scholarly journals The Effect of Midyear Report Cards on Colonoscopy Quality Measures

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Kunal Suradkar ◽  
Benjamin Lebwohl ◽  
Ravi P. Kiran ◽  
Steven Lee-Kong
Keyword(s):  
National Standards ◽  
Report Cards ◽  
Annual Reports ◽  
Withdrawal Time ◽  
Mean Values ◽  
Adenoma Detection ◽  
Standardized Reporting ◽  
Periodic Feedback ◽  
Colonoscopy Quality ◽  
The Impact

Introduction. Since 2011, our institution has distributed annual reports, in June, to providers with personalized data regarding adenoma detection rate (ADR), colonoscope withdrawal time (CW), and cecal intubation (CI) rate, using standardized reporting systems. We examined the impact of distribution of individualized reports at the midpoint of each year on colonoscopy outcomes in the latter half of each year. Methods. Providers with endoscopy privileges, performing ≥20 colonoscopies/year, at our center throughout a five-year period (2011-2015) were included. The three metrics recorded and reported were ADR, CW, and CI using standard benchmark rates. The mean values of each metric from January through June (1st half) and July through December (2nd half) were calculated. Curve estimation test was used to determine the significance of ADR in the respective time period. Results. Fifteen providers were eligible for the study. Collective ADR in the 1st half of all years was 26.9% and in the second half of all years was 28.1% (p=0.476). CW for all years was more than 9 minutes while CI was above 90% for all providers. There was no significant increase in the CI and CW during the 5-year study period. Overall, ADR increased from 26.43% (2011) to 33.47% (2015) (p=0.137). When examining ADR during each of the 12 months following the June report cards, there was no month-to-month trend observed (p=0.893). Conclusion. Endoscopists at our institutions met/exceeded the quality metrics in the first half of each year from the beginning of the study. Routine reporting may maintain, but not improve, outcomes. Long-term studies to determine if periodic feedback to endoscopists improves the quality of endoscopy as per national standards for detection of early colorectal cancers are required.

scholarly journals The Impact of Colonoscopy Quality Control Table on Adenoma Detection Rates

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Bin Deng ◽  
Jiehua Zhi ◽  
Yaosheng Chen ◽  
Lanyu Liang ◽  
Jian Wu ◽  
...  
Keyword(s):  
Success Rate ◽  
Detection Rate ◽  
Intervention Group ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Significant Difference ◽  
Adenoma Detection Rates ◽  
Colonoscopy Quality ◽  
The Impact

Objective. This study aims to investigate the effects of reporting colonoscopy findings and the regular review of outcomes on adenoma detection rates.Methods. Patients who underwent colonoscopy from August 2013 to February 2014 were selected as the intervention group. The preintervention group included patients who underwent colonoscopy from January 2013 to July 2013, in which the procedure sheet for this group of patients was not accomplished. The primary outcome was adenoma detection rate (ADR), and secondary outcomes included the success rate of intubation and withdrawal time.Results. This study included 2,467 cases: 1,302 cases in the intervention group and 1,165 cases in the preintervention group. There was no significant difference in demographic characteristics between the two groups. In the intervention group, withdrawal time of colonoscopy was longer (P<0.01), and the success rate of intubation (92.5% versus 89.1%,P<0.05) and detection rate of polyps (32.6% versus 27.6%,P<0.05) and adenomas (20.0% versus 16.1%,P<0.05) were higher. Significantly high detection rates for proximal adenomas, flat adenomas, and adenomas with a diameter <5 mm were observed in the intervention group (allP<0.01).Conclusion. The reporting and review of procedure details help to improve quality indicators of colonoscopy.

Endocuff vision-assisted vs. standard polyp resection in the colorectum (the EVASTA study): a prospective randomized study

Endoscopy ◽  
2019 ◽  
Vol 52 (01) ◽  
pp. 45-51 ◽  
Author(s):  
Guido von Figura ◽  
Moritz Hasenöhrl ◽  
Bernhard Haller ◽  
Alexander Poszler ◽  
Jörg Ulrich ◽  
...  
Keyword(s):  
Randomized Study ◽  
Colorectal Polyps ◽  
University Hospital ◽  
Standard Group ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Adenoma Detection Rates ◽  
Standard Colonoscopy ◽  
The Impact

Abstract Background Cap-assisted colonoscopy is frequently used to facilitate adenoma detection during endoscopy. However, data on how cap assistance influences polyp resection are scarce. We aimed to evaluate the impact of cap assistance with the Endocuff vision device (EVD) on the resection time for colorectal polyps in patients undergoing colonoscopy. Methods A randomized, prospective study was performed in a university hospital in Germany. A total of 250 patients were randomly assigned 1:1 to undergo either colonoscopy with the EVD (EVD arm) or standard colonoscopy without the use of a cap (standard arm). The primary outcome was the average duration of polypectomy. Secondary outcomes included adenoma detection rate, cecal and ileal intubation times, and propofol dosage. Results The use of EVD led to a significant reduction in the median polypectomy time in the EVD vs. standard arm (54 vs. 80 seconds, respectively; P = 0.02). This effect was strongest for polyps ≥ 6 mm. Compared with the standard group, Endocuff assistance also resulted in a shorter cecal intubation time (6 vs. 8 minutes; P = 0.03) and overall colonoscopy time (23 vs. 27 minutes; P = 0.02). In contrast, no difference in withdrawal time was observed. The polyp and adenoma detection rates did not differ significantly between the two groups. Conclusion Endocuff-assisted colonoscopy reduces the duration of polypectomy, which may be due to a more stable scope position during resection. Further studies are needed to investigate whether comparable effects will be seen for other interventions, such as clipping or biopsy sampling.

scholarly journals A65 ENDOSCOPIST-TARGETED INTERVENTIONS TO OPTIMIZE ADENOMA DETECTION RATE - A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 25-26
Author(s):  
A Arora ◽  
C McDonald ◽  
A Iansavitchene ◽  
M Brahmania ◽  
M Sey
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Detection Rate ◽  
Meta Analysis ◽  
Report Card ◽  
Adenoma Detection Rate ◽  
Report Cards ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Statistical Heterogeneity

Abstract Background Adenoma detection rate (ADR) has emerged as the strongest quality assurance metric that has consistently been shown to be inversely associated with the development of colorectal cancer after colonoscopy. Unfortunately, marked variability in ADR exists among endoscopists. A multitude of interventions targeted at endoscopists to optimize their ADR have been reported, including but not limited to withdrawal time, in room observers, physician report cards, and quality improvement and training programs. However, it is unclear which of them are truly effective. Aims We performed a systematic review and meta-analysis of the literature to evaluate the effectiveness of endoscopist-targeted interventions to improve adenoma detection rate (ADR) or polyp detection rate (PDR). Methods Systematic searches of major databases were conducted through to March 2018 to identify potentially relevant studies. Both randomized controlled trials and observational studies were included. Data for ADR and PDR were analyzed on the log-odds scale using a random-effects meta-analysis model using restricted maximum likelihood (with Mantel-Haenszel fixed-effect meta-analysis used for fewer than 4 studies). Statistical effect-size heterogeneity was assessed using a Chi2 test and quantifying the relative proportion of variation using the I2 statistic. Publication bias was assessed by the Harbord regression test. Results From 4299 initial studies, 24 were included in the systematic review and 13 were included in the meta-analysis representing a total of 55,090 colonoscopies. Physician report card interventions (7 studies) and withdrawal time focused interventions (6 studies) were meta-analyzed. The pooled odds ratio for ADR for report card interventions was 1.31 (95% CI: 1.15, 1.50; p&lt;0.0001), favoring report cards to detect more adenomas. Statistical heterogeneity was detected with substantial relative effect-size variability (Chi2, p&lt;0.0001; I2=80.1%). No statistical evidence of publication bias was found. 6 studies reported data for PDR using withdrawal time focused interventions, with 3 of these reporting data on ADR. The pooled odds ratio for ADR was 1.02 (95% CI: 0.86, 1.22; p=0.81) and for PDR was 1.07 (95% CI: 0.88, 1.31; p=0.51) which were not statistically significant. Statistical heterogeneity was detected in both groups (Chi2, p&lt;0.001; I2=82.2% for ADR and I2=89.4% for PDR) and there was statistical evidence of publication bias. Figures 1 and 2 represent Forest plots for the effect of pre-and post-report card and withdrawal time focused interventions on ADR. Conclusions Our study provides evidence that the distribution of colonoscopy quality report cards to physicians significantly improves overall ADR and should strongly be considered as part of quality improvement programs aimed at optimizing colonoscopy performance. Funding Agencies None

scholarly journals Physician Perceptions on Colonoscopy Quality: Results of a National Survey of Gastroenterologists

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Ziad F. Gellad ◽  
Corrine I. Voils ◽  
Li Lin ◽  
Dawn Provenzale
Keyword(s):  
Quality Indicators ◽  
Detection Rate ◽  
Quality Measurement ◽  
Adenoma Detection Rate ◽  
Withdrawal Time ◽  
Physician Perceptions ◽  
Continuous Quality ◽  
Adenoma Detection ◽  
Time Standards ◽  
Colonoscopy Quality

Background. Quality indicators for colonoscopy have been developed, but the uptake of these metrics into practice is uncertain. Our aims were to assess physician perceptions regarding colonoscopy quality measurement and to quantify the perceived impact of quality measurement on clinical practice.Methods. We conducted in-person interviews with 15 gastroenterologists about their perceptions regarding colonoscopy quality. Results from these interviews informed the development of a 34-question web-based survey that was emailed to 1,500 randomlyselected members of the American College of Gastroenterology.Results. 160 invitations were undeliverable, and 167 out of 1340 invited physicians (12.5%) participated in the survey. Respondents and nonrespondents did not differ in age, sex, practice setting, or years since training. 38.8% of respondents receive feedback on their colonoscopy quality. The majority of respondents agreed with the use of completion rate (90%) and adenoma detection rate (83%) as quality indicators but there was less enthusiasm for withdrawal time (61%). 24% of respondents reported usually or always removing diminutive polyps solely to increase their adenoma detection rate, and 20% reported prolonging their procedure time to meet withdrawal time standards.Conclusions. A minority of respondents receives feedback on the quality of their colonoscopy. Interventions to increase continuous quality improvement in colonoscopy screening are needed.

scholarly journals Colonoscopy Quality and Adherence to Postpolypectomy Surveillance Guidelines in an Underinsured Clinic System

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jaison John ◽  
Abdul Al-Douri ◽  
Bretta Candelaria ◽  
Saurin Gandhi ◽  
Paul Guzik ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Safety Net ◽  
Adenoma Detection Rate ◽  
Evidence Based ◽  
High Quality ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Colonoscopy Quality

Background. Delivery of high-quality colonoscopy and adherence to evidence-based surveillance guidelines is essential to a high-quality screening program, especially in safety net systems with limited resources. We sought to assess colonoscopy quality and ensure appropriate surveillance in a network of safety net practices. Methods. We identified age-eligible patients ages 50-75 within a Federally Qualified Health Center (FQHC) clinic system with evidence of colonoscopy in preceding 10 years. We performed chart reviews to assess key aspects of colonoscopy quality: bowel preparation quality, evidence of cecal intubation, cecal withdrawal time, and the adenoma detection rate. We then utilized established guidelines to assess and revise surveillance colonoscopy intervals, determine whether appropriate surveillance had taken place, and schedule overdue patients as appropriate. Results. Of 26,394 age-eligible patients, a total of 3,970 patients had evidence of prior colonoscopy and 1,709 charts were selected and reviewed. Mean age was 57, 54% identified as women and 51% identified as Hispanic. Of 1709 colonoscopies reviewed, 77% had data on bowel preparation, and of those, 85% had adequate preparation quality. Cecal intubation was documented in 89% of procedures. Adequate cecal withdrawal time was documented in 59% of those with documented cecal intubation. Overall adenoma detection rate was 42%. Initial surveillance interval was clearly stated in 72% ( n = 1238 ) of procedures. Of these, initial recommended intervals were too short in 24.5% ( n = 304 ) and too long in 3.6% ( n = 45 ). A total of 132 patients (10.7%) were overdue for appropriate surveillance and were referred for follow-up colonoscopy. Conclusions. Overall, the quality of screening colonoscopy was high, but reporting was incomplete. We found fair adherence to evidence-based surveillance guidelines, with significant opportunities to extend surveillance intervals and improve adherence to best practices.

scholarly journals Sustained colonoscopy quality improvement using a simple intervention bundle

Endoscopy ◽  
2020 ◽  
Vol 52 (04) ◽  
pp. 285-292 ◽  
Author(s):  
Laura J. Neilson ◽  
James E. East ◽  
Praveen T. Rajasekhar ◽  
Paul Bassett ◽  
Simon Dunn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Statistical Significance ◽  
Post Intervention ◽  
Withdrawal Time ◽  
Hyoscine Butylbromide ◽  
The United Kingdom ◽  
Adenoma Detection ◽  
Change In Practice ◽  
Sustained Change ◽  
Colonoscopy Quality

Abstract Background Unacceptable variation in colonoscopy quality exists. The Quality Improvement in Colonoscopy (QIC) study in 2011 improved quality by introducing an evidence-based “bundle” of measures into routine colonoscopy practice. The QIC bundle included: minimal cecal withdrawal time of ≥ 6 minutes; hyoscine butylbromide use; supine patient position for transverse colon examination; rectal retroflexion. Colonoscopy quality was measured by adenoma detection rate (ADR). The current study measured whether these effects led to a sustained change in practice 3 years following implementation. Methods This observational study collected data from eight hospital trusts (sites) in the United Kingdom for a 6-month period, 3 years following QIC bundle implementation. Use of the antispasmodic, hyoscine butylbromide, was measured as a marker of bundle uptake. Bundle effectiveness was measured by ADR change. Comparisons were made between data before and immediately after implementation of the bundle. Results 28 615 colonoscopies by 188 colonoscopists were studied. Hyoscine butylbromide use increased from 15.8 % pre-implementation to 47.4 % in the sustainability phase (P < 0.01) indicating sustained engagement with QIC measures. ADR was higher in the sustainability period compared with pre-intervention, but only reached statistical significance among the poorest-performing colonoscopists. Conclusions The introduction of a simple, inexpensive, pragmatic intervention significantly changed practice over a sustained period, improving colonoscopy quality as measured by ADR, particularly in poorer performers. QIC demonstrates that an easy-to-implement quality improvement approach can deliver a sustained change in practice for many years post intervention.

scholarly journals Impact of real-time use of artificial intelligence in improving adenoma detection during colonoscopy: A systematic review and meta-analysis

2021 ◽  
Vol 09 (04) ◽  
pp. E513-E521
Author(s):  
Munish Ashat ◽  
Jagpal Singh Klair ◽  
Dhruv Singh ◽  
Arvind Rangarajan Murali ◽  
Rajesh Krishnamoorthi
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Meta Analysis ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Polyp Detection ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
The Impact

Abstract Background and study aims With the advent of deep neural networks (DNN) learning, the field of artificial intelligence (AI) is rapidly evolving. Recent randomized controlled trials (RCT) have investigated the influence of integrating AI in colonoscopy and its impact on adenoma detection rates (ADRs) and polyp detection rates (PDRs). We performed a systematic review and meta-analysis to reliably assess if the impact is statistically significant enough to warrant the adoption of AI -assisted colonoscopy (AIAC) in clinical practice. Methods We conducted a comprehensive search of multiple electronic databases and conference proceedings to identify RCTs that compared outcomes between AIAC and conventional colonoscopy (CC). The primary outcome was ADR. The secondary outcomes were PDR and total withdrawal time (WT). Results Six RCTs (comparing AIAC vs CC) with 5058 individuals undergoing average-risk screening colonoscopy were included in the meta-analysis. ADR was significantly higher with AIAC compared to CC (33.7 % versus 22.9 %; odds ratio (OR) 1.76, 95 % confidence interval (CI) 1.55–2.00; I2 = 28 %). Similarly, PDR was significantly higher with AIAC (45.6 % versus 30.6 %; OR 1.90, 95 %CI, 1.68–2.15, I2 = 0 %). The overall WT was higher for AIAC compared to CC (mean difference [MD] 0.46 (0.00–0.92) minutes, I2 = 94 %). Conclusions There is an increase in adenoma and polyp detection with the utilization of AIAC.

scholarly journals Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group

2021 ◽  
Vol 09 (10) ◽  
pp. E1456-E1462
Author(s):  
Cristiano Spada ◽  
Anastasios Koulaouzidis ◽  
Cesare Hassan ◽  
Pedro Amaro ◽  
Anurag Agrawal ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Gastrointestinal Endoscopy ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Cecal Intubation Rate ◽  
Colonoscopy Quality

Abstract Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires. Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites. Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received.Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively.Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing. Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.

scholarly journals Utilisation of Maqalika Reservoir as a source of potable water for Maseru city in Lesotho

2005 ◽  
Author(s):  
◽  
Masupha Letsie
Keyword(s):  
Water Quality ◽  
National Standards ◽  
Quality Data ◽  
Ungauged Catchments ◽  
Water Quality Data ◽  
Mean Values ◽  
Run Off ◽  
Remaining Capacity ◽  
The Impact

Lesotho is a land locked country, entirely surrounded by the Republic of South Africa. Maseru is the capital of Lesotho and the country’s main centre for commerce and industry. The study area is located on the North-Eastern outskirts of the Maseru urban area. The catchment occupies an area of 44km2 with a length of about 13 km and channel slope of 0.4 km/km. The Maqalika Reservoir was built in 1983 to meet the water demands for Maseru city up to 1995, and its storage capacity was 3.7 Mm3. The storage is gradually decreasing as sediment, carried by the natural run-off accumulates in the reservoir. Moreover, water pumped into the reservoir from the Caledon River (which is heavily sedimented) adds its own contribution of silt. The reservoir is located in a very densely populated area, and is heavily polluted leading to high purification costs. The study was motivated by the fact that Welbedacht Dam was constructed in 1973 in the Caledon catchment but downstream of Maqalika. After 20 years, 85% of the volume of the dam was silted. The study was intended in finding whether the positioning of the Maqalika reservoir is acceptable and to find its remaining capacity as a water body supplying a fast growing city. Consideration was also given to the effect of land use practices on the water quality of the Maqalika reservoir, including the cost incurred during purification. The water quality data on physico- chemical was collected from the Water and Sewerage Authority and was analysed using excel spreadsheets. Results obtained were compared with WHO, SABS and National Standards of Lesotho. It was found that nitrates, phosphates and faecal coliforms levels were by far above minimum standards rendering water to be very contaminated and the source being leaking sewers, defeacation in dongas and leachate from Tsosane and Lower Thamae dumping site. Iron levels were also high with mean values beyond 0.3mg/l and the source being leachate from dumping sites, poor disposal of scraps and minerals from soil. Conductivity levels were high and the suspected source is waste solid disposal having a maximum of 442mS/m in March 2001. Hardness, temperature and alkalinity do not pose much danger to Maqalika water since recorded results were almost within limits. Turbidity levels were very high and the main source was found to be catchment sedimentation through run-off. For determination of the impact of sedimentation through pumping, hydrological data was obtained from the Department of Water Affair (DWA) and analysed using Excel spreadsheets to get sediment concentrations. A linear regression graph was plotted using discharge against sediment concentration that yielded y = 0.0007x – 0.0019. This was used in the Rooseboom mathematical equation for estimation of volume occupied by sediment from 1983 - 2002 and was found to be 6789 m3. For determination of the impact due to catchment run-off, a map method of estimating sedimentation from ungauged catchments developed by Rooseboom was used and a volume of 4.598 x 106 m3 was obtained showing that the main contributor of sedimentation in the reservoir is catchment run-off. The chemical costs employed during purification were also compared between WASA and Umgeni Water of Kwazulu- Natal and WASA was found to be expensive with 9 cents/kl while Umgeni spent only 5.24 cents/kl.

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