Findings on interval colonoscopies: an auditable performance indicator for colonoscopy quality?

Area of Science:

• Gastroenterology
• Endoscopy
• Quality Improvement

Background:

• Colonoscopy quality is crucial for detecting pathology and minimizing missed diagnoses.
• Ethical limitations prevent routine back-to-back colonoscopies for quality assurance.
• Clinically indicated repeat colonoscopies offer a potential avenue for quality assessment.

Purpose of the Study:

• To investigate the incidence of new findings in colonoscopies repeated within a 12-month period.
• To evaluate the utility of analyzing repeat colonoscopies for quality assurance.
• To assess the rate of missed pathology in initial colonoscopies.

Main Methods:

• A retrospective analysis of 5747 colonoscopies performed over 3 years at an endoscopy training unit.
• Inclusion of 137 repeat colonoscopies performed within a 12-month interval.
• Analysis of new findings, including cancers and polyps, in repeat procedures.

Main Results:

• 19 (14%) repeat colonoscopies revealed new pathology, including one cancer detected 234 days after a normal colonoscopy.
• Additional polyps were found in 13 cases, indicating a 9% missed polyp rate (median 2 polyps, median size 5.5 mm).
• Repeat colonoscopies showed no associated morbidity. Non-consultant endoscopists had a higher, though not statistically significant, rate of new findings (23% vs. 11%).

Conclusions:

• Analyzing clinically indicated repeat colonoscopies can identify new pathology and missed findings.
• This approach offers a direct method for assessing a critical aspect of colonoscopy quality.
• The findings support the utility of repeat colonoscopy analysis for quality assurance in endoscopy training units.