InFocus - Issue 4, October 2016 

Focus On...


The future of endsocopic performance measurement

Prof. Matthew Rutter talks to InFocus about UEGW, ESGE and the importance of performance measures in endoscopy.

  • Consultant Gastroenterologist, University Hospital of North Tees
  • Professor of Gastroenterology, Durham University
  • Published extensively and lectured worldwide on quality in endoscopy, colorectal cancer screening and cancer surveillance in inflammatory bowel disease
  • Co-author of many national and international guidelines for polyp screening, colonoscopic screening for cancer in inflammatory bowel disease, colonoscopy quality and inflammatory bowel disease.
  • Clinical Director, Tees Bowel Cancer Screening Centre
  • Chair, European Society of Gastrointestinal Endoscopy quality improvement committee
  • Chair, National Bowel Cancer Screening Programme Evaluation Group


PENTAX Medical: Dear Matt, thank you for your time. As the QIC committee chair for ESGE and leading author of “The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures”, can you explain why the development of performance measures in endoscopy are so important? How will this project be implemented across the different countries among their very different healthcare realities?

Prof. Matthew Rutter: I passionately believe in the importance of delivering high quality endoscopy for our patients in everyday endoscopic practice. Tens of millions of people undergo endoscopic procedures each year in Europe. Endoscopy is the pivotal diagnostic test for luminal pathology and offers an increasing array of therapeutic opportunities. High quality endoscopy delivers better health outcomes; unfortunately, we know there is clinically significant variation in the quality of endoscopy currently delivered. The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. One of the most fundamental steps to achieving this is to raise the quality of everyday endoscopy.

The development of key performance measures is the first step in this vision. Performance measures are measurements that are used to assess the performance of a service or aspect of a service. They set a quality benchmark for endoscopists and endoscopy services, and form an important component of quality improvement. Measuring performance, and setting minimum and target standards within these measures incentivises improvement and also permit users of the service to assess quality for themselves, thus making better informed choices and further incentivising improvements in healthcare.

PM: Do you think that in the future the performance measures will be open published nationwide? If yes, what the benefits and risks? Will the patients be able to interpret such results and make their choices? 

MR: Although open publication has definite potential benefits, it can cause unintended damage if poorly handled, for example if data are open to misinterpretation or inappropriate comparison. Hence both the benefits and risks of open publication need to be considered. Clear explanation of the relevance of the measures and any variability within them must be provided. Providing data in an anonymized or summated (service level) form can mitigate some of these potential issues. It is important that performance measures are primarily used to identify areas where improvements can be made. Where this relates to endoscopist performance, this must be done in a sensitive and supportive way, aiming to improve performance rather than punish.

PM: Where do you see the role of the industry in contributing to raise endoscopy’s performance measures? Is innovation and training playing a big role?

MR: Technology can help in many of the components of quality improvement in endoscopy. For example, colonoscopy training and ongoing skills improvement is enhanced significantly by the use of magnetic endoscopy imaging technology, which creates a greater understanding of the complex dynamics of the interplay of the colonoscope and the mobile colon during insertion, and permits more rapid and more comfortable intubation. Likewise, the use of high definition equipment and enhanced imaging techniques allow more accurate lesion characterisation.

PM: What are your greatest expectations for the UEGW this year scientifically wise?

MR: I think UEGW is an excellent meeting. I enjoy the state-of-the-art presentations, and finding out what is just around the corner - there are always some very clever and innovative ideas. However, I think one of the exciting themes in gastroenterology of recent years has been the increasing trend towards higher quality, larger scale, collaborative international research and the careful analysis of increasingly large databases to answer some of the more fundamental questions we have in endoscopy, providing a platform for the development of increasingly useful evidence-based clinical guidelines, which in turn should help us deliver even higher quality care to our patients.

PM: Can you disclose a little bit about your presentation at the PENTAX Medical Expert Dinner?

MR: I intend to give a personal reflection on the interplay between endoscopic technologies and endoscopy techniques, full of practical tips on how endoscopists can refine their skills and deliver higher quality patient care. 


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