Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 20;135(16):2003-2010.
doi: 10.1097/CM9.0000000000002366.

Utilization and quality assessment of digestive endoscopy in China: results from 5-year consecutive nationwide surveys

Lei Xin  1 , Ye Gao  2 , Zhiyuan Cheng  3 , Tianjiao Wang  4 , Han Lin  1 , Yanan Pang  1 , Chang Sun  1 , Zengjun Fu  4 , Zhaoshen Li  1   4 , Xudong Ma  5 , Luowei Wang  1   4
Affiliations

Utilization and quality assessment of digestive endoscopy in China: results from 5-year consecutive nationwide surveys

Lei Xin et al. Chin Med J (Engl). .

Abstract

Background: Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.

Methods: We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight.

Results: From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.

Conclusions: Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
The flow diagram of the survey and data inspection. The survey refers to the national annual surveys on endoscopy services (from 2015 to 2019). A hospital participated in one annual survey would generate one record. Some hospitals participated in multiple surveys, and had more than one record.
Figure 2
Figure 2
Distribution of the EQI to evaluate digestive endoscopy in different economic regions and grades of hospitals in 2019 (East China includes Beijing, Shanghai, Tianjin, Hebei, Shandong, Jiangsu, Zhejiang, Fujian, Guangdong, and Hainan. Northeast China includes Heilongjiang, Jilin, and Liaoning. Central China includes Anhui, Henan, Hubei, Hunan, Jiangxi, and Shanxi. West China includes Chongqing, Gansu, Guangxi, Guizhou, Yunnan, Inner Mongolia, Ningxia, Qinghai, Shaanxi, Sichuan, Tibet, and Xinjiang). EQI: Endoscopy quality index.
See this image and copyright information in PMC

References

    1. Wani S, Williams JL, Komanduri S, Muthusamy VR, Shaheen NJ. Time trends in adherence to surveillance intervals and biopsy protocol among patients with Barrett's esophagus. Gastroenterology 2020; 158:770–772. doi: 10.1053/j.gastro.2019.10.004. - PubMed
    1. Shaukat A, Holub J, Pike IM, Pochapin M, Greenwald D, Schmitt C, et al. . Benchmarking adenoma detection rates for colonoscopy: results from a US-based registry. Am J Gastroenterol 2021; 116:1946–1949. doi: 10.14309/ajg.0000000000001358. - PubMed
    1. Keswani RN, Yadlapati R, Gleason KM, Ciolino JD, Manka M, O’Leary KJ, et al. . Physician report cards and implementing standards of practice are both significantly associated with improved screening colonoscopy quality. Am J Gastroenterol 2015; 110:1134–1139. doi: 10.1038/ajg.2015.103. - PubMed
    1. Uche-Anya EN, Brown JJ, Asumeng C, Striplin J, Carlesimo M, Krauskopf M, et al. . Impact of a citywide benchmarking intervention on colonoscopy quality performance. Dig Dis Sci 2020; 65:2534–2541. doi: 10.1007/s10620-020-06067-y. - PubMed
    1. Kaminski MF, 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. doi: 10.1056/NEJMoa0907667. - PubMed