Quality indicators in colonoscopy: the chasm between ideal and reality

Area of Science:

• Gastroenterology
• Endoscopy
• Healthcare Quality Improvement

Background:

• Significant variations in colonoscopy performance and quality exist in Korea.
• Continuous measurement of quality indicators (QIs) is essential for standardizing colonoscopy procedures.

Purpose of the Study:

• To emphasize the importance of monitoring key colonoscopy QIs in daily clinical practice.
• To highlight specific QIs that require routine monitoring for quality enhancement.

Main Methods:

• Focus on monitoring adenoma detection rate (ADR), average withdrawal time, bowel preparation adequacy (using Boston Bowel Preparation Scale - BBPS), and cecal intubation rate.
• Discusses the potential of natural language processing to improve ADR measurement.
• Recommends a minimum withdrawal time of 6 minutes and adherence to bowel preparation protocols for optimal results.

Main Results:

• A well-executed colonoscopy with a withdrawal time of at least 6 minutes maximizes mucosal exposure.
• Routine adherence to bowel preparation protocols can achieve a BBPS score of ≥6 in ≥85% of outpatient screening colonoscopies.
• A cecal intubation rate of ≥95% is recommended for all screening colonoscopies.

Conclusions:

• Implementing continuous measurement of key colonoscopy QIs is the primary step toward improving colonoscopy quality in Korea.
• Standardizing the monitoring of ADR, withdrawal time, bowel preparation, and cecal intubation rates is vital for enhancing patient safety and procedural effectiveness.