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UK national analysis of colonoscopy quality in inflammatory bowel disease surveillance: a National Endoscopy Database
Keith Pohl1, Gaurav B Nigam2, Alexandra Kent3
1Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom.
Background:
Patients with inflammatory bowel disease (IBD) undergo colonoscopy for diagnosis, disease assessment, and colorectal cancer surveillance. We used the UK National Endoscopy Database (NED) to evaluate the quality of IBD surveillance and identify factors associated with procedural quality.
Design:
All colonoscopies uploaded to NED between January 1 and December 31, 2024 were analyzed. IBD procedures were identified from recorded indications and classified as assessment or surveillance. Key performance indicators (KPIs) were assessed against national guidance. Case-mix-adjusted impacts of endoscopist- and service-level factors were evaluated using multilevel mixed-effects logistic regression.
Results:
Of 588 841 colonoscopies, 2.7% (n = 15 971) were IBD surveillance. Although 56.8% of endoscopists performed at least one surveillance procedure, 18.9% performed one or more per month and delivered 57.1% of all surveillance. IBD surveillance quality was high (cecal intubation 96.1%; median withdrawal time 13 min), but adequate bowel preparation was below target (80.2%). Endoscopists performing ≥1 surveillance/month had higher adjusted polyp detection (used as a surrogate marker of mucosal inspection quality rather than true dysplasia) (odds ratio [OR] 1.26), and procedures allocated extended time had higher detection (OR 1.40).
Conclusion:
These findings suggest that regular exposure to IBD surveillance, adequate procedural time, and consistent use/documentation of dye-based chromoendoscopy are associated with higher polyp detection during IBD surveillance colonoscopy. Importantly, these findings relate to polyp detection rather than histologically confirmed dysplasia detection. Further work is required to determine whether service concentration or minimum surveillance volumes improve dysplasia-related outcomes. Service-level pathways analogous to English Bowel Cancer Screening with national standards and performance monitoring may warrant consideration.
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