ASSESSMENT OF COLONOSCOPY QUALITY IN CLINICAL PRACTICE IN SWEDEN
27 March 2018 (online)
Population-based CRC screening is planned in Sweden and its success will depend upon the quality of colonoscopy. Our aim was to assess quality of colonoscopy in current clinical practice in Sweden, through the use of online questionnaires developed by the European Colonoscopy Quality Investigation (ECQI) Group, compared with recently published European Society of Gastrointestinal Endoscopy (ESGE) performance measures.
Development of the validated online questionnaires has been previously presented in posters at UEGW 2015 and 2016. The questionnaires aim to evaluate colonoscopy at a European, national and individual level. The Swedish Gastroenterology Society has endorsed the ECQI questionnaire as a method to assess colonoscopy quality in clinical practice. We analysed completed questionnaires from Sweden between 2/6/16 and 12/9/17.
Data were obtained from 13 institutions, 29 practitioners and 539 procedures. Minimum standard of 25% adenoma detection rate (ADR) is recommended by ESGE, however, of the 24 practitioners who completed the practitioner form, only 4 (16.7%) reported routinely recording ADR.
Adequate bowel preparation was defined as Boston Bowel Preparation Scale score ≥6 (ESGE minimum standard ≥90%). From our data, 84.8% (n = 457) of procedures had adequate bowel cleansing (data unavailable for 22, 4.1%).
Caecal intubation rate: ESGE minimum standard of ≥90% of all diagnostic and screening colonoscopies visualise the whole caecum, where indication exists. The caecum was the intended endpoint in 51.9% of procedures (ileum 44.7%, anastomosis 2.2%, data unavailable 1.1%). For those colonoscopies where the caecum was the intended endpoint (n = 280), 92.9% reached the caecum but only 81.4% stated endpoint photo-documentation.
Patient satisfaction was recorded at 3/13 (23.1%) institutions and retraction time was recorded by 14/24 (58.3%) practitioners.
Our findings indicate that some important colonoscopy performance measures recommended by ESGE are not currently being achieved in clinical practice in Sweden.