Quality control & credentialing guidelines in colonoscopy: Is the endoscopist success rate of caecal intubation the only factor?

Ahmed Hammad, Milda Jancauskaite, Haitham Aboudeep, Arjit Mukherjee. Hairmyres Hospital NHS Lanarkshire

Aim: The aim of this study is to assess the colonoscopy results of a single Joint Advisory Group (JAG) UK accredited endoscopist and analysis of causes of failure of completion.

Methods: A retrospective analysis of prospective annual colonoscopy data  of a designated accredited colonoscopist (April 2013 –  2014).  Patient demography, completion rate indicated by caecal intubation and causes of incomplete cases were retrieved.

This data is compared to the key measurable quality indicator of caecal intubation rate, as minimum  rate greater than 90% have been endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group (JAG) UK.

Results: Total number of colonoscopies performed over a calendar year were 740. Caecal intubation rate(corrected for pathology) was 87.16% (n=645). Failed completion in 12.84% (n=95), mean age 69 (range17-88). 23% (n=21) were due to poor bowel prep,  77%(n=74) due to looping, discomfort, pain, sigmoid angulations and consent withdrawal.

Conclusion: Colonoscopy remains the gold standard  investigation of most colorectal disease. Quality assurance of colonoscopy could be expected to contribute significantly to improved patient care. Unfortunately, disparity in quality prevails even amongst accredited dedicated colonoscopists.

Amongst the different confounding factors, poor bowel preparation contributed significantly towards incomplete caecal intubation.

Quality improvement in colonoscopy should  focus not only on improving technical skills, but also on methods to  optimise bowel prep and emphasise on stringent patient selection. Detailed breakdown of confounding factors would probably favour a better  quality comparison than an universally defined completion rate.

« Return to SAGES 2016 abstract archive