Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme

Area of Science:

• Gastroenterology and Endoscopy
• Public Health and Screening Programs
• Colorectal Cancer Research

Background:

• Colonoscopy is crucial for colorectal cancer (CRC) screening effectiveness.
• The NHS Bowel Cancer Screening Programme (BCSP) uses faecal occult blood (FOB) testing to identify individuals needing colonoscopy.
• Colonoscopist quality assurance is mandated within the BCSP.

Purpose of the Study:

• To examine the quality of colonoscopies performed within the NHS BCSP.
• To describe established and novel metrics for assessing and maintaining colonoscopy quality in a national screening program.

Main Methods:

• Analysis of prospectively collected data from the NHS BCSP database (August 2006 - August 2009).
• Calculation of key colonoscopy quality indicators: adenoma detection rate (ADR), withdrawal time, caecal intubation rate, and adverse event incidence.
• Assessment of total adenoma detection measures (MAP, MAP+).

Main Results:

• Over 36,000 colonoscopies were performed, with a mean caecal intubation rate of 95.2% and a mean withdrawal time of 9.2 minutes.
• The mean adenoma detection rate (ADR) per colonoscopist was 46.5%, with a mean of 0.91 adenomas per procedure (MAP).
• Low adverse event rates were observed, including 0.09% perforation and no procedure-related deaths.

Conclusions:

• The NHS BCSP delivers high-quality colonoscopy, evidenced by high caecal intubation rates, ADR, patient comfort, and low adverse event rates.
• Stringent pre-screening standards and continuous quality assurance are key to maintaining BCSP colonoscopy quality.
• Incorporating total adenoma detection metrics (MAP, MAP+) alongside ADR can further enhance quality assurance.