Performance Indicators of Colonoscopy Quality in the Czech Colorectal Cancer Screening Program

Aims The primary objective of this study was to assess the overall volume and diagnostic efficacy of the preventive colonoscopies in the Czech Colorectal Cancer Screening Program based on the national registry data. The diagnostic performance of screening modalities in 2023 was evaluated through adenoma detection rates and the identification of colorectal cancer cases. A secondary objective involved assessing the performance of six predefined quality indicators at the Screening Colonoscopy Centers.

Methods To optimize the quality assesment of colonoscopies within the screening program, specific benchmarks in quality indicators were established: each screening center should perform a minimum of 100 preventive colonoscopies annually, achieve adequate bowel preparation in at least 90% of cases, and reach a cecal intubation rate of≥95%. Additionally, the ADR should be≥25% overall, with target rates of≥30% in males and≥20% in females. The evaluation utilized data from the National Health Information System, the Register of Preventive Colonoscopies, and the National Oncology Registry, and demographic statistics provided by the Czech Statistical Office. Data analysis was conducted on records available up to the year 2023.

Results Between the inception of the National Registry of Screening Colonoscopies in 2006 and 2023, a total of 531,362 preventive colonoscopies were recorded, comprising 384,755 colonoscopies following a positive FIT and 146,607 primary screening colonoscopies. In 2023, a total of 1,171,933 FITs were administered with a cut-off threshold of 15 μg/g, yielding a positivity rate of 9.1%. Among the 35,476 colonoscopies performed on FIT-positive individuals in 2023, adenomas were detected in 45.7% of cases, while carcinomas were identified in 2.5% of cases. Conversely, among the 20,259 primary screening colonoscopies conducted in 2023, adenomas were detected in 31.6% of cases, with carcinomas identified in 0.6%. The secondary analysis focused on evaluating the performance of the Centers for Screening Colonoscopy based on adherence to the six established quality indicators. In 2023, a total of 195 centers were assessed, with 140 centers (72%) meeting all six monitored quality criteria. However, three centers met only one indicator, and six centers fulfilled only two indicators.

Conclusions The analysis of the National Colorectal Cancer Screening Program in the Czech Republic demonstrates a high diagnostic yield, with significant adenoma and carcinoma detection rates, particularly in FIT-positive colonoscopies. The majority of Screening Colonoscopy Centers successfully met the established quality indicators, confirming the overall effectiveness of the screening program in achieving its preventive goals. However, continuous monitoring and targeted improvements in underperforming centers are necessary to maintain high-quality standards across all facilities.

Supported by the educational projects DZRVO MO1012 and Cooperatio.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025