Carolina Mangas-Sanjuan1, Enrique Santana1, Joaquín Cubiella2, Elena Rodríguez-Camacho3, Agustín Seoane4, Marco Antonio Alvarez-Gonzalez4, Adolfo Suárez5, Verónica Álvarez-García5, Natalia González6, Alberto Luè7, Lucía Cid-Gomez8, Marta Ponce9, Luis Bujanda10, Isabel Portillo11, María Pellisé12, Pilar Díez-Redondo13, Maite Herráiz14, Akiko Ono15, Ángeles Pizarro16, Pedro Zapater17, Rodrigo Jover18. 1. Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria and Biomédica de Alicante, ISABIAL, Alicante, Spain. 2. Department of Gastroenterology, Complexo Hospitalario de Ourense, Instituto de Investigación Biomédica de Ourense, Pontevedra y Vigo, Ourense, Spain. 3. Dirección Xeral de Saúde Pública, Consellería de Sanidade, Santiago de Compostela, Spain. 4. Department of Gastroenterology, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain. 5. Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain. 6. Department of Gastroenterology, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas and Centro de Investigación Biomédica de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain. 7. Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute, Zaragoza, Spain. 8. Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica, Xerencia de Xestión Integrada de Vigo, Vigo, Spain. 9. Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain. 10. Department of Gastroenterology, Biodonostia Medical Research Institute, San Sebastián, Spain. 11. BioCruces Health Research Institute, Colorectal Screening Program, Basque Health Service, Barakaldo, Spain. 12. Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain. 13. Endoscopy Unit, Hospital Universitario Rio Hortega, Valladolid, Spain. 14. Department of Gastroenterology, Clínica Universitaria and Medical School, University of Navarra, Navarra, Spain. 15. Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain. 16. Department of Gastroenterology, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 17. Unit of Clinical Pharmacology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) Alicante, Spain. 18. Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria and Biomédica de Alicante, ISABIAL, Alicante, Spain. Electronic address: rodrigojover@gmail.com.
Abstract
BACKGROUND & AIMS: Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. METHODS: We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. RESULTS: Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49-0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55-0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22-0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71-2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20-1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30-11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32-2.14). CONCLUSIONS: Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.
BACKGROUND & AIMS: Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. METHODS: We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. RESULTS: Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49-0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55-0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22-0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71-2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20-1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30-11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32-2.14). CONCLUSIONS: Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.
Authors: Alexander J Eckardt; Joan Kheder; Anjali Basil; Taryn Silverstein; Krunal Patel; Mohamed Mahmoud; Yasir Al-Azzawi; Daniel Ellis; William Gillespie; Yoel Carrasquillo Vega; Sharina D Person; John M Levey Journal: Endosc Int Open Date: 2020-11-17