Quality evaluation of colonoscopy reporting and colonoscopy performance in daily clinical practice

Background: Comprehensive monitoring of colonoscopy quality requires complete and accurate colonoscopy reporting.

Objective: This study aimed to assess the compliance with colonoscopy reporting and to assess the quality of colonoscopy performance.

Design: Consecutive colonoscopy reports were reviewed by hand. Four hundred reports were included from each department.

Setting: Daily clinical practice in 12 Dutch endoscopy departments.

Patients: Consecutive patients undergoing scheduled colonoscopy procedures.

Main outcome measurements: Quality of reporting was assessed by using the American Society for Gastrointestinal Endoscopy criteria for colonoscopy reporting. Quality of colonoscopy performance was evaluated by using the cecal intubation rate and adenoma detection rate (ADR).

Results: A total of 4800 colonoscopies were performed by 116 endoscopists: 70% by gastroenterologists, 16% by gastroenterology fellows, 10% by internists, 3% by nurse-endoscopists, and 1% by surgeons. The mean age of the patients was 59 years (standard deviation 16), and 47% were male. Reports contained information on indication, sedation practice, and extent of the procedure in more than 90%. Only 62% of the reports mentioned the quality of bowel preparation (range between departments 7%-100%); photographic documentation of the cecal landmarks was present in 71% (range 22%-97%). The adjusted cecal intubation rate was 92% (range 84%-97%). The ADR was 24% (range 13%-32%).

Limitations: Dependent on reports, no intervention in endoscopic practice. No analysis for performance per endoscopist.

Conclusion: Colonoscopy reporting varied significantly in clinical practice. Colonoscopy performance met the suggested standards; however, considerable variability between endoscopy departments was found. The results of this study underline the importance of the implementation of quality indicators and guidelines. Moreover, by continuous monitoring of quality parameters, the quality of both colonoscopy reporting and colonoscopy performance can easily be improved.