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. 2017 Sep;24(5):211-218.
doi: 10.1159/000478940. Epub 2017 Jul 21.

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Filipe Taveira  1 , Miguel Areia  1   2 , Luís Elvas  1 , Susana Alves  1 , Daniel Brito  1 , Sandra Saraiva  1 , Ana Teresa Cadime  1
Affiliations

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Filipe Taveira et al. GE Port J Gastroenterol. 2017 Sep.

Abstract
in English, Portuguese

Background: Colonoscopy quality is a hot topic in gastroenterological communities, with several actual guidelines focusing on this aspect. Although the adenoma detection rate (ADR) is the single most important indicator, several other metrics are described and need reporting. Electronic medical reports are essential for the audit of quality indicators; nevertheless, they have proved not to be faultless.

Aim: The aim of this study was to analyse and audit quality indicators (apart from ADR) using only our internal electronic endoscopy records as a starting point for improvement.

Methods: An analysis of electronically recorded information of 8,851 total colonoscopies from a single tertiary centre from 2010 to 2015 was performed.

Results: The mean patient age was 63.4 ± 8.5 years; 45.5% of them were female, and in 14.6% sedation was used. Photographic documentation was done in 98.4% with 10.7 photographs on average, and 37.4% reports had <8 pictures per exam. Bowel preparation was rated as adequate in 67%, fair in 27% and inadequate in 4.9% of cases. The adjusted caecal intubation rate (CIR) was 92%, while negative predictors were inadequate preparation (OR 119, 95% CI 84-170), no sedation (OR 2.39, 95% CI 1.81-3.15), female gender (OR 1.61, 95% CI 1.38-1.88) and age ≥65 years (OR 1.56, 95% CI 1.34-1.82). In 28% of patients, a snare polypectomy was performed, correlating with adequate preparation (OR 5.75, 95% CI 3.90-8.48), male gender (OR 1.82, 95% CI 1.64-2.01) and age ≥65 years (OR 1.25, 95% CI 1.13-1.37; p < 0.01) as positive predictors. An annual evolution was observed with improvements in photographic documentation (10.7 vs. 12.9; p < 0.001), CIR (91 vs. 94%; p = 0.002) and "adequate" bowel preparation (p = 0.004). Conclusions: There is much more to report than the ADR to ensure quality in colonoscopy practice. Better registry systematization and integrated software should be goals to achieve in the short term.

Introdução: A qualidade em colonoscopia tem sido um tópico de importante discussão com várias orientações publicadas nesta área. Embora a taxa de deteção de adenomas (ADR) seja o indicador mais importante, vários outros indicadores estão descritos e precisam ser estudados/publicados. Os registos médicos eletrónicos são essenciais para a auditoria de indicadores de qualidade, mas provaram não ser infalíveis.

Objetivo: Analisar e auditar os indicadores de qualidade, além do ADR, recorrendo apenas à base de dados de endoscopia do nosso centro, como ponto de partida para a melhoria.

Métodos: Análise do registo eletrónico de 8,851 colonoscopias totais realizadas em um único centro no período 2010–2015.

Resultados: A idade média dos pacientes foi de 63.4 ± 8.5 anos, 45.5% do sexo feminino. Em 14.6%, foi utilizada sedação. Documentação fotográfica em 98.4%, com média de 10.7 fotografias por exame e 37.4% com menos de 8 fotos por exame. A preparação intestinal foi avaliada como “adequada” em 67%, “razoável” em 27% e “inadequada” em 4.9%. A taxa de intubação cecal ajustada (CIR) foi de 92%, com preparação inadequada (OR 119, 95% CI 84–170), exame sem sedação (OR 2.39, 95% CI 1.81–3.15), sexo feminino (OR 1.61, 95% CI 1.38–1.88) e idade ≥65 (OR 1.56, 95% CI 1.34–1.82) como preditores negativos. Em 28%, foi realizada polipectomia, correlacionando-se com preparação “adequada” (OR 5.75, 95% CI 3.90–8.48), sexo masculino (OR 1.82, 95% CI 1.64–2.01) e idade ≥65 (OR 1.25, 95% CI 1.13–1.37; p < 0.01). Da evolução anual destacar melhorias na documentação fotográfica (10.7 vs. 12.9; p < 0.001), taxa de intubação cecal (91 vs. 94%; p = 0.002) e preparação intestinal „adequada” (p = 0.004).

Conclusões: Há muito mais para reportar, além do ADR, de modo a garantir colonoscopias com qualidade. Uma maior sistematização no registo e softwares integrados devem ser objetivos a alcançar no curto prazo.

Keywords: Colonoscopy; Electronic health records; Gastroenterology standards; Quality improvement; Quality of health care.

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