Article Text


Endoscopy III
PWE-189 Achieving high quality colonoscopy: using graphical representation to measure performance and reset standards
  1. P T Rajasekhar1,2,
  2. M D Rutter3,
  3. M G Bramble4,
  4. D W Wilson5,
  5. J E East6,
  6. J R Greenaway7,
  7. B P Saunders8,
  8. T J Lee9,
  9. R Barton10,
  10. P Hungin4,
  11. C J Rees2,
  12. The Northern Region Endoscopy Group
  1. 1Department of Gastroenterology, Northern Region Endoscopy Group, Stockton-on-Tees, UK
  2. 2Department of Gastroenterology, South Tyneside Foundation Trust, South Shields, UK
  3. 3Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
  4. 4School of Medicine and Health, Stockton-on-Tees, UK
  5. 5Wolfson Research Institute, Durham University, Stockton-on-Tees, UK
  6. 6Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK
  7. 7Department of Gastroenterology, James Cook University Hospital, Middlesbrough, UK
  8. 8Department of Gastroenterology, St. Mark's Hospital, Harrow, UK
  9. 9Department of Gastroenterology, North Tyneside District Hospital, North Shields, UK
  10. 10Medical Sciences and Education Development, Newcastle University, Newcastle, UK


Introduction The aim of colonoscopy is to examine the colon completely and meticulously looking for malignant and pre-malignant lesions (adenomas). The measure for completeness is the caecal intubation rate (CIR) and for thoroughness the adenoma detection rate (ADR). National Standards (NS) are ≥90% and ≥10% respectively.1 Variability in CIR, ADR and thusly quality, have been shown but comparison between individuals and units is difficult.2 3 We aimed to use graphical representation to assess colonoscopy performance in the North East of England.

Methods Data on colonoscopy performance and sedation use were collected over 3 months from 12 units. Colonoscopies performed by screening colonoscopists were included in the global CIR only. Funnel plots with upper and lower 95% confidence limits (CL) for CIR and ADR were created using the binomial probability distributions for inferences about a single proportion.

Results CIR was 92.5% (n=5720) and ADR 15.9% (n=4748). All units and 128 (99.2%) colonoscopists were above the lower limit for CIR. All units achieved the ADR standard with 10 above the upper limit. Ninety-nine (76.7%) colonoscopists were above 10%, 16 (12.4%) above the upper limit and 7 (5.4%) below the lower limit (Abstract PWE-189 figure 1). Median medication doses were: 2.2 mg midazolam, 29.4 mg pethidine, and 83.3 mg fentanyl. 15.1% of colonoscopies were unsedated. Complications were bleeding (0.10%) and perforation (0.02%). There was 1 death possibly related to bowel preparation.

Abstract PWE-189 Figure 1

Funnel plot showing each colonoscopist's ADR with respect to the NS. CLs calculated relative to the NS.

Conclusion Results indicate colonoscopies are performed safely and to a high standard. Funnel plots can highlight variability and areas for improvement. Analyses of ADR presented graphically around the global mean suggest that the NS should be reset at 15%.

Competing interests None declared.

References 1. The Joint Advisory Group for Gastrointestinal Endoscopy. Guidance for colonoscopy certification and continued practice. Dr Colin Rees and Dr John Painter. 2006.

2. Bowles CJ, Leicester R, Romaya C. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for the national colorectal cancer screening tomorrow? Gut 2004;53:277–83.

3. van Rijn JC, Reitsma JB, Stoker J, et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006;101:343–50.

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