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Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists
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Measuring and Improving Quality of Colonoscopy for Colorectal Cancer Screening.
Christopher V Almario1,2,3,4,5,6, Jaspreet Shergill1, Janice Oh1
1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Techniques and Innovations in Gastrointestinal Endoscopy
|February 13, 2023
Summary
Colonoscopy is the gold standard for colorectal cancer (CRC) screening, preventing cancer and reducing mortality. Quality indicators and interventions are crucial for improving colonoscopy performance and patient outcomes.
Area of Science:
- Gastroenterology
- Oncology
- Public Health
Background:
- Colorectal cancer (CRC) is a significant public health concern in the US, being the third most common and deadly malignancy.
- Colonoscopy is the gold standard for CRC screening, offering both detection and prevention of neoplastic lesions.
- Despite its effectiveness, colonoscopy quality varies due to factors like missed lesions and endoscopist performance differences.
Purpose of the Study:
- To review recommended colonoscopic quality indicators and benchmarks for average-risk screening colonoscopies.
- To examine evidence-based interventions aimed at improving key colonoscopy quality measures.
- To preview the impact of the CMS Advancing Care for Appropriate Colon Health Merit-Based Incentive Payment System Value Pathway.
Main Methods:
- Review of guidelines from the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on Quality in Endoscopy.
- Synthesis of evidence on interventions targeting adenoma detection rate, withdrawal time, cecal intubation, and bowel preparation.
- Analysis of the potential influence of the forthcoming CMS Merit-Based Incentive Payment System.
Main Results:
- Colonoscopy significantly reduces CRC incidence (31%-91%) and mortality (65%-88%) through polyp removal.
- Established quality indicators and benchmarks are essential for measuring and improving endoscopist performance.
- Interventions focusing on adenoma detection rate, withdrawal time, cecal intubation, and bowel preparation quality show promise for enhancing exam quality.
Conclusions:
- Measuring and monitoring endoscopist performance using quality indicators is critical for high-quality colonoscopic exams.
- Implementing evidence-based interventions can further improve colonoscopy effectiveness in preventing CRC.
- The upcoming CMS payment system is expected to influence clinical practice and drive quality improvement in colonoscopy.
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