Safety domain summary
| Domain | Safety |
|---|---|
| Objective | To maximise the safety of endoscopic therapy |
| KPI |
|
| Denominator | Include all patients with LNPCPs undergoing endotherapy |
| Numerator | Patients with LNPCPs undergoing endotherapy who present with a perforation (definite or probable) within 30 days of endotherapy |
| Analysis | Calculate at patient level (not at LNPCP level)Report as percentage (proportion of patients) |
| Frequency | Calculate annually. As these are rare events, calculating the rates over longer periods of time may be useful |
| Level of analysis | Service and individual colonoscopist level |
| Minimum standard | EMR Perforation: <2%; PPB: <5% ESD Perforation and PPB: no current standard defined |
| Aspirational standard | EMR Perforation: <0.5%; PPB: no current standard defined ESD Perforation and PPB: no current standard defined |
| Action | Qualitative review of each case |
| Evidence | Supporting evidence—perforation: Rutter et al25 Rabeneck et al26 Nivatongs198 NHS BCSP Publication36 Supporting evidence for standards—perforation: Lee et al7 Moss et al9 Buchner et al31 Longcroft-Wheaton et al29 Supporting evidence—post-procedure bleeding: Metz et al22 Sawhney et al104 NHS BCSP Publication36 Supporting evidence—post-procedure bleeding standards: Lee et al7 Moss et al9 Buchner et al31 |
BCSP, Bowel Cancer Screening Programme; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; KPI, key performance indicators; LNPCPs, large non-pedunculated colorectal polyps; NHS, National Health Service; PPB, post-procedure bleeding.