How to improve the performances in diagnostic colonoscopy?

Endoscopic colonoscopy seems to be the most useful tool for screening for colorectal cancer, but experienced endoscopists are required.

of this study was to establish an internal audit of the colonoscopies performed in our department and to evaluate if they influenced the quality of the procedure.

We evaluated the number of coecal intubations performed by three experienced endoscopists between January 2004 and December 2006. We followed up the percentage of total colonoscopies performed by each endoscopist (A, B and C) each year, the percentage of coecal intubation as compared to the total number of examined patients, to the number of patients from Gastroenterology and from other departments, respectively. We compared the data obtained during the three years, trying to identify the factors that would improve the quality of the procedure.

Following discussions and critical analysis of their results with endoscopists B and C, the percentage of coecal intubation performed by them increased significantly (p<0.001). The progressively increasing number of total colonoscopies in the last three years (70.1% in 2004 to 96.1% in 2006) could also be explained by the increase of use of sedation and analgesia during this period: 40% - 2004, 91.8% - 2005 (p<0.001), 99.7% - 2006 (p<0.001).

The factors that led to the increase of performances in colonoscopy in our department were the use of proper sedation and analgesia, the permanent internal audit of the maneuver, as well as the motivation of the endoscopist to obtain good results.