Introduction Adenoma detection rate (ADR) is the most widely used contemporaneous measure of colonoscopy quality. Low ADRs are associated with higher post colonoscopy colorectal cancer rates and poorer patient outcomes.1 A study implementing a “bundle” of evidence-based interventions demonstrated practice change and ADR improvement driven by improvements amongst the poorest performing colonoscopists.2 Interventions were: withdrawal time ≥6 min; hyoscine butylbromide use; position change; rectal retroflexion. We assessed whether practice change and ADR improvements were sustained 3 years following intervention.
Method Data were collected from the original study sites, including ADR and hyoscine butylbromide use (marker of bundle uptake). Comparisons were made with baseline data collected for 3 months prior to bundle implementation and for a duration of 9 months following completion. Sustainability data were collected for 6 months, 3 years following implementation. Data were compared globally, by endoscopy unit and by quartile, where colonoscopists were ranked by baseline ADR. Multilevel logistic regression analyses were undertaken.
Results 12 endoscopy units housed within 8 UK NHS Trusts participated. Global analyses included data from a total of 184 colonoscopists and 28 615 procedures. Quartile analyses included data from 50 colonoscopists and 14 435 procedures. Hyoscine butylbromide use rose and was sustained above baseline globally in all units and quartiles. A sustained ADR increase (18.2%) was observed globally. Quartile analyses demonstrated that improvement was most marked in the lowest colonoscopist quartile (Table 1).
Conclusion A simple, evidence-based intervention changed colonoscopy practice and improved ADR. These effects were sustained 3 years following implementation, suggesting this approach is a feasible and durable means of improving ADR with minimal resources.
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. Rajasekhar PT, et al. Endoscopy2015;47(3):217–24.
Disclosure of Interest None Declared
- colonoscopy quality