Introduction Colonoscopy is the gold standard assessment for large bowel mucosal pathology, but a complete examination is an essential requirement. The first national colonoscopy audit carried out in 1999 demonstrated caecal intubation rates (CIRs) of 56.9%, which the authors described as “unacceptably low”. As a result the Joint Advisory Group on Gastrointestinal endoscopy (JAG) launched a programme of continuous quality improvement by standardising training, peer review and audit. JAG recommends practitioners undertake at least 100 procedures per annum with target CIRs of 90%. This current audit provides an assessment of performance against these quality standards.
Methods Data were collected from all procedures undertaken in 2008–2009 from six hospitals across three English regions. The data included grade and specialism of operator, number of procedures and CIRs. Caecal intubation was recorded if reports positively documented reaching defined landmarks.
Results 16 064 colonoscopies performed with a CIR of 90.57% (95% CI 90.11% to 91.01%). Operators doing 100+ procedures per annum. CIR=91.76% (95% CI 91.24% to 92.25%). Operators doing <100 procedures per annum=87.77% (95% CI 86.82% to 88.67%). Gastroenterologists=91.01% (95% CI 90.32% to 91.70%). Surgeons=91.03% (95% CI 90.27% to 91.79%). Others practitioners=81.51% (95% CI 78.79% to 84.22%). Bowel cancer screening colonoscopies=97.71% (95% CI 97.07% to 98.34%). Non-screening colonoscopies=88.31% (95% CI 87.68% to 88.94%).
Conclusion This audit of 16 064 colonoscopies over three regions demonstrates aggregated achievement of the CIR quality standard, which is evidence of the effects of improvements in training and the implementation of standards Introduced by JAG since the 1999 national audit of colonoscopy. There is however a significant performance gap when comparing BCSP colonoscopists with non-screening colonoscopists and the CIR of >90% is supported by the volume of BCS colonoscopy work load (BCSP colonoscopies should be considered the new “gold standard”). Endoscopists performing low volume colonoscopy (<100 procedures per annum) and non-GI practitioners have a CIR (including the 95% CIs) of <90%. Endoscopists and/or non-GI practitioners with low volume practice who does not meet the quality standards should engage in skills augmentation plus further training and increase the numbers of procedures performed with local mentorship, or stop performing colonoscopy.
Competing interests None declared.
References 1. Bowles CJ, Leicester R, Romaya C, et al. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut 2004;53:277–83.