Quality measures for lower gastrointestinal endoscopy: a review of recent consensus statements and guidelines

Abstract

Colonoscopy is utilised in the diagnosis and treatment of disorders of the lower gastrointestinal tract. Complete visualization of the large intestinal mucosa and also the terminal ileum should be done safely and in a well-tolerable manner. Colonoscopy plays a major role in screening for colorectal cancer and is useful in the early detection and prevention. Prevention of colorectal cancer requires prompt detection of potentially precancerous lesions and resection. In recent decades, considerable variation in performing colonoscopies and outcomes have been reported and therefore, the necessity for standardization of the procedure with quality measures was recognized. Quality/ performance measures are defined as indicators that aid in quantifying health-care processes and help to achieve high-quality healthcare. Several quality indicators have been proposed in relation to pre-procedure preparation, intra-procedure and post-procedure events. Some of these quality measures include adenoma detection rate, caecal intubation rate, withdrawal times and quality of bowel preparation. Endoscopists should not only ensure adequate quality in relation to the above parameters but should also have high compliance rates with recommended guidelines on indications, evidence-based screening and surveillance intervals. These will ensure better colonoscopy yields while maintaining high standards of patient safety and will translate into better patient outcomes. Guidelines proposed by the American Society of Gastro-intestinal endoscopy/American College of Gastroenterology and European Society of Gastrointestinal Endoscopy/United European Gastroenterology and recent evidence were analysed and the summary of the recommendations have been discussed in this review. Although these guidelines are not based on evidence from the Asian populations, it may still be useful to adopt these key quality measures for colonoscopy in Asia. This will be helpful in the evaluation of daily practice at the endoscopy unit. However, guidelines targeting the regional population should be formulated in the future.