An Executive Summary of the Quality Indicators for Colonoscopy
And
The North Country Gastroenterology Experience 2021
“Five studies have established that gastroenterologists are more effective than surgeons and primary care physicians at preventing colorectal cancer by colonoscopy (CRC).” I.
According Corley published in the New England Journal of Medicine, there is a 3 percent reduction in colorectal cancer incidence and a 5 percent reduction in cancer mortality for each 1 percent increase in adenoma detection rate.
Colonoscopy is the most effective procedure for finding adenomatous polyps if the adenoma detection rate is high enough; according to the studies adenomas should be detected at least 25% of the time.
In 2021 we have had an adenoma detection rate of 50%. For the last 8 years our adenoma detection rate is 47%.
According to the recent studies, inadequate preparation should not occur in more than 15% of colonoscopies.
Patients at North Country Gastroenterology (NCG) have an inadequate prep rate of only 7%.
Cecal intubation should happen in at least 90% of colonoscopies and photographic documentation in 95%.
At NCG we reach cecal intubation in 100% of colonoscopies and every patient goes home with photographs of our findings.
Perforation should occur in less than 1/1000 for screening procedures and 1/500 for all other exams.
Out of a total of approximately 15,625 cases, we have only had 2 perforations; both with polyp removal and none for screening purposes.
Withdrawal time of the colonoscopy should be greater than or equal to 6 mins.
100% of completed colonoscopies done at NCG take greater than 6 minutes to withdraw. The average withdrawal time at NCG is more than 10 minutes.
Sessile polyps less than 2cm should be removed endoscopically in more than 90% of cases.
100% of those polyps have been removed at the time of endoscopy here at NCG.
A second look in the colon via forward view should be done in the majority of screening cases, as this can increase adenoma detection rates thus decreasing colorectal cancer.
100% of colonoscopies performed include a second look at the ascending colon.
I. Rex, Douglas K. MD, Schoenfeld, Philip S. MD, MSEd, MSc (Epi), Cohen, Jonathan MD, Pike, Irving M. MD, Adler, Douglas G. MD, Fennerty, M. Brian MD, Lieb II, John G. MD, Park, Walter G. MD, Rizk, Maged K. MD, Sawhney, Mandeep S. MD, MS, Shaheen, Nicholas J. MD, MPH, Wani, Sachin MD, and Weinberg, David S. MD, MSc. (2014). Quality Indicators for Colonoscopy. The American Journal of Gastroenterology, 110: 72-90. Doi 10.1038/ajg.2014.385