluated. Overall, a significant proportion of centers did not meet CQ standards as concerns endoscopy facilities and equipments (e.g., dedicated recovery room, dirty-to-clean path, reporting software). CQ assurance programs were implemented in only 25% of centers. Concerning peri-procedural issues, main discrepancies with guidelines were recorded in the underuse of split-dose preparation (routinely adopted by 18% of centers), the routine request of coagulation tests prior to colonoscopy (30%), the routine interruption of aspirin for polypectomy (18%), and the adoption of 3-year surveillance for low-risk adenoma (49%). CONCLUSIONS: Present survey shows a significant variation in the CQ of endoscopy centers in Italy on many items of colonoscopy practice that should be targeted for future interventions.
BACKGROUND: The provision of high-quality colonoscopy can be assessed by evaluating technical aspects of the procedure and, at individual center level, by comparing structural indicators and institutional policies for managing peri-procedural issues with guideline recommendations. AIM: To assess the colonoscopy quality (CQ) in Italy at center level. METHODS: Gastroenterologists participating in a nationwide colonoscopy education initiative provided information on structural indicators of their centers and on institutional policies by answering 10 multiple-choice clinical scenarios. Practice variation across centers and compliance with guidelines were analyzed. RESULTS: Data from 282 Italian centers were evaluated. Overall, a significant proportion of centers did not meet CQ standards as concerns endoscopy facilities and equipments (e.g., dedicated recovery room, dirty-to-clean path, reporting software). CQ assurance programs were implemented in only 25% of centers. Concerning peri-procedural issues, main discrepancies with guidelines were recorded in the underuse of split-dose preparation (routinely adopted by 18% of centers), the routine request of coagulation tests prior to colonoscopy (30%), the routine interruption of aspirin for polypectomy (18%), and the adoption of 3-year surveillance for low-risk adenoma (49%). CONCLUSIONS: Present survey shows a significant variation in the CQ of endoscopy centers in Italy on many items of colonoscopy practice that should be targeted for future interventions.
Authors: Giancarlo Spinzi; Angelo Milano; Piero Brosolo; Paola Da Massa Carrara; Maurizio Labardi; Alberto Merighi; Luisa Riccardi; Francesco Torresan Journal: Endosc Int Open Date: 2020-02-21