Quality indicatorMinimal standardAspirational targetComment
Caecal intubation rate (CIR) (unadjusted)90%95%Photographic proof of ileocaecal valve, terminal ileum, anastomosis or appendix orifice required in all cases
Adenoma detection rate (ADR) in general all patient population (not screening)15%20%ADR is the quality standard. Given the difficulty in reporting ADR then polyp detection rate or polypectomy rate may be used where it has been demonstrated to reflect  accurately ADR for that unit/clinician
Bowel preparation of sufficient diagnostic quality to not warrant repeat or alternative test90%95%
Rectal retroversion rate90%
Colonoscopy withdrawal time (for negative procedures)Mean of ≥6 minMean of ≥10 min
Sedation level for age <70
Median total dose:
≤50 mg pethidine (≤100 μg fentanyl)
≤5 mg midazolam (or equivalent drugs)
Auditable outcome
Sedation level
for age ≥70
Median total dose:
≤25 mg pethidine (≤50 μg fentanyl)
≤2 mg midazolam (or equivalent drugs)
Auditable outcome
Number of colonoscopies undertaken by endoscopist (or directly supervising trainee in room) per year100If numbers <150 then other key performance indicators, eg, CIR and ADR, should be scrutinised more closely and, if concerns, action taken
Polyp retrieval rate≥90%
Tattooing of all lesions ≥20 mm and/or suspicious of cancer outside of rectum and caecumTattoo placed in 100% of casesTattoo according to trust policy
Diagnostic biopsies for unexplained diarrhoeaRectal biopsies taken in 100% of casesRight and left colonic biopsies taken in 100% of casesAspiration should be that a minimum of two right and two left colon biopsies should be taken, but as minimum standard rectal biopsies should always be taken (unless there is a contraindication)
Post-colonoscopy colorectal cancerAuditable outcomeAll post-colonoscopy colorectal cancers diagnosed within 3 years of a colonoscopy should be reported as adverse events and each unit should have a policy for capturing post-colonoscopy colorectal cancer data
Comfort levelAuditable outcomeUnits should audit this and <10% of patients should have moderate or severe discomfort
Overall colonoscopic perforation rate<1 in 1000<1 in 3000
Diagnostic colonoscopic perforation rate<1 in 2000<1 in 4000
Colonoscopic perforation rate where polypectomy performed<1 in 500<1 in 1500
Colonoscopic perforation rate where dilatation performed<3% (<1 in 33)<1% (<1 in 100)
Diagnostic flexible sigmoidoscopy (FS) perforation rate<1 in 5000<1 in 10 000
Colorectal stenting perforation rate<10%<5%
Post-polypectomy bleeding rate (intermediate severity or higher)<1 in 200<1 in 1000
Unplanned admission rateAuditable outcome; review every case
Use of reversal agentsAuditable outcome; review every case
  • Auditable outcome—endoscopy units should audit these measures.

  • Additional recommendations

  • Management of polyps—all units should have a policy for management of polyps including a policy for dealing with large and large sessile polyps.

  • Tattoo policy—all units should have a policy for tattooing of polyps and cancers and should audit whether this is being followed.

  • Rectal examination should be performed at colonoscopy or before endoscopy. All units should audit practice.

  • Terminal ileal intubation—all units should audit practice and agree local policy.