Evaluation of Colonoscopic Procedures Performed in A University Hospital According to International Standards

Abstract

Aim: Colonoscopy continues to be the most dependable technique for early detection of colorectal cancer, one of the most prevalent cancers globally. To enhance the effectiveness of colonoscopic procedures, various international quality benchmarks have been established. This study aimed to assess whether colonoscopies conducted at the Endoscopy Unit of the Gastroenterology Clinic at Fırat University Hospital met internationally recognized quality standards. Material and Method: This retrospective study analyzed 2,805 colonoscopy procedures performed between 2015 August and 2019 January. International quality indicators were used for evaluation. Due to the lack of recorded procedure times prior to November 2018, the data were categorized into two periods: 2015 August –2018 October and 2018 November –2019 January. Results: From August 2015 to October 2018, the adenoma detection rate was 36% in males and was 26.4% in females. From November 2018 to January 2019, the adenoma detection rate (ADR) increased to 27.5% in females and 43% in males. The cecal intubation rate was 82% in the earlier period and rose slightly to 84.4% in the latter. Sedation was administered in 91.4% of procedures during the first period and in 98% during the second. Procedure duration, recorded only in the latter period, averaged 13.6 minutes. Conclusion: The ADR observed in this study align with international benchmarks; however, cecal intubation and colorectal cancer detection rates were below the recommended standards. These findings indicate that procedural improvements are necessary to meet international quality criteria more consistently.

Keywords

• Colonoscopy
• colorectal cancer
• polyp
• adenoma detection rate
• quality indicators

Kaynakça

1. Xi Y, Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Transl Oncol. 2021;14:101174.
2. Murphy N, Moreno V, Hughes DJ, et al. Lifestyle and dietary environmental factors in colorectal cancer susceptibility. Mol Asp Med. 2019;69:2-9.
3. Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16:713-32.
4. Lewandowska A, Rudzki G, Lewandowski T, et al. Risk factors for the diagnosis of colorectal cancer. Cancer Control. 2022;29:10732748211056692.
5. Roselló S, Simón S, Cervantes A. Programmed colorectal cancer screening decreases incidence and mortality. Transl Gastroenterol Hepatol. 2019;4:84.
6. Young PE, Womeldorph CM. Colonoscopy for colorectal cancer screening. J Cancer. 2013;4:217-26.
7. Barkun A, Chiba N, Enns R, et al. Commonly used preparations for colonoscopy: efficacy, tolerability, and safety-a Canadian Association of Gastroenterology position paper. Can J Gastroenterol. 2006;20:699-710.
8. Pan J, Xin L, Ma YF, et al. Colonoscopy reduces colorectal cancer incidence and mortality in patients with non-malignant findings: a meta-analysis. Am J Gastroenterol. 2016;111:355-65.

9. Pullens HJ, Siersema PD. Quality indicators for colonoscopy: Current insights and caveats. World J Gastrointest Endosc. 2014;6:571-83.
10. Rex DK. Key quality indicators in colonoscopy. Gastroenterol Rep (Oxf). 2023;11:goad009.
11. Binefa G, García M, Milà N, et al. Colonoscopy quality assessment in a mass population screening programme based on faecal occult blood test. Rev Esp Enferm Dig. 2013;105:400-8.
12. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31-53.
13. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977-81.
14. Ross WA, Thirumurthi S, Lynch PM, et al. Detection rates of premalignant polyps during screening colonoscopy: time to revise quality standards?. Gastrointest Endosc. 2015;81:567-74.
15. Rex DK, Petrini JL, Baron TH, et al.; ASGE/ACG taskforce on quality in endoscopy. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873-85.
16. Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795-803.
17. Schottinger JE, Jensen CD, Ghai NR, et al. Association of physician adenoma detection rates with postcolonoscopy colorectal cancer. JAMA. 2022;327:2114-22.
18. Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298-306.
19. Floer M, Biecker E, Fitzlaff R, et al. Higher adenoma detection rates with endocuff-assisted colonoscopy - a randomized controlled multicenter trial. PLoS One. 2014;9:e114267.
20. Coşkun A, Kandemir A. Analysis of colonoscopic polypectomy results. Endoscopy Gastrointestinal. 2017;25:66-9.
21. Solakoğlu T, Atalay R, Köseoğlu H, et al. Analysis of 2222 colorectal polyps in 896 patients: a tertiary referreal hospital study. Turk J Gastroenterol. 2014;25:175-9.
22. Şahintürk Y, Çekin AH. Colon polyps localization, histology, and size - five years colonoscopic research. Endoskopi Gastrointestinal. 2018:26;57-60.
23. Leung FW. Methods of reducing discomfort during colonoscopy. Dig Dis Sci. 2008;53:1462-7.
24. Sonnenberg A. Sedation in colonoscopy. Gastroenterol Hepatol (N Y). 2016;12:327-9.
25. Borsotti E, Barberio B, D'Incà R, et al. Terminal ileum ileoscopy and histology in patients undergoing high-definition colonoscopy with virtual chromoendoscopy for chronic nonbloody diarrhea: A prospective, multicenter study. United European Gastroenterol J. 2019;7:974-81.
26. Zhao S, Deng XL, Wang L, et al. The impact of sedation on quality metrics of colonoscopy: a single-center experience of 48,838 procedures. Int J Colorectal Dis. 2020;35:1155-61.
27. Bannert C, Reinhart K, Dunkler D, et al. Sedation in screening colonoscopy: impact on quality indicators and complications. Am J Gastroenterol. 2012;107:1837-48.
28. Lee TJ, Rees CJ, Blanks RG, et al. Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program. Endoscopy. 2014;46:203-11.
29. Zhao S, Deng XL, Wang L, et al. The impact of sedation on quality metrics of colonoscopy: a single-center experience of 48,838 procedures. Int J Colorectal Dis. 2020;35:1155-61.
30. Cirocco WC, Rusin LC. Confirmation of cecal intubation during colonoscopy. Dis Colon Rectum. 1995;38:402-6.
31. Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonos-copy and death from colorectal cancer. Ann Intern Med. 2009;150:1-8.
32. Chilton A, Rutter M, editors. Quality Assurance Guidelines for Colonoscopy. Sheffield: NHS Cancer Screening Programmes, 2011.
33. Foutch PG, Mai H, Pardy K, et al. Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic, average-risk men. Dig Dis Sci. 1991;36:924-8.
34. Kadakia S, Wrobleski C, Kadakia A, et al. Prevelance of proximal colonic polyps in average-risk asymptomatic patients with negative fecal occult blood tests and flexible sigmoidoscopy. Gastrointest Endosc. 1996;44:112-7.
35. Imperiale T, Wagner D, Lin C, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169-74.
36. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med. 2004;351:2704-14.
37. Kim DH, Lee SY, Choi KS, et al. The usefulness of colonoscopy as a screening test for detecting colorectal polyps. Hepatogastroenterology. 2007;54:2240-2.
38. Alsumait AF, Al-Farsi YM, Waly MI, et al. Hospital prevalence of colorectal cancer among colonoscopy recipients attending a tertiary hospital in oman: a cross-sectional study. ScientificWorldJournal. 2020;2020:5863126.
39. Utku ÖG, Ergül B, Dilek O. Evaluation of colonoscopic and pathological outcomes of patients who have undergone colonoscopy with a positive fecal occult blood screening test. Akademik Gastroenteroloji Dergisi. 2018;17:17-20.
40. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844-57.