PERFORMANCE MEASURES IN IBD SURVEILLANCE COLONOSCOPY- IMPLEMENTING CHANGES TO PRACTICE IMPROVES PERFORMANCE

Aims:

Currently dye-based chromoendoscopy (DCE) is recommended for Inflammatory Bowel Disease (IBD) surveillance. However DCE has not been widely adopted into clinical practice yet. We aimed to evaluate performance in IBD surveillance colonoscopy following introduction of structured changes in delivery of service.

Methods:

In August 2016 we introduced a number of changes in practice of surveillance colonoscopy in IBD. These included training/education using interactive videos and images in a structures module; DCE as standard; allocation of 45-minute procedure slot; targeted biopsies (except high risk patients); scoring of endoscopic disease activity; lesion detection and morphology characterisation. All IBD surveillance colonoscopies were allocated to a small team of experienced and expert endoscopists (n = 4 A-D).

We compared quality measures for surveillance procedures performed between 01/2014 – 07/2016 and 08/2016 – 10/2018.

The two groups were compared using Chi-square statistics.

Results:

A total of 598 IBD surveillance procedures (277 pre-August 2016 and 321 post-August 2016) were performed. DCE increased (54.2% vs. 76.0% p < 0.0005) whilst random biopsy surveillance reduced (12.3% vs. 3.1% p < 0.0005). Adenoma detection rate increased (7.2% vs. 10.0%) although did not reach statistical significance. Morphology assessments increased also with the use of Paris classification (26.1% vs. 57.0% p < 0.0005) and Kudo pit pattern (21.7% vs. 59.0% p < 0.0005). The total number of endoscopists performing IBD surveillance was reduced with the majority of procedures carried out by fewer endoscopists (81.9% by endoscopists A-D) which led to further improvements when analysing the performance of these four endoscopists as well as an increased lesion detection rate (24.9% vs. 33.1% p < 0.05).

Conclusions:

Implementation of extensive changes in practice of surveillance colonoscopy resulted in significant improvement in quality indicators within a short period. However, training, education and audit may continue to facilitate the adoption of DCE and improve quality of performance further in IBD surveillance.