Quality Of Screening Colonoscopy Research Articles

Evaluating Colonoscopy Quality by Performing Provider Type.

Colorectal Cancer (CRC) is the third most diagnosed cancer and the second leading cause of cancer death in the United States. Colonoscopy is an essential tool for screening, used both as a primary approach and follow-up to an abnormal stool-based CRC screening result. Colonoscopy quality is often measured with four key indicators: bowel preparation, cecal intubation, mean withdrawal time, and adenoma detection. Colonoscopies are most often performed by gastroenterologists (GI), however, in rural and medically underserved areas non-GI providers often perform colonoscopies. This study aims to evaluate the quality and safety of screening colonoscopies performed by non-GI providers, comparing their outcomes to those of GI providers. Descriptive statistics were used to characterize the study population. Results for quality indicators were stratified by provider type and compared. Statistical significance was determined using p < 0.05 as the threshold for all comparisons; all p-values were two-sided. No statistical difference was found when comparing performance by provider type. Median performance for gastroenterologists, general surgeons, and family medicine providers ranged form 98-100% for cecal intubation; 97.4-100% for bowel preparation; 57.4-88.9% for male adenoma detection rate; 47.7-62.13% for female adenoma detection rate; and 0:12:10-0:20:16 for mean withdrawal time. All provider types met and exceeded the goal metric for each of the quality indicators (p < 0.001). In this analysis, non-GI providers can be expected to perform colonoscopies with similar quality to GI providers based on performance outcomes for the key quality metrics.

Artificial Intelligence-assisted colonoscopy and colorectal cancer screening: Where are we going?

Colorectal cancer is a significant global health concern, necessitating effective screening strategies to reduce its incidence and mortality rates. Colonoscopy plays a crucial role in the detection and removal of colorectal neoplastic precursors. However, there are limitations and variations in the performance of endoscopists, leading to missed lesions and suboptimal outcomes. The emergence of artificial intelligence (AI) in endoscopy offers promising opportunities to improve the quality and efficacy of screening colonoscopies. In particular, AI applications, including computer-aided detection (CADe) and computer-aided characterization (CADx), have demonstrated the potential to enhance adenoma detection and optical diagnosis accuracy. Additionally, AI-assisted quality control systems aim to standardize the endoscopic examination process. This narrative review provides an overview of AI principles and discusses the current knowledge on AI-assisted endoscopy in the context of screening colonoscopies. It highlights the significant role of AI in improving lesion detection, characterization, and quality assurance during colonoscopy. However, further well-designed studies are needed to validate the clinical impact and cost-effectiveness of AI-assisted colonoscopy before its widespread implementation.

Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer.

The incidence and mortality of colorectal cancer (CRC) have decreased through regular screening colonoscopy, surveillance, and endoscopic treatment. However, CRC can still be diagnosed after negative colonoscopy. Such CRC is called interval CRC and accounts for 1.8-9.0% of all CRC cases. Most cases of interval CRC originate from missed lesions and incompletely resected lesions. Interval CRC can be minimized by improving the quality of colonoscopy. This has led to a growing interest in and demand for high-quality colonoscopy. It is important to reduce the risk of CRC and its associated mortality by improving the quality of colonoscopy. In this review article, we provide an overview of colonoscopy quality indicators, including bowel preparation adequacy, the cecal intubation rate, the adenoma detection rate, the colonoscopy withdrawal time, appropriate polypectomy, and complication of the procedure. Because colonoscopy is a highly endoscopist-dependent procedure, colonoscopists should be well-acquainted with quality indicators and strive to apply them in daily clinical practice for the prevention of CRC.

The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide, despite the widespread uptake of population surveillance strategies. This is in part due to the persistent development of ‘interval colorectal cancers’, where patients develop colorectal cancer despite appropriate surveillance intervals, implying pre-malignant polyps were not resected at a prior colonoscopy. Multiple techniques have been developed to improve the sensitivity and accuracy of lesion detection and characterisation in an effort to improve the efficacy of colorectal cancer screening, thereby reducing the incidence of interval colorectal cancers. This article presents a comprehensive review of the transformative role of artificial intelligence (AI), which has recently emerged as one such solution for improving the quality of screening and surveillance colonoscopy. Firstly, AI-driven algorithms demonstrate remarkable potential in addressing the challenge of overlooked polyps, particularly polyp subtypes infamous for escaping human detection because of their inconspicuous appearance. Secondly, AI empowers gastroenterologists without exhaustive training in advanced mucosal imaging to characterise polyps with accuracy similar to that of expert interventionalists, reducing the dependence on pathologic evaluation and guiding appropriate resection techniques or referrals for more complex resections. AI in colonoscopy holds the potential to advance the detection and characterisation of polyps, addressing current limitations and improving patient outcomes. The integration of AI technologies into routine colonoscopy represents a promising step towards more effective colorectal cancer screening and prevention.

S386 Assessing for Racial and Ethnic Disparities in Initial Average Risk Screening Colonoscopy Quality Metrics in a Large Military Gastroenterology Fellowship Program

S386 Assessing for Racial and Ethnic Disparities in Initial Average Risk Screening Colonoscopy Quality Metrics in a Large Military Gastroenterology Fellowship Program

Gastroenterologist focus of clinical practice affects adenoma detection in screening colonoscopy.

Our objective was to determine whether the clinical focus of gastroenterology practice would affect screening colonoscopy quality metrics, specifically adenoma detection (AD). In a retrospective study of screening colonoscopies, gastroenterologists were categorized based on their clinical subspecialty focus into general/motility, hepatology, inflammatory bowel disease (IBD), and interventional endoscopy. The primary outcome was AD with a secondary outcome of adenoma and/or sessile serrated polyp (SSP) detection (AD + SSP). A total of 5271 (male: 49.1%) complete colonoscopies were performed between 2010 and 2020 by 16 gastroenterologists (male: 62.5%, general/motility specialists: 3, hepatologists: 3, IBD specialists: 4, interventional endoscopists: 6). The AD and AD + SSP rate between each specialty focus were 27.5% and 31.0% for general/motility, 31.4% and 35.5% for hepatology, 38.4% and 43.6% for IBD, and 37.5% and 43.2% for interventional endoscopy. In regression analysis, patient's male gender (odds ratios [OR]: 1.81, 95% CI: 1.60-2.05, P < .001), longer withdrawal time (OR: 1.16, 95% CI: 1.14-1.18, P < .001), hepatologist (OR: 1.25, 95% CI: 1.02-1.53, P = .029), IBD subspecialist (OR: 1.60, 95% CI: 1.30-1.98, P < .001), and interventional endoscopist (OR: 1.36, 95% CI: 1.13-1.64, P < .001) were independently associated with AD. Moreover, patient's male gender (OR: 1.64, 95% CI: 1.45-1.85, P < .001), acceptable bowel preparation (OR: 1.29, 95% CI: 1.06-1.56, P = .010), withdrawal time (1.20, 95% CI: 1.18-1.22, P < .001), hepatologist (OR: 1.30, 95% CI: 1.07-1.59, P = .008), IBD subspecialist (OR: 1.72, 95% CI: 1.39-2.12, P < .001), interventional endoscopist (OR: 1.44, 95% CI: 1.20-1.72, P < .001) were independent factors that improved detection of AD + SSP. Subspecialty focus of practice was an important factor in AD rate along with the male gender of the patient, bowel preparation, and withdrawal time.

S315 Does Having a Fellow Improve the Quality of Screening Colonoscopy?

S315 Does Having a Fellow Improve the Quality of Screening Colonoscopy?

S285 Validation of a Deep Machine Learning Tool to Determine Intra-Procedural Screening Colonoscopy Quality Indicators in an Academic Health System

S285 Validation of a Deep Machine Learning Tool to Determine Intra-Procedural Screening Colonoscopy Quality Indicators in an Academic Health System

Safe, efficient, and effective screening colonoscopy.

Colorectal cancer continues to be one of the most common causes of cancer-related death. Widespread dissemination of screening colonoscopy in the United States has led to a significant reduction in the incidence and mortality. Here we review current literature with an aim to highlight recent improvements in the safety, efficiency, and effectiveness of screening colonoscopy. Colon capsule endoscopy is an emerging noninvasive method to capture images of colonic mucosa for select patients with appreciable sensitivity for polyp detection. Recent literature supports the use of the novel oral anticoagulant apixaban over other anticoagulants to reduce the risk of gastrointestinal bleeding related to colonoscopy. Cold snare polypectomy for smaller lesions and prophylactic clipping following resection of large polyps in the proximal colon may reduce the rate of delayed bleeding. Novel methods and devices for improving bowel preparation continue to emerge. Mechanical attachment devices and artificial intelligence represent recent innovations to improve polyp detection. Clinicians should be aware of relevant data and literature that continue to improve the quality and safety of screening colonoscopy and incorporate these findings into their clinical practice.

Nurse-led reinforced education by mobile messenger improves the quality of bowel preparation of colonoscopy in a population-based colorectal cancer screening program: A randomized controlled trial

BackgroundAdequate bowel preparation is an important colonoscopy quality indicator. Reinforced education is effective in improving bowel preparation quality of colonoscopy with mixed indications. However, it remains unclear whether such improvement can be consistently observed in pre- and post-irrigation during colonoscopy in screening population. ObjectiveWe aimed to study the effectiveness of nurse-led reinforced education delivered via mobile messenger (WhatsApp Messenger) on pre- and post-irrigation bowel preparation adequacy in colonoscopies for positive fecal immunochemical test in a population-based colorectal cancer screening program. DesignRandomized controlled trial. SettingA hospital-based endoscopy centre in Hong Kong, China. ParticipantsPatients undergoing colonoscopy for positive fecal immunochemical test in a population-based colorectal cancer screening program. MethodsThe recruited patients were randomized to receive either WhatsApp Reinforced Education (WRE) or No Reinforced Education (NRE) (1:1). Patients in WRE group received one-off reinforced education of bowel preparation in text and video formats via WhatsApp Messenger four days prior to colonoscopy sent by investigator while NRE group received standard-of-care only.Primary outcome was the bowel preparation adequacy rate as evaluated by Aronchick Scale. Secondary outcomes included bowel preparation adequacy rate as evaluated by Boston Bowel Preparation Scale, adenoma detection rate and risk factors of bowel preparation inadequacy. Continuous variables were described as means with standard deviation (SD) and analyzed with Student's t-test. The Pearson Chi Square Test or Fisher Exact Test was used to assess categorical variables when appropriate. Risk factors were determined by logistic regression. ResultsFrom July 2017 to April 2019, 685 eligible patients were randomized to WRE (n = 343) and NRE (n = 342) groups. Patients in WRE group had higher bowel preparation adequacy rate as evaluated by Aronchik Scale (83.4% vs 75.4%, p = 0.010) and Boston Bowel Preparation Scale (94.2% vs 88.9%, p = 0.013). Adenoma detection rate was higher in WRE group but without statistical significance (71.4% vs 67.5%, p = 0.27). In logistic regression, WhatsApp Reinforced Education reduced the inadequate bowel preparation risk (Adjusted odds ratio: 0.564; 95% confidence interval: 0.371–0.856, p = 0.007). Male gender (Adjusted odds ratio [AOR]: 1.638; 95% confidence interval [CI]: 1.054–2.546, p = 0.028) and diabetes (AOR: 2.062; 95% CI: 1.215–3.497, p = 0.007) were risk factors of bowel preparation inadequacy. ConclusionsNurse-led mobile messenger-initiated reinforced education improves both pre- and post-irrigation bowel preparation quality of screening colonoscopy following positive fecal immunochemical test. It is readily incorporable in clinical practice because of its low setup cost. Registration numberRegistered on 4 July 2017 on https://clinicaltrials.gov/ (NCT03209739).

The challenge of quantifying screening colonoscopy quality: Development and psychometric properties of the Colonoscopy Quality Score instrument

Introduction and aimsColonoscopy quality is measured by the degree in which the examination increases the likelihood of obtaining adequate results on health. Our aim was to develop an instrument for evaluating the quality of screening colonoscopies, taking into account the performance of endoscopists and endoscopy units. Materials and methodsMixed methodology was employed. The first stage (qualitative) consisted of a Medline search, from which a group of experts developed the quality score items. The second stage (quantitative) utilized a modified Delphi technique to reach consensus (3 rounds). We evaluated the psychometric properties of the instrument (reliability and construct validity) in elective screening colonoscopies (in patients ≥ 50 years of age), performed within the January–April 2017 time frame. ResultsA final instrument with 8 items was produced: (1) the Boston Bowel Preparation Scale score; (2) cecal intubation rate; (3) colonoscopy withdrawal time; (4) image documentation; (5) adenoma detection rate; (6) endoscopic surveillance planning; (7) perforation rate, and (8) continuous improvement programs. The instrument was evaluated in 323 colonoscopies performed by 31 endoscopists and found to be one-dimensional and reliable (Cronbach’s alpha 0.76). Performance was compared between endoscopists (center 1) and an expert endoscopist from another center (center 2): Boston Bowel Preparation Scale score 8.3 vs. 7.36 (P < .001), cecal intubation rate 93.5 vs. 96%, colonoscopy withdrawal time 14.8 vs. 8.4 min (P < .001), and adenoma detection rate 34 vs. 52.2% (P < .001), respectively. ConclusionThe Colonoscopy Quality Score is a reliable and valid instrument for evaluating screening colonoscopy quality. Its results could be adapted to the usual endoscopic report to adjust monitorization frequency post-colonoscopy.

The quality of screening colonoscopy in rural and underserved areas.

Screening colonoscopy effectiveness depends on procedure quality; however, knowledge about colonoscopy quality in rural and underserved areas is limited. This study aimed to describe the characteristics and quality of colonoscopy and to examine predictors of colonoscopy quality at rural and underserved hospitals. Adults undergoing colonoscopy from April 2017 to March 2019 at rural or underserved hospitals across the Illinois Surgical Quality Improvement Collaborative were prospectively identified. The primary outcome was colorectal adenoma detection, and secondary outcomes included bowel preparation adequacy, cecum photodocumentation, and withdrawal time. Performance was benchmarked against multisociety guidelines, and multivariable logistic regression was used to examine patient, physician, and procedure characteristics associated with adenoma detection. In total, 4217 colonoscopy procedures were performed at 8 hospitals, including 1865 screening examinations performed by 19 surgeons, 9 gastroenterologists, and 2 family practitioners. Physician screening volume ranged from 2 to 218 procedures (median 50; IQR 23-74). Adenoma detection occurred in 26.6% of screening procedures (target: ≥ 25%), 90.7% had adequate bowel preparation (target: ≥ 85%), 93.1% had cecum photodocumentation (target: ≥ 95%), and mean withdrawal time was 8.1min (target: ≥ 6). Physician specialty was associated with adenoma detection (gastroenterologists: 36.9% vs. surgeons: 22.5%; OR 2.30, 95% CI 1.40-3.77), but adequate bowel preparation (OR 1.15, 95% CI 0.76-1.73) and cecum photodocumentation (OR 1.56, 95% CI 0.91-2.69) were not. Colonoscopies performed at rural and underserved hospitals meet many quality metrics; however, quality varied widely. As physicians are scarce in rural and underserved areas, individualized interventions to improve colonoscopy quality are needed.

S243 Gastroenterologist Focus of Clinical Practice Affects Adenoma Detection in Screening Colonoscopy

Introduction: Screening colonoscopy stands as the gold standard of preventative care for colorectal cancer. The procedure is done by endoscopists with varying degrees of training. As the percentage of screening colonoscopies increases among the nations, improving the quality of procedures would have significant impact on plausible outcomes. Our objective was to determine whether the clinical focus of practice would affect screening colonoscopy quality metrics, specifically adenoma detection. Methods: We conducted a retrospective study of screening colonoscopies performed at an academic ambulatory surgical center. We categorized the gastroenterologists based on their clinical subspecialty focus, which includes general/motility, hepatology, inflammatory bowel disease (IBD), and interventional endoscopy. We looked at variables pertaining to the patients’ and providers’ backgrounds and the procedural reports. The primary outcome was adenoma detection (AD) with secondary outcome of adenoma and/or sessile serrated polyp detection (AD+SSP). Multivariable logistic regression analysis was applied. Results: A total of 5,271 (male: 49.1%) complete first-time screening colonoscopies were performed from 2010 to 2020 by 16 gastroenterologists (male: 62.5%, general/motility specialists: 3, hepatologists: 3, IBD specialists: 4, interventional endoscopists: 6). 87.6% had either adequate, good, or excellent bowel preparation. The AD rate between each specialty focus were 27.5% (n = 264) for general/motility, 31.4% (n = 409) for hepatology, 38.4% (n = 346) for IBD, and 37.5% (n = 765) for interventional endoscopy. The AD+SSPs rate between each specialty focus were 31.0% (n = 298) for general/motility, 35.5% (n = 467) for hepatology, 43.6% (n = 396) for IBD, and 43.2% (n = 889) for interventional endoscopy. Binary regression analysis was performed with AD and AD+SSP as the outcome of interest, and the results are shown in Table 1. Male gender followed by subspecialty focus of practice, and withdrawal time were independent factors in finding adenomatous polyps. Acceptable bowel preparation enhanced AD+SSP detection in addition to aforementioned factors, Table 1. Conclusion: Gastroenterologists met all key quality metrics for screening colonoscopies. However, subspecialty focus of practice is important factor in adenoma detection rate along with patient’s male gender, bowel preparation, and withdrawal time. The result of this study may need further validation with larger multicenter prospective studies.Table 1.: Regression analysis finding independent factors for detecting polyps

S237 Validation of Machine Learning Tool to Determine Post-Polypectomy Surveillance Intervals After Screening Colonoscopy in a Large Health System

Introduction: Accurate determination and documentation of post-polypectomy surveillance intervals after screening colonoscopy is essential to reduce colorectal cancer (CRC) incidence and mortality. However, this remains clinically challenging particularly in light of recent post-polypectomy guidelines that increase the number of surveillance intervals. In order to improve guideline-concordant surveillance after CRC screening, we sought to validate a previously developed natural language processing (NLP) algorithm that automates determination of post-polypectomy colonoscopy surveillance intervals. Methods: UCLA Health is a large, academic healthcare system performing over 15,000 screening colonoscopies per year. We previously developed an automated NLP pipeline to extract and analyze relevant polyp features from free-text colonoscopy (polyp number, size, location) and pathology reports (polyp histology) to determine appropriate post-polypectomy surveillance interval based on 2020 USMSTF guidelines (Figure 1). To validate the algorithm, we used a random selection of screening colonoscopies performed between 6/2/2020 and 2/2/2021 for individuals at average-risk for CRC. We determined the performance (sensitivity, specificity, PPV, F-score, accuracy) of the NLP algorithm to identify guideline-concordant surveillance intervals compared to manual chart review and characterized common errors made by the algorithm. Results: Our validation cohort (n = 469) was 50.3% female and mean age was 57.9 (SD = 7.3). The most common surveillance interval per chart review was 10-years (60.1%), followed by 7-10 years (22.8%) (Table 1). The NLP pipeline identified the appropriate surveillance interval after screening colonoscopy with an overall 82.6% sensitivity (range: 68.8-99.6%), 98.3% specificity (95.7-99.8%), 82.4% PPV (42.3-97.2%), 81.6% F-score (52.4-98%), and 97.6% accuracy (95.5-99.8%) (Table 1). Among the 58 cases misclassified by the NLP algorithm, 14 (25.9%) were allocated a longer surveillance interval than the manual gold standard. Conclusion: We developed an automated NLP algorithm that is moderately sensitive and highly specific at identifying appropriate surveillance intervals after screening colonoscopy. Future work will refine the algorithm to increase sensitivity and specificity. This tool will help providers and health systems achieve the ASGE/ACG Taskforce screening colonoscopy quality indicator goal that > 90% screening colonoscopies document a guideline-concordant surveillance interval.Figure 1.: Automated NLP Pipeline to Determine Guideline-Concordant Post-Polypectomy Surveillance Intervals (Gupta et al. 2020; US Multi-Society Task Force (MSTF)). HP, hyperplastic polyp; TA, tubular adenoma; SSP, sessile serrated polyp; TSA, total serrated polyp; TVA, tubulovillous adenoma; HGD, high-grade dysplasia.Table 1.: A) Surveillance colonoscopy interval determination from manual chart review versus NLP pipeline, N=469. B) Performance of the NLP algorithm to identify appropriate surveillance interval after screening colonoscopy, N=469

Do Gastroenterologists Have a "Weak" Day? Impact of Day of the Week on the Quality of Outpatient Screening Colonoscopies.

The goal of this study is to determine the significance of day of the work week and its contribution to endoscopist performance using adenoma detection rate (ADR) and proposed surrogate quality measures. Nearly a quarter of adenomas are missed on routine screening colonoscopy which contributes to between 50% and 60% of interval colorectal cancer. Adult patients who underwent outpatient screening colonoscopy between January 2015 and April 2020 were included. Measurement of ADR and proposed quality metrics were analyzed for each day of the work week. Secondary outcomes included rates of good or excellent bowel preparation, trainee fellow participation, performance quartile of individual endoscopists, and patient demographic data. A generalized linear mixed model was used to analyze predictors of ADR. A total of 1884 screening procedures were included in our analysis. ADR on Friday (35.6%) was significantly lower than all other days of the work week ( P <0.001). When compared with Friday, all days were found to be independent predictors of increased ADR. Male gender [95% confidence interval (CI): 1.12-1.65, P =0.002], good rather than excellent bowel preparation (95% CI: 1.22-2.28, P =0.001) and colonoscopy withdrawal time (CWT) (95% CI: 1.02-1.03, P <0.001) were all found to be predictors of increased ADR. Proposed quality indicators were all well correlated with ADR ( r >0.811, P ≤0.001) apart from CWT ( r =0.28, P =0.379). The data suggests there is a decline in endoscopist performance on Friday when compared with all other days of the work week. ADR correlates well with many proposed quality parameters, however, CWT may be of additional value as a quality metric.

Association of Adenoma Detection Rate and Adenoma Characteristics With Colorectal Cancer Mortality After Screening Colonoscopy

Background & AimsThe adenoma detection rate (ADR) and characteristics of previously resected adenomas are associated with colorectal cancer (CRC) incidence and mortality. However, the combined effect of both factors on CRC mortality is unknown. Patients and methodsUsing data of the Austrian quality assurance program for screening colonoscopy, we evaluated the combined effect of ADR and lesion characteristics on subsequent risk for CRC mortality. We analyzed mortality rates for individuals with low-risk adenomas (1–2 adenomas <10 mm), individuals with high-risk adenomas (advanced adenomas or ≥3 adenomas), and after negative colonoscopy (negative colonoscopy or small hyperplastic polyps) performed by endoscopists with an ADR <25% compared with ≥25%. Cox regression was used to determine the association of combined risk groups with CRC mortality, adjusted for age and sex. ResultsWe evaluated 259,885 colonoscopies performed by 361 endoscopists. A total of 165 CRC-related deaths occurred during the follow-up period, up to 12.2 years. In all risk groups, CRC mortality was higher when colonoscopy was performed by an endoscopist with an ADR <25%. Compared with negative colonoscopy with an ADR ≥25%, CRC mortality was similar for individuals with low-risk adenomas irrespective of ADR (for ADR ≥25%: adjusted hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.59–2.49; for ADR <25%: adjusted HR, 1.25; 95% CI, 0.64–2.43) and after negative colonoscopy with ADR <25% (adjusted HR, 1.27; 95% CI, 0.81–2.00). Individuals with high-risk adenomas were at significantly higher risk for CRC death if colonoscopy was performed by an endoscopist with an ADR <25% (adjusted HR, 2.25; 95% CI, 1.18–4.31) but not if performed by an endoscopist with an ADR ≥25% (adjusted HR, 1.35; 95% CI, 0.61–3.02). ConclusionsOur study adds important evidence for mandatory assessment and monitoring of performance quality in screening colonoscopy. High-quality colonoscopy was associated with a lower risk for CRC death, and the impact of ADR was strongest for individuals with high-risk adenomas.

Impact of cumulative experience on the quality of screening colonoscopy: A 13-year observational study.

To investigate trends in quality of screening colonoscopy (using the Global Rating Score) in the 13 years since introduction of the Bowel Cancer Screening Programme in England. An English Bowel Cancer Screening Programme colonoscopy service from 2007 to 2019. A retrospective observational study was undertaken using a prospectively collected database in order to analyse trends in screening endoscopies (including patients following positive faecal occult blood test or with high-risk findings on flexible sigmoidoscopy). The Global Rating Score quality indicators for Bowel Cancer Screening Programme colonoscopy were used as outcome measures, and trends over time were analysed. These included caecal intubation rate, adenoma detection rate, colorectal cancer detection rate, proportion of patients with minimal or mild discomfort scores, proportion of patients who required intravenous sedation, and adverse events. There were 5352 colonoscopies included, performed by 3 endoscopists; 73.8% were index procedures (i.e. first Bowel Cancer Screening Programme colonoscopy) and the remainder were follow-up or surveillance colonoscopies. The mean age of patients was 66 (standard deviation 5) years, and 59.8% were male. Mean age increased over time (R2=0.033; p < 0.001). There were significant trends over time towards higher caecal intubation rate (p = 0.015), higher adenoma detection rate (p < 0.001), lower proportion requiring intravenous sedation (p < 0.001). There were no significant trends in comfort scores (p = 0.606), adverse events (p = 0.503) or colorectal cancer detection (p = 0.089). There was a consistent improvement in the Global Rating Score for Bowel Cancer Screening Programme colonoscopies since the start of the programme, even when quality was already high at the start. Patients can expect high-quality colonoscopy when participating in the Bowel Cancer Screening Programme.

Increased Driving Distance to Screening Colonoscopy Negatively Affects Bowel Preparation Quality: an Observational Study.

To prepare for colonoscopy, patients must consume a bowel purgative and travel from their home to the site of their procedure. The timing of bowel purgative ingestion predicts bowel preparation quality. Currently, it is not known if driving distance impacts bowel preparation quality or adenoma detection. This study investigates the effect of driving distance on bowel preparation and adenoma detection. This is a cross-sectional retrospective analysis of outpatient screening colonoscopy procedures that were completed at an academic medical center. A total of 5089 patients who completed screening colonoscopy across 3 procedure units were analyzed. Description of bowel preparation was dichotomized to either adequate or inadequate. Patient residential addresses were converted into geographic coordinates for geospatial analysis of driving distance to their colonoscopy site. Median driving distance was 13.1 miles. Eighty-nine percent of patients had an adequate bowel preparation. The rate of adenoma detection was 37%. On multivariable logistic regression adjusting for age, sex, race, insurance, endoscopist, and site, increasing driving distance (10-mile increments) was negatively associated with adequate bowel preparation (odds ratio = 0.91; 95% confidence interval 0.85 to 0.97), while adenoma detection was positively associated with adequate bowel preparation (odds ratio = 1.53; 95% confidence interval 1.24 to 1.88) but not with driving distance (odds ratio = 1.02; 95% confidence interval 0.98 to 1.06). Driving distances of 30 miles or less were associated with adequate bowel preparation (odds ratio = 1.37; 95% confidence interval 1.09 to 1.72). Increasing driving distance to screening colonoscopy was negatively associated with adequate bowel preparation but not adenoma detection. Among an academic medical center population, the likelihood of adequate bowel preparation was highest in patients traveling 30 miles or less to their screening colonoscopy. Patient driving distance to colonoscopy is an important consideration in optimizing screening colonoscopy quality.

Time-of-day variation in the diagnostic quality of screening colonoscopies: a registry-based study.

BackgroundThe diagnostic quality of screening colonoscopies has been found to differ between morning and afternoon. Specifically, the adenoma detection rate (ADR) is higher in the morning. Our aim was to assess if time-of-day dependent differences in colonoscopy quality exist in a Danish screening setting. Following national screening guidelines, an individual will be exempt from screening invitations for 8 years if the colonoscopy is without pathology. Therefore, it is of utmost importance to identify factors systematically affecting the detection of lesions.MethodsThis was a single-center study of screening colonoscopies performed between 2014 and 2018. Records were retrieved from the Danish Colorectal Cancer Screening Database and coupled with local data. The ADR and the cecal intubation rate were compared between morning (8-12 a.m.) and afternoon (12-4 p.m.) colonoscopies. Multivariate logistic regression analysis was performed.ResultsA total of 3659 screening colonoscopies were included. The ADR was 51% in the morning and 58% in the afternoon. Multivariate analysis found this statistically significant, with the “afternoon vs. morning” odds ratio for adenoma detection being 1.4 (95% confidence interval 1.17-1.68; P<0.001). The cecal intubation rate was 95.6% in the morning and 94.7%, a non-significant difference.ConclusionsThe ADR of screening colonoscopies was higher in the afternoon. Our study highlights the need for local/regional evaluation of factors affecting colonoscopy quality to address such issues. A clean colonoscopy exempts the patient from subsequent screening invitations for 8 years. Therefore, any observed systematic differences in quality must be addressed and eliminated.

Colonoscopy Quality and Adherence to Postpolypectomy Surveillance Guidelines in an Underinsured Clinic System.

Background Delivery of high-quality colonoscopy and adherence to evidence-based surveillance guidelines is essential to a high-quality screening program, especially in safety net systems with limited resources. We sought to assess colonoscopy quality and ensure appropriate surveillance in a network of safety net practices. Methods We identified age-eligible patients ages 50-75 within a Federally Qualified Health Center (FQHC) clinic system with evidence of colonoscopy in preceding 10 years. We performed chart reviews to assess key aspects of colonoscopy quality: bowel preparation quality, evidence of cecal intubation, cecal withdrawal time, and the adenoma detection rate. We then utilized established guidelines to assess and revise surveillance colonoscopy intervals, determine whether appropriate surveillance had taken place, and schedule overdue patients as appropriate. Results Of 26,394 age-eligible patients, a total of 3,970 patients had evidence of prior colonoscopy and 1,709 charts were selected and reviewed. Mean age was 57, 54% identified as women and 51% identified as Hispanic. Of 1709 colonoscopies reviewed, 77% had data on bowel preparation, and of those, 85% had adequate preparation quality. Cecal intubation was documented in 89% of procedures. Adequate cecal withdrawal time was documented in 59% of those with documented cecal intubation. Overall adenoma detection rate was 42%. Initial surveillance interval was clearly stated in 72% (n = 1238) of procedures. Of these, initial recommended intervals were too short in 24.5% (n = 304) and too long in 3.6% (n = 45). A total of 132 patients (10.7%) were overdue for appropriate surveillance and were referred for follow-up colonoscopy. Conclusions Overall, the quality of screening colonoscopy was high, but reporting was incomplete. We found fair adherence to evidence-based surveillance guidelines, with significant opportunities to extend surveillance intervals and improve adherence to best practices.