InFocus - Issue 1, June 2015
Focus On...
“How much can you influence your quality indicators in colonoscopy?”
The Quality in Colonoscopy metrics
A colonoscopy is a commonly performed procedure for the diagnosis and treatment of a wide range of conditions and symptoms and for the screening and surveillance of colorectal neoplasia.
Many studies demonstrate that colonoscopy offers substantial protection against colorectal cancer (CRC). Nevertheless several studies have raised warnings about the limited effectiveness of colonoscopy for the prevention of CRC, especially of the proximal colon (larger surface, bowel preparation more difficult, more flat lesions/adenomas and serrated lesions are detected in the right side of the colon). The effectiveness of colonoscopy in preventing colorectal cancer is influenced by multiple factors including the quality of the bowel preparation. The following criteria is increasingly being used for objective evaluation and feedback.
- Adenoma detection rate
- Cecal intubation rate
- Withdrawal time
- Lowest rate of complications
- Patient comfort
They contribute to the continuous monitoring of the quality of colonoscopy, and ultimately might reduce the number of interval CRCs. The targets of every medical intervention are safety and effectiveness of the procedure. In this regard, both ESGE and ASGE recently published statements to guarantee uniformization of procedures regarding quality in colonoscopy.
Colonoscopy efficacy depends on the ability to detect colorectal neoplasia. In order to maximize the detection of colorectal neoplasia we may not only need to improve the examination technique and quality of bowel preparation but also to engage advanced imaging technologies such as high definition endoscopy, virtual chromoendoscopy, or add-on devices.
The right to choose: How much do patients know about your ADR?
This topic is now reaching the patients who are having a screening colonoscopy and who look more and more to be informed about the procedure. A recent American study1, aiming to determine patients’ familiarity with colonoscopy quality measures (CQMs) and their influence on patient selection of a colonoscopist, found out that the rates of familiarity with CQM were:
- 88% for adequate bowel preparation
- 30% for adenoma detection rate (ADR)
- 26% for cecal intubation rate
- 21% for greater-than-six-min withdrawal time
Ninety-six percent believed that colonoscopists’ reporting of ADR to other physicians was important or very important. In selecting a colonoscopist, primary care provider referral was ranked as the first or second-most important of four factors in 87% of patients. Even amongst patients who responded “it is very important” to report CQM to other doctors and patients, none ranked CQM as the most important factor in selecting a colonoscopist. As conclusions, the study points out that patient awareness of CQM, other than adequate bowel preparation, was low. Quality measure reporting is important to patients, but primary care provider referral was the most important factor in colonoscopist selection.
This suggests that primary care providers, as well as patients, are important to include in educational strategies regarding quality metrics.
Why is PENTAX Medical the optimal partner for Quality in Colonoscopy?
“The idea of one endoscope fitting all the procedures is obsolete. To increase the patient comfort and the effectiveness of the procedure it is essential to choose the right endoscope in order to personalize the procedure and adapt it to the characteristics of the patient.” Dr. Silvia Sanduleanu, Maastricht University Hospital, Netherlands
Aware of our doctors’ needs, PENTAX Medical offers the widest range of technologies and HD+ colonoscopes (i10 series, RetroView, MagniView, slim scopes..) contributing to the optimization of your quality metrics. In combination with the clear, bright high definition white-light imaging, i-scan enhances tissue and blood vessel structures which may help improve disease detection and characterization. In fact, studies have demonstrated the effectiveness of i-scan in adenoma detection rate and polyp characterization.
The routine use of HD white-light endoscopy systems is a supported practice by ESGE. Actually, ESGE is also suggesting the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations, as well as high definition systems and virtual chromoendoscopy such as i-scan2, in patients with known or suspected Lynch syndrome. i-scan can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤5mm) colorectal polyps to replace histopathological diagnosis.
In light of our commitment to this need, PENTAX Medical has developed the “Quality in Colonoscopy” app showing our broad range of HD+ colonoscopes and innovative associated technologies.
In this app, you can find studies which support i-scan as an effective tool in ADR and in polyp characterization or get to know more on the incremental ADR due to retroflexion with RetroView in the right side of the colon.
The “QiC” app is available for tablets and phones and can be downloaded from Apple (Apple Store) and Android (Google Play). See below for download links:
- Apple iPad: https://itunes.apple.com/us/app/quality-in-colonoscopy/id917276354?ls=1&mt=8
- Apple iPhone: https://itunes.apple.com/us/app/quality-in-colonoscopy-s/id926830930?mt=8
- Android (phone & tablet): https://play.google.com/store/apps/developer?id=Dr.+Carl+GmbH
ESGE recognizes that new endoscopic techniques and procedures are under continuous development and that endoscopists are incorporating them into their practices. New technologies enable new techniques which require new skills and formal training within specific programs with the guidance of a preceptorship. PENTAX Medical has developed a Training for Excellence program featuring dedicated technology and other scientific tools to reinforce the Company’s commitment to education and excellence in endoscopy supported by a wide range of Centers of Excellence accredited by ESGE across Europe and Middle East.
Our aim is to keep developing a partnership with you in the endoscopy field to guarantee best practice, patient comfort and to support the colon cancer screening program. The continuous quality improvement process should be instituted and embraced in all colonoscopy practices.
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1 Am J Gastroenterol. 2015 Feb;110(2):215-9. doi: 10.1038/ajg.2014.201. Epub 2014 Jul 29. Influence of colonoscopy quality measures on patients' colonoscopist selection. Solad Y1, Wang C2, Laine L3, Deng Y4, Schwartz H5, Ciarleglio MM4, Aslanian HR2.
2 To learn more about i-scan scientific evidence please visit: http://www.i-scanimaging.com/index.php?pg=Home
Feel free to contact our editorial staff with any questions or suggestions concerning the newsletter. We look forward to receiving your feedback: newsletter.emea@pentaxmedical.com
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