Variations in colonoscopy practice in Europe: a multicentre descriptive study (EPAGE).

Area of Science:

• Gastroenterology
• Endoscopy
• Health Services Research

Background:

• Colonoscopy volumes are rising globally.
• Existing data suggest variability in colonoscopy practices across different centers and over time.
• Benchmarking current practices is crucial for quality assessment.

Purpose of the Study:

• To investigate and quantify variations in colonoscopy practices among international endoscopy centers.
• To identify factors contributing to these practice variations.

Main Methods:

• An observational, prospective study including 6004 consecutive patients undergoing colonoscopy.
• Data collected from 21 centers across 11 countries via patient, procedure, and center questionnaires.
• Descriptive statistics and controlled analyses for case-mix variation were performed.

Main Results:

• Significant inter-center variations observed in indications for colonoscopy (e.g., surveillance, hematochezia), quality of bowel preparation (74%), deep sedation use (30%), patient monitoring (75%), and polypectomy rates (25%).
• Colonoscopy completion rates (89%) and median procedure duration (20 min) also showed wide ranges between centers.
• Variations persisted even after controlling for patient case-mix, indicating the influence of center-specific factors.

Conclusions:

• Wide variations in colonoscopy practice exist internationally, not fully explained by patient case-mix.
• Center and procedural characteristics significantly influence practice patterns.
• While most centers adhere to guidelines, efforts are needed to ensure consistent high-quality colonoscopy delivery worldwide.