Quality measures and quality improvements in colonoscopy

Approximately 14 million colonoscopies are performed annually in the United States making this the most common gastrointestinal endoscopic procedure. Although the demand for colonoscopy remains strong, improvements in fecal DNA technology and computed tomography colonography now compete with colonoscopy as viable colon cancer screening alternatives. Increasing costs of providing healthcare have renewed the focus on the value of medical services. For colonoscopy to remain the dominant colon cancer screening strategy, it is imperative that we continue to measure and improve the quality of colonoscopy. The purpose of this article is to discuss quality measures and quality improvement in colonoscopy.

We describe recent advances in five prominent quality measures: cecal intubation rate, adherence to recommended screening and surveillance interval, adenoma detection rate, quality of bowel preparation, and colonoscopy withdrawal time.

Quality measures should be used by endoscopists to document and compare their performance with recommended benchmarks. Quality-improvement programmes can then be developed and targeted towards areas of deficiency.