scholarly journals The Quality of Screening Colonoscopies in an Office-Based Endoscopy Clinic

2009 ◽  
Vol 23 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Douglas Bair ◽  
Joe Pham ◽  
M Bianca Seaton ◽  
Naveen Arya ◽  
Michelle Pryce ◽  
...  
Keyword(s):  
Academic Community ◽  
Screening Colonoscopy ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Adequate Sedation ◽  
Cecal Intubation Rate ◽  
Hospital Practices

BACKGROUND: Wait times for hospital screening colonoscopy have increased dramatically in recent years, resulting in an increase in patient referrals to office-based endoscopy clinics. There is no formal regulation of office endoscopy, and it has been suggested that the quality of service in some office locations may be inferior to hospital procedures.OBJECTIVE: To compare the quality of office-based screening colonos-copies at a clinic in Oakville, Ontario, with published benchmarks for cecal intubation, withdrawal times, polyp detection, adenoma detection, cancer detection and patient complications.METHODS: Demographic information on consecutive patients and colonoscopy reports by all nine gastroenterologists at the Oakville Endoscopy Centre between August 2006 and December 2007 were prospectively obtained.RESULTS: A total of 3741 colonoscopies were analyzed. The mean age of patients was 57.1 years and 51.9% were women. The cecal intubation rate was 98.98% with an average withdrawal time of 9.75 min. A total of 3857 polyps were retrieved from 1725 patients (46.11%), and 1721 adenomas were detected in 953 patients (25.47%). A total of 126 patients (3.37%) had advanced polyps and 18 (0.48%) were diagnosed with colon cancer. One patient (0.027%) had a colonic perforation and two patients had postpolypectomy bleeding (0.053%). These results meet or exceed published benchmarks for quality colonoscopy.CONCLUSIONS: The Oakville Endoscopy Centre data demonstrate that office-based colonoscopies, performed by well-trained physicians using adequate sedation and hospital-grade equipment, result in outcomes at least equal to or better than those of published academic/community hospital practices and are therefore a viable option for the future of screening colonoscopy in Canada.

scholarly journals Effect of Using Personal Protective Equipment during the COVID-19 Pandemic on the Quality Indicators of Screening Colonoscopies

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Subin Chirayath ◽  
Janak Bahirwani ◽  
Parampreet Kaur ◽  
Noel Martins ◽  
Ronak Modi
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Time Period ◽  
Adenoma Detection ◽  
Cecal Intubation Time ◽  
Practice Of Medicine ◽  
Cecal Intubation Rate

Background. Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Aims. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as the cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT), and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods. We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT, and ADR from outpatient, nonemergent procedures conducted at 3 endoscopy suites of St. Luke’s University Health Network. All inpatient and emergent procedures were excluded. Results. Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 and 2020 (318 in 2019 vs. 157 in 2020, p = 0.005 ). CIT ( 320 ± 105 seconds in 2019 vs. 392 ± 107 seconds in 2020, p = 0.001 ) and SWT ( 706 ± 232 seconds in 2019 vs. 830 ± 241 seconds in 2020, p = 0.001 ) were increased while CIR (98.2% in 2019 vs. 96.6% in 2020, p = 0.04 ) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs. 38.18 (16.66-66.00) in 2020, p = 0.8 ). Conclusion. Our study showed that quality indices for screening colonoscopies like CIR, CIT, and SWT were negatively impacted during the COVID-19 time period. ADR, however, was similar. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopy’s clinical benefit.

scholarly journals Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group

2021 ◽  
Vol 09 (10) ◽  
pp. E1456-E1462
Author(s):  
Cristiano Spada ◽  
Anastasios Koulaouzidis ◽  
Cesare Hassan ◽  
Pedro Amaro ◽  
Anurag Agrawal ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Gastrointestinal Endoscopy ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Cecal Intubation Rate ◽  
Colonoscopy Quality

Abstract Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires. Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites. Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received.Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively.Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing. Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.

Cuff-assisted versus cap-assisted colonoscopy for adenoma detection: results of a randomized study

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. 742-749 ◽  
Author(s):  
Javier Sola-Vera ◽  
Lourdes Catalá ◽  
Francisco Uceda ◽  
María Dolores Picó ◽  
Estefanía Pérez Rabasco ◽  
...  
Keyword(s):  
Detection Rate ◽  
Removal Rate ◽  
Randomized Study ◽  
Intubation Rate ◽  
Device Removal ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Abstract Background The adenoma detection rate (ADR) is the most important marker of colonoscopy quality. Devices to improve adenoma detection have been developed, such as the Endocuff and transparent cap. The aim of the current study was to examine whether there was a difference in ADR between Endocuff-assisted (EAC) and cap-assisted colonoscopy (CAC). Methods A randomized prospective trial was conducted. Eligible patients included adults ≥ 18 years referred because of symptoms, surveillance, or colonoscopies as part of the Bowel Cancer Screening Programme (BCSP). The primary outcome measure was ADR. Secondary outcomes included mean number of adenomas, mean number of polyps, polyp detection rate, cecal intubation rate, and time to cecal intubation. Procedural measures, device removal rate, and adverse events were also recorded. Results A total of 711 patients (51.1 % men; median age 63 years) were included, of whom 357 patients were randomized to EAC and 354 patients to CAC. In the intention-to-treat analysis, the ADR was similar in both groups: EAC 50.4 % (95 % confidence interval [CI] 45.1 – 55.7) vs. CAC 50.6 % (95 %CI 45.2 – 55.9). Similar results were obtained in the per-protocol analysis: EAC 51.6 % (95 %CI 46.2 – 57) vs. CAC 51.4 % (95 %CI 46 – 56.8). There were no differences between the two devices in ADR according to the mean number of adenomas and polyps per procedure, polyp detection rate, cecal intubation rate, and time to cecal intubation. Device removal rate and adverse events were also similar. Conclusion In this randomized study, no differences in ADR were found between Endocuff- and cap-assisted colonoscopy.

scholarly journals Impact of real-time use of artificial intelligence in improving adenoma detection during colonoscopy: A systematic review and meta-analysis

2021 ◽  
Vol 09 (04) ◽  
pp. E513-E521
Author(s):  
Munish Ashat ◽  
Jagpal Singh Klair ◽  
Dhruv Singh ◽  
Arvind Rangarajan Murali ◽  
Rajesh Krishnamoorthi
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Meta Analysis ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Polyp Detection ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
The Impact

Abstract Background and study aims With the advent of deep neural networks (DNN) learning, the field of artificial intelligence (AI) is rapidly evolving. Recent randomized controlled trials (RCT) have investigated the influence of integrating AI in colonoscopy and its impact on adenoma detection rates (ADRs) and polyp detection rates (PDRs). We performed a systematic review and meta-analysis to reliably assess if the impact is statistically significant enough to warrant the adoption of AI -assisted colonoscopy (AIAC) in clinical practice. Methods We conducted a comprehensive search of multiple electronic databases and conference proceedings to identify RCTs that compared outcomes between AIAC and conventional colonoscopy (CC). The primary outcome was ADR. The secondary outcomes were PDR and total withdrawal time (WT). Results Six RCTs (comparing AIAC vs CC) with 5058 individuals undergoing average-risk screening colonoscopy were included in the meta-analysis. ADR was significantly higher with AIAC compared to CC (33.7 % versus 22.9 %; odds ratio (OR) 1.76, 95 % confidence interval (CI) 1.55–2.00; I2 = 28 %). Similarly, PDR was significantly higher with AIAC (45.6 % versus 30.6 %; OR 1.90, 95 %CI, 1.68–2.15, I2 = 0 %). The overall WT was higher for AIAC compared to CC (mean difference [MD] 0.46 (0.00–0.92) minutes, I2 = 94 %). Conclusions There is an increase in adenoma and polyp detection with the utilization of AIAC.

scholarly journals Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

2018 ◽  
Vol 06 (09) ◽  
pp. E1149-E1156 ◽  
Author(s):  
Isabel Portillo ◽  
Isabel Idigoras ◽  
Isabel Bilbao ◽  
Eunate Arana-Arri ◽  
María José Fernández-Landa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Detection Rate ◽  
Screening Colonoscopy ◽  
Hospital Type ◽  
Cecal Intubation ◽  
Academic Hospitals ◽  
Adenoma Detection

Abstract Background and study aims To compare the quality of colonoscopy in a population-based coordinated program of colorectal cancer screening according to type of hospital (academic or non-academic). Patients and methods Consecutive patients undergoing colonoscopy after positive FIT (≥ 20 ug Hb/g feces) between January 2009 and September 2016 were prospectively included at five academic and seven non-academic public hospitals. Screening colonoscopy quality indicators considered were adenoma detection rate, cecal intubation rate, complications and bowel preparation quality. Results A total of 48,759 patients underwent colonoscopy, 34,616 (80 %) in academic hospitals and 14,143 in non-academic hospitals. Among these cases, 19,942 (37.1 %) advanced adenomas and 2,607 (5.3 %) colorectal cancers (CRCs) were detected, representing a total of 22,549 (46.2 %) cases of advanced neoplasia. The adenoma detection rate was 64 %, 63.1 % in academic hospitals and 66.4 % in non-academic hospitals (P < 0.001). Rates of advanced adenoma detection, cecal intubation and adequate colonic preparation were 45.8 %, 96.2 % and 88.3 %, respectively, and in all cases were lower (implying worse quality care) in academic hospitals (45.3 % vs 48.7 %; odds ratio [OR] 0.87, 95 % confidence interval [CI] 0.84 – 0.91; 95.9 % vs 97 %; OR 0.48, 95 % CI 0.38 – 0.69; and 86.4 % vs 93 %; OR 0.48, 95 % CI 0.45 – 0.5; respectively; P < 0.001 in all cases). In 13 patients, all in the academic hospital group, CRC was diagnosed after colonoscopy (0.26 cases × 1000 colonoscopies). Rates of CRC treated by endoscopy were similar in both types of hospital (30 %). The rate of severe complication was 1.2 % (602 patients), with no significant differences by hospital type: bleeding occurred in 1/147 colonoscopies and perforation in 1/329. One patient died within 30 days after screening colonoscopy. Conclusions The quality of colonoscopy was better in non-academic hospitals. The rate of detection of advanced neoplasia was higher in non-academic hospitals and correlated with the rate of post-colonoscopy CRC.

scholarly journals The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Qiongmei Zhang ◽  
Zhiyu Dong ◽  
Yuanxi Jiang ◽  
Tingting Zhan ◽  
Junwen Wang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Detection Rate ◽  
Logistic Regression Model ◽  
Independent Factor ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Purpose. To explore the effect of sedation on the quality of colonoscopy. Methods. The data collected from the Digestive Endoscopy Center of Shanghai Tongji Hospital from March 2012 to June 2019 were retrospectively analyzed. The rate of sedation and quality metrics of colonoscopy such as adenoma detection rate (ADR) and cecal intubation rate (CIR) were calculated. The logistic regression model was used to explore the relationship between sedation and quality metrics of colonoscopy. The interaction effects between experience of endoscopists and sedation on quality of colonoscopy was also investigated in subgroups stratified by total number of colonoscopies during career using the logistic regression model. Results. A total of 63,417 colonoscopies including 11,417 colonoscopies without sedation and 52,000 colonoscopies with sedation were enrolled in our study. The proportion of colonoscopy with sedation was 82.0%. The ADR and CIR were all significantly higher in cases with sedation compared with cases without sedation (ADR, 22.5% vs. 17.0%, p < 0.001 ; CIR, 94.7% vs. 91.2%, p < 0.001 ). Multivariate analysis showed that the sedation was an independent factor associated with adenoma detection ( OR = 1.448 , 95% CI: 1.372~1.529, p < 0.001 ) and cecal intubation ( OR = 1.560 , 95% CI: 1.446~1.683, p < 0.001 ). A total of 14 endoscopists with complete colonoscopy data in our database and corresponding 20,949 colonoscopies data were enrolled for further analysis. The logistic regression model yielded a similar result that sedation was an independent factor on adenoma detection and cecal intubation when the factor, experience of endoscopists, was also entered into the model as a confounder (adenoma detection, OR = 1.408 , 95% CI: 1.333~1.487, p < 0.001 ; cecal intubation, OR = 1.601 , 95% CI: 1.482-1.729, p < 0.001 ). Conclusion. Colonoscopy with sedation has a positive effect on ADR and CIR in all endoscopists with different experience of colonoscopy, which makes the quality of colonoscopy better.

scholarly journals Weekend and evening planned colonoscopy activity: a safe and effective way to meet demands

2021 ◽  
Vol 09 (07) ◽  
pp. E1026-E1031
Author(s):  
Shimaa A. Afify ◽  
Omnia M. Abo-Elazm ◽  
Ishak I. Bahbah ◽  
Mo H. Thoufeeq
Keyword(s):  
Performance Indicators ◽  
Gastrointestinal Endoscopy ◽  
Working Hours ◽  
Key Performance Indicators ◽  
Advisory Group ◽  
Cecal Intubation ◽  
Related Data ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Abstract Background and study aims Colonoscopy is the “gold standard” investigation for assessment of the large bowel that detects and prevents colorectal cancer, as well as non-neoplastic conditions. The Joint Advisory Group (JAG) on Gastrointestinal Endoscopy recommends monitoring key performance indicators such as cecal intubation rate (CIR) and adenoma detection rate (ADR). We aimed to investigate the quality of colonoscopies carried out during evening and Saturday lists in our unit and compare them against JAG standards of quality for colonoscopies. Patients and methods We retrospectively collected and analyzed demographical and procedure-related data for non-screening colonoscopies performed between January 2016 and November 2018. Evenings and Saturdays were defined as the out-of-hour (OOH) period. We compared the outcomes of the procedures done in these against the working hours of the weekdays. We also wanted to explore whether the outcomes were different among certain endoscopists. Other factors that could affect the KPIs, such as endoscopist experience and bowel preparation, were also analyzed. Results There were a total of 17634 colonoscopies carried out; 56.9 % of the patients (n = 10041) < 70 years old. Key Performance Indicators (KPIs) of weekday, evening, and Saturday colonoscopies regarding the CIR and ADR met the JAG standards as they were above 93 % and 24 %, respectively. Advanced colonoscopists had better KPIs when compared to the non-advanced colonoscopists, with CIR at 97.6 % vs. 93.2 % and ADR at 40.8 % vs. 26 %, respectively. Conclusions JAG standards were maintained during colonoscopies done on weekdays, evenings, and Saturdays. Advanced colonoscopists had higher CIR and ADRs.

scholarly journals Effect of using personal protective equipment during the COVID-19 pandemic on the quality indicators of screening colonoscopies.

2021 ◽  
Author(s):  
Subin G Chirayath ◽  
Janak Bahirwani ◽  
Parampreet Kaur ◽  
Noel Martins ◽  
Ronak Modi
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Intubation Time ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Cecal Intubation Time ◽  
Cecal Intubation Rate

Background and Aims: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT) and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods: We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT and ADR from outpatient, non-emergent procedures conducted at 3 endoscopy suites of St Lukes University Health Network. All inpatient and emergent procedures were excluded. Data was obtained by performing chart review on EPIC electronic health record. Results: Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 to 2020 (318 in 2019 vs 157 in 2020, p= 0.005). CIT (320+/-105 seconds in 2019 vs 392+/-107 seconds in 2020, p=0.001) and SWT (706+/-232 seconds in 2019 vs 830+/-241 seconds in 2020, p=0.001) were increased while CIR (98.2% in 2019 vs 96.6% in 2020, p=0.04) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs 38.18(16.66-66.00) in 2020, p=0.8). Conclusion: Our study showed that quality indices for screening colonoscopies like cecal intubation rate, cecal intubation time and scope withdrawal time were negatively impacted during the initial COVID time period compared to pre-COVID time. The study also displayed that though there was a significant decline in both screening and diagnostic colonoscopies during pandemic, adenoma detection rates were comparable. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopies clinical benefits.

scholarly journals Colonoscopy for colorectal cancer screening - is it effective in the hands of a general surgery resident?

2018 ◽  
Vol 90 (4) ◽  
pp. 11-15
Author(s):  
Maciej Matyja ◽  
Artur Pasternak ◽  
Michał Wysocki ◽  
Michał Pędziwiatr ◽  
Mirosław Szura ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
General Surgery ◽  
Detection Rate ◽  
Screening Colonoscopy ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Group I ◽  
Adenoma Detection ◽  
Patient Tolerance ◽  
Cecal Intubation Rate

INTRODUCTION: Colonoscopy is considered to be a gold standard for colorectal cancer (CRC) screening. Endoscopy training is an essential component of general surgery training program. Patients should receive care at the highest level possible, nevertheless residents need to gain experience. The aim of our study was to evaluate the effectiveness of colonoscopy performed by general surgery residents by comparing quality indicators between surgical trainees and consultants MATERIALS AND METHODS: The analysis included 6384 patients aged 40-65 who underwent screening colonoscopy between October 2014 and February 2018. The patients were divided into two groups: group I - patients examined by residents, group II - patients examined by board certified general surgeons. Quality indicators such as cecal intubation rate, adenoma detection rate and patient tolerance scale were compared between the two groups. RESULTS: Group I comprised 2268 (35.53%) and group II 4116 (64.47%) patients. The overall cecal intubation rate (CIR) was 95.99%, equal for the both groups (p=0.994). There was no statistically significant difference in adenoma detection rate: 29.30% in residents group and 27.66% among consultants (p=0.203). Patient tolerance for exam was very good (4-point scale) in consultants group in 78.98% of cases and in 75.18% cases among residents (p<0.001). CONCLUSION: . Within a proper learning environment general surgery residents are able to perform high quality and effective screening colonoscopy. However, residents need to continue the progress in their technique to improve patient tolerance in order to reach the proficiency of the consultant.

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