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Quality of colonoscopy in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy)
  1. Manuel Zorzi1,
  2. Carlo Senore2,
  3. Filippo Da Re3,
  4. Alessandra Barca4,
  5. Luigina Ada Bonelli5,
  6. Renato Cannizzaro6,
  7. Renato Fasoli7,
  8. Lucia Di Furia8,
  9. Emilio Di Giulio9,
  10. Paola Mantellini10,
  11. Carlo Naldoni11,
  12. Romano Sassatelli12,
  13. Douglas Rex13,
  14. Cesare Hassan14,
  15. Marco Zappa15,
  16. the Equipe Working Group
    1. 1Registro Tumori del Veneto, Padova, Italy
    2. 2CPO Piemonte and San Giovanni Battista University Hospital, Turin, Turin, Italy
    3. 3Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venice, Italy
    4. 4Regione Lazio, Rome, Italy
    5. 5SS Prevenzione Secondaria e Screening, IRCCS AOU San Martino-IST, Genova, Italy
    6. 6Department of Oncological Gastroenterology, National Cancer Institute, IRCCS, Centro di Riferimento Oncologico, Aviano, Italy
    7. 7U.O. multizonale di Gastroenterologia, Ospedale S. Chiara, Trento, Italy
    8. 8Agenzia Regionale Sanitaria, Regione Marche, Ancona, Italy
    9. 9Endoscopia Digestiva, Università di Roma “Sapienza”, Azienda Ospedaliera Sant'Andrea, Rome, Italy
    10. 10Department of Clinical Epidemiology, Cancer Prevention and Research Institute (ISPO), Florence, Italy
    11. 11Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy
    12. 12Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova—IRCCS, Reggio Emilia, Italy
    13. 13Indiana University School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
    14. 14Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy, Rome, Italy
    15. 15SS Valutazione Screening, Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
    1. Correspondence to Dr Manuel Zorzi, Veneto Tumour Registry, Passaggio Gaudenzio 1, Padova (PD) 35131, Italy; manuel.zorzi{at}


    Objectives To assess variation in the main colonoscopy quality indicators in organised colorectal cancer (CRC) screening programmes based on faecal immunochemical test (FIT).

    Design Data from a case-series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected. The adenoma detection rate (ADR) and caecal intubation rate (CIR) were assessed for the whole population and the individual endoscopists. To explore variation in the quality indicators, multilevel analyses were performed according to patient/centre/endoscopist characteristics.

    Results We analysed 75 569 (mean age: 61.3 years; men: 57%) colonoscopies for positive FIT performed by 479 endoscopists in 79 centres. ADR ranged from 13.5% to 75% among endoscopists (mean: 44.8%). ADR was associated with gastroenterology specialty (OR: 0.87 for others, 95% CI 0.76 to 0.96) and, at the endoscopy centre level, with the routine use of sedation (OR: 0.80 if occasional (<33%); 95% CI 0.64 to 1.00) and availability of screening-dedicated sessions (OR: 1.35; 95% CI 1.11 to 1.66). CIR ranged between 58.8% and 100% (mean: 93.1%). Independent predictors of CIR at the endoscopist level were the yearly number of screening colonoscopies performed (OR: 1.51 for endoscopists with >600 colonoscopies; 95% CI 1.11 to 2.04) and, at the endoscopy centre level, screening-dedicated sessions (OR: 2.18; 95% CI 1.24 to 3.83) and higher rates of sedation (OR: 0.47 if occasional; 95% CI 0.24 to 0.92).

    Conclusions The quality of colonoscopy was affected by patient-related, endoscopist-related and centre-related characteristics. Policies addressing organisational issues should improve the quality of colonoscopy in our programme and similar programmes.


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