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- Open Access
Quality of colonoscopy practice: a single-center experience in Egypt
The Egyptian Journal of Internal Medicine volume 28, pages 108–115 (2016)
Colonoscopy is a technically demanding procedure with the potential to cause harm if its performance is suboptimal. It is incumbent on endoscopists, therefore, to evaluate their practices and to make improvements wherever possible. Bolak Eldakror Hospital is a secondary-care governmental hospital in Egypt in which we set up an endoscopy quality-assurance program in 2003.
The aim of this study was specifically to evaluate the quality of colonoscopy practice in our endoscopy unit and by publishing our experience to encourage others to develop a quality-improvement program.
Patients and methods
Predetermined international quality indicators for colonoscopy were employed to monitor the standard of endoscopic procedures between 2010 and 2014. Recorded information included all medical and technical details.
A total of 286 colonoscopies were assessed. The main indication of colonoscopy was hematochezia (58.7%). Polyps were the main endoscopic findings (34.6%). Conscious sedation was used in 56.6%. Cecal intubation was achieved in 77.6%. The adjusted cecal intubation was 94%. Image documentation of cecal intubation was achieved in 92.3% examinations reaching the cecum. Mean cecal intubation time was 17.4±10 min. Mean withdrawal time was 6.6±4 min. The main reasons for unsuccessful cecal intubation were impassable mass or stricture in 23 (8%) colonoscopies and poor bowel preparation in 23 (8%). Colon preparation was rated adequate in 66.4%. Diagnostic colorectal biopsies for those with persistent diarrhea were obtained in 97%. Polyp detection rate was 36.1% and adenoma detection rate was 5.3%. Polypectomy was carried out in 89 (93.6%) patients with detected polyp/s. Retrieval of all excised polyps was successful in 84.3%. Postpolypectomy perforation occurred in one (0.4%) patient.
A high standard of colonoscopy can be achieved by the rigorous application of quality-assurance measures.
Balfour TW. Training for colonoscopy. J R Soc Med 1999; 94:160–161.
Kaminski M, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362:1795–1803.
Romagnuolo J, Enns R, Ponich T, Springer J, Armstrong D, Barkun A, et al. Canadian credentialing guidelines for colonoscopy. Can J Gastroenterol 2008; 22:17–22.
Rex D, Bond J, Winawer S, Levin T, Burt R, Johnson D, et al. Quality in the technical performance of colonoscopy, the continuous quality improvement process for colonoscopy: recommendations of the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2002; 97:1296–1308.
Garborg K, Bretthauer M. Cecal intubation failure: refer or change technique? Gastrointest Endosc 2016; 82:1245–1247.
Imperiali G, Minoli G, Meucci GM, Spinzi G, Strocchi E, Terruzzi V, et al. Effectiveness of a continuous quality improvement program on colonoscopy practice. Endoscopy 2007; 39:314–318.
Ball J, Osbourne J, Jowett S, Pellen M, Welfar M. Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study. BMJ 2004; 329:665–667.
Gavin DR, Valori RM, Anderson JT, Donnelly MT, Williams JG, Swarbrick ET. The national colonoscopy audit: a nationwide wide assessment of the quality and safety of colonoscopy in the UK. Gut 2013; 62:242–249.
Gado A, Ebeid B, Abdelmohsen A, Axon A. Improving the quality of endoscopic polypectomy by introducing a Colonoscopy Quality Assurance Programme. Alex J Med 2013; 49:317–322.
Gado A, Ebeid B, Axon A. High quality colonoscopy in a low volume unit; is it achievable? Arab J Gastroenterol 2010; 11:161–164.
Bjorkman DJ, Popp JW. Measuring the quality of endoscopy. Gastrointest Endosc 2006; 63:S1–S2.
Morán Sánchez S, Torrella E, Esteban Delgado P, Baños Madrid R, García A, Ono A, et al. Colonoscopy quality assessment. Rev Esp Enferm Dig 2009; 101:107–112.
Sedlack RE, Coyle WJ; ACE Research Group. Assessment of competency in endoscopy: establishing and validating generalizable competency benchmarks for colonoscopy. Gastrointest Endosc 2016; 83:516–523.e1.
Raymond J, Tissot B, Dartigues J, Saint-Martin E, Vergier J, Michel P, et al. Quality assessment of colonoscopy in usual practice in a French area: aquitaine. Abstr Int Soc Technol Assess Health Care Meet 1993; 9:142.
Lee SH, Chung IK, Kim SJ, Han DS. An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve. Gastrointest Endosc 2008; 67:683–689.
Baxter NN, Sutraduhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures associated with post colonoscopy colorectal cancer. Gastroenterology 2011; 140:65–72.
Rizk MK, Sawhney MS, Cohen J, Pike IM, Adler DG, Dominitz LA, et al. Quality indicators for all GI endoscopic procedures. Gastrointest Endosc 2015; 81:3–16.
Rees CJ, Gibson ST, Rutter MD, Baragwanath P,Pullan R,Feeney M, et al. UK key performance indicators and quality assurance standards for colonoscopy. 2013. Available at: http://www.bsg.org.uk/images/stories/docs/clinical/guidance/uk_kpi_qa_standards_for_colonoscopy.pdf. [Last accessed 2016 Oct].
Hewett DG, Rex DK. Improving colonoscopy quality through health-care payment reform. Am J Gastroenterol 2010; 105:1925–1933.
BSG Endoscopy Committee. Quality and safety indicators for endoscopy. 2007. Available at: http://www.bsg.org.uk/attachments/170_bsg_grs_indic07.pdf. [Last accessed 2016 Oct].
Morini S, Hassan C, Meucci G, Toldi A, Zullo A, Minoli G. Diagnostic yield of open access colonoscopy according to appropriateness. Gastrointest Endosc 2001; 54:175–179.
American Society for Gastrointestinal Endoscopy. Appropriate use of gastrointestinal endoscopy. Gastrointest Endosc 2000; 52:831–837.
Froehlich F,Pache I, Burnand B, Vader JP, Fried M, Beglinger Kolodnny M, et al. Performance of panel-based criteria to evaluate the appropriateness of colonoscopy of colonoscopy: a prospective study. Gastrointest Endosc 1998; 48:128–136.
Grassini M, Verna C, Niola P, Navino M, Battaglia E, Bassotti G. Appropriateness of colonoscopy: diagnostic yield and safety in guidelines. World J Gastroenterol 2007; 13:1816–1819.
Varma M, Rafferty J, Buie W. Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for the management of rectal prolapse. Dis Colon Rectum 2011; 54:1339–1346.
Slim R, Khairallah L, Yaghi C, Honein K, Chemaly M, Kheir B, et al. Prospective audit of colonoscopy practice in a Lebanese University Hospital. Clin Med Insights Gastroenterol 2008; 1:5–10.
Gavin D, Valori R, Anderson J, Donnelly M, Williams J, Swarbrick E. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut 2012; 61(Suppl 2):242–249.
Denis B, Weiss AM, Peter A, Bottlaender J, Chiappa P. Quality assurance and gastrointestinal endoscopy: an audit of 500 colonoscopic procedures. Gastroenterol Clin Biol 2004; 28:1245–1255.
Al-Enezi SA, Alsurayei SA, Ismail AE, Aly NY, Ismail WA, Abu-Bakr AA. Adenomatous colorectal polyps in patients referred for colonoscopy in a regional hospital in Kuwait. Saudi J Gastroenterol 2010; 16:188–193.
Alatise OI, Arigbabu AO, Agbakwuru AE, Lawal OO, Sowande OA, Odujoko OO, et al. Polyp prevalence at colonoscopy among Nigerians: A prospective observational study. Niger J Clin Pract 2014; 17: 756–762.
Zaher T, Bahgat M, Ibrahim A, Ahmady M, Esmat S, Gouda H, et al. Colorectal polyps in Sharkia, Egypt: clinico-pathological study of our experience with endoscopy. J Med Sci 2008; 8:196–200.
Younis H, Moustafa H, Alaam M. Value of colonoscopy in the diagnosis of lower gastrointestinal disorders. Al-Azhar Med J 2003; 1:1–14.
Gurudu SR, Ramirez FC. Quality metrics in endoscopy. Gastroenterol Hepatol 2013; 9:228–232.
MacIntosh D, Dubé C, Hollingworth R, Veldhuyzen van Zanten S, Daniels S, Ghattas G. The endoscopy global rating scale – Canada: development and implementation of a quality improvement tool. Can J Gastroenterol 2013; 27:74–82.
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Gado, A.S., Ebeid, B.A., Abdelmohsen, A.M. et al. Quality of colonoscopy practice: a single-center experience in Egypt. Egypt J Intern Med 28, 108–115 (2016). https://doi.org/10.4103/1110-7782.200968
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