Quality in screening colonoscopy

Over the past two decades, the importance of colonoscopy quality has gained increasing recognition. Variability in lesion detection rates among endoscopists and missed lesions have been identified as key contributors to post-colonoscopy colorectal cancer (post-colonoscopy CRC). This has driven the development of standardized quality indicators aimed at minimizing these gaps. Quality indicators are categorized into pre-procedural, intra-procedural, and post-procedural phases and encompass a range of technical, cognitive, and administrative factors. While different professional societies emphasize the importance of various indicators, they all include the most validated measures, such as bowel preparation quality, detection metrics, cecal intubation rate, complication rates, and appropriate surveillance recommendations. It is important not to evaluate these indicators in isolation, as they interact and influence each other, collectively determining the overall effectiveness of the procedure. This review discusses the latest evidence on colonoscopy quality indicators, their impact on clinical outcomes, and practical strategies to enhance detection rates and procedural quality.