Variation in Colonoscopy Performance Measures According to Procedure Indication.

Adenoma / diagnosis Cecum Colonoscopy Colorectal Neoplasms / diagnosis Cross-Sectional Studies Early Detection of Cancer Humans

ADR Colon Cancer Comparison FIT

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

ISSN: 1542-7714

Titre abrégé: Clin Gastroenterol Hepatol

Pays: United States

ID NLM: 101160775

Informations de publication

Date de publication:
05 2020

Historique:

received: 02 07 2019

accepted: 02 08 2019

pubmed: 26 8 2019

medline: 19 8 2021

entrez: 26 8 2019

Statut: ppublish

Résumé

Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49-0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55-0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22-0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71-2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20-1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30-11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32-2.14). Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.

Sections du résumé

BACKGROUND & AIMS

METHODS

We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard.

RESULTS

Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49-0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55-0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22-0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71-2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20-1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30-11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32-2.14).

CONCLUSIONS

Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.

Identifiants

DOI: 10.1016/j.cgh.2019.08.035 PMID: 31446179

pubmed: 31446179

pii: S1542-3565(19)30910-3

doi: 10.1016/j.cgh.2019.08.035

pii:

doi:

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

1216-1223.e2

Investigateurs

Rodrigo Jover (R)

Carolina Mangas-Sanjuan (C)

Enrique Santana (E)

Juan A Casellas (JA)

Francisco A Ruíz-Gómez (FA)

Eva Serrano (E)

Cristina Mira (C)

Adolfo Suárez (A)

Verónica Álvarez-García (V)

Olegario Castaño (O)

Lorena Blanco (L)

Natalia González (N)

Javier Lara (J)

Enrique Quintero (E)

H Clínic (H)

María Pellisé (M)

Liseth Rivero (L)

Josep Llach (J)

Henry Cordova (H)

Isis Araujo (I)

Ariadna Sánchez (A)

Ingrid Ordas (I)

Karina Lisette (K)

H Del Mar (H)

Agustín Seoane (A)

Marco Antonio Álvarez-González (MA)

Laura Carot (L)

Inés Ana Ibáñez (IA)

Faust Riu (F)

Miguel Pantaleón (M)

Josep María Dedeu (JM)

Luis Eugenio Barranco (LE)

Akiko Ono (A)

Joaquín Cubiella (J)

Elena Rodríguez-Camacho (E)

Franco Baiocchi (F)

Coral Tejido (C)

Luis Bujanda (L)

Isabel Portillo (I)

Isabel Idígoras (I)

Isabel Bilbao (I)

Maite Herráiz (M)

Cristina Carretero (C)

Maite Betés (M)

Ángeles Pizarro (Á)

Marta Ponce (M)

Marco Bustamante (M)

Vicente Pons (V)

Lidia Argüello (L)

Carla Satorres (C)

Pilar Díez-Redondo (P)

Henar Núñez (H)

Victoria Busto (V)

Lucía Cid-Gómez (L)

Vicent Hernández (V)

Luisa de Castro (L)

Nereida Fernández-Fernández (N)

Alfonso Martínez-Turnes (A)

Beatriz Romero-Mosquera (B)

Romina Fernández-Poceiro (R)

Alberto Lué (A)

Ángel Lanas (Á)

Angel Ferrández (A)

Pilar Roncales (P)