Improving Quality and Safety in the Endoscopy Unit (Virtual) | October 2024-ASGE ACG QI for colonoscopy 2024

ASGE ACG QI for colonoscopy 2024

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The document highlights the importance of quality indicators for colonoscopy, which is crucial in colorectal cancer (CRC) prevention. Colonoscopy is extensively used in the U.S. for CRC screening and other diagnostic purposes, including surveillance after CRC resection, screening in individuals with a family history of CRC, and dysplasia surveillance in ulcerative and Crohn's colitis. Evidence shows that colonoscopy significantly reduces CRC incidence and mortality, particularly in the left colon.<br /><br />The quality of colonoscopy outcomes is highly dependent on the operator’s skill, leading to variability in detecting precancerous lesions. This variability initiated a movement by gastroenterology societies to improve the consistency and quality of colonoscopy performance. The American Society for Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) have developed updated recommendations to enhance colonoscopy quality, focusing on specific indicators.<br /><br />Key quality indicators include adenoma detection rate (ADR), sessile serrated lesion detection, bowel preparation adequacy, and cecal intubation rate (CIR). These indicators are chosen based on their clinical relevance, evidence of varied performance among practitioners, and the feasibility of measurement. High ADR correlates with a decrease in the risk of post-colonoscopy CRC. Thus, continuous quality measurement and improvement efforts are essential. The document also details pre-, intra-, and post-procedure quality indicators, emphasizing the significance of measuring outcomes like lesion resection competency and managing adverse events efficiently.<br /><br />For inflammatory bowel disease (IBD) patients, specific quality indicators include documentation of disease extent and activity, using scores like the Mayo Endoscopic Score for ulcerative colitis and the Crohn's Disease Endoscopic Index of Severity for Crohn's disease. Post-procedurally, appropriate surveillance intervals are recommended based on patient risk factors.<br /><br />Overall, the document underscores the need for consistent measurement and adherence to quality benchmarks to enhance colonoscopy effectiveness, thereby improving CRC outcomes and ensuring patient safety.

Keywords

colonoscopy

colorectal cancer prevention

quality indicators

adenoma detection rate

American Society for Gastrointestinal Endoscopy

American College of Gastroenterology

inflammatory bowel disease

bowel preparation adequacy

surveillance intervals

operator skill variability