Endoscopy 2015; 47(03): 217-224
DOI: 10.1055/s-0034-1391563
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A multicenter pragmatic study of an evidence-based intervention to improve adenoma detection: the Quality Improvement in Colonoscopy (QIC) study

Praveen T. Rajasekhar
1  South Tyneside District General Hospital, South Shields. UK
2  Northern Region Endoscopy Group, South Shields. UK
,
Colin J. Rees
1  South Tyneside District General Hospital, South Shields. UK
2  Northern Region Endoscopy Group, South Shields. UK
3  School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
,
Mike G. Bramble
2  Northern Region Endoscopy Group, South Shields. UK
3  School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
,
Douglas W. Wilson
3  School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
,
Matthew D. Rutter
2  Northern Region Endoscopy Group, South Shields. UK
3  School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
4  University Hospital of North Tees, Stockton-on-Tees, UK
,
Brian P. Saunders
5  St Mark’s Hospital, Northwick Park, Harrow, UK
,
A. Pali S. Hungin
3  School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
,
James E. East
6  Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Weitere Informationen

Publikationsverlauf

submitted 11. Juli 2014

accepted after revision 28. Dezember 2014

Publikationsdatum:
12. Februar 2015 (online)

Background and study aims: Low adenoma detection rates (ADRs) at colonoscopy are linked to significantly higher interval cancer rates, and vary between colonoscopists. Studies demonstrate that lesion detection is improved by: withdrawal time of ≥ 6 minutes; use of hyoscine butylbromide; position change; and rectal retroflexion. We evaluated the feasibility of implementing the above “bundle” of interventions into colonoscopy practice, and the effect on ADR.

Materials and methods: A longitudinal cohort design was used. Implementation combined central training, local promotion, and feedback. The uptake marker was change in hyoscine butylbromide use. Comparisons were between the 3 months before and the 9 months after the implementation phase, globally, by endoscopy unit and by quartile when colonoscopists were ranked according to baseline ADR. Chi-squared or Fisher’s tests were used to evaluate significance.

Results: 12 units participated. Global and quartile analyses included data from 118 and 68 colonoscopists and 17 508 and 14 193 procedures respectively. A significant increase in hyoscine butylbromide use was observed globally (54.4 % vs. 15.8 %, P < 0.001), in all endoscopy units (P < 0.001) and quartiles (P < 0.001). A significant increase in ADR was observed globally (18.1 % vs. 16.0 %, P = 0.002) and in the lower two colonoscopist quartiles (P < 0.001), with a nonsignificant increase in the upper middle quartile and a significant fall to 21.5 %. in the upper quartile. The significant variations in ADR among the upper three quartiles disappeared.

Conclusion: In routine clinical practice, introduction of a simple, inexpensive, evidence-based “bundle” of measures is feasible and is associated with higher global ADR, driven by improvements amongst the poorest performing colonoscopists.