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United European Gastroenterol J. 2016 Feb;4(1):110-20. doi: 10.1177/2050640615570147. Epub 2015 Feb 5.

Time trends in quality indicators of colonoscopy.

Author information

1
Department of Medicine, Telemark Hospital, Skien, Norway.
2
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
3
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
4
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
5
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Departments of Epidemiology and Biostatistics; Harvard School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA; Cancer Registry of Norway, Oslo, Norway.
6
Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
7
Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway.
8
Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway.
9
Department of Medicine, Østfold Hospital, Frederikstad, Norway.
10
Department of Medicine, Telemark Hospital, Skien, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway; Cancer Registry of Norway, Oslo, Norway.

Abstract

BACKGROUND:

There is considerable variation in the quality of colonoscopy performance. The Norwegian quality assurance programme Gastronet registers outpatient colonoscopies performed in Norwegian endoscopy centres. The aim of Gastronet is long-term improvement of endoscopist and centre performance by annual feedback of performance data.

OBJECTIVE:

The objective of this article is to perform an analysis of trends of quality indicators for colonoscopy in Gastronet.

METHODS:

This prospective cohort study included 73,522 outpatient colonoscopies from 73 endoscopists at 25 endoscopy centres from 2003 to 2012. We used multivariate logistic regression with adjustment for relevant variables to determine annual trends of three performance indicators: caecum intubation rate, pain during the procedure, and detection rate of polyps ≥5 mm.

RESULTS:

The proportion of severely painful colonoscopies decreased from 14.8% to 9.2% (relative risk reduction of 38%; OR = 0.92 per year in Gastronet; 95% CI 0.86-1.00; p = 0.045). Caecal intubation (OR = 0.99; 95% CI 0.94-1.04; p = 0.6) and polyp detection (OR = 1.03; 95% CI 0.99-1.07; p = 0.15) remained unchanged during the study period.

CONCLUSIONS:

Pain at colonoscopy showed a significant decrease during years of Gastronet participation while caecal intubation and polyp detection remained unchanged - independent of the use of sedation and/or analgesics and level of endoscopist experience. This may be due to the Gastronet audit, but effects of improved endoscopy technology cannot be excluded.

KEYWORDS:

Abdominal pain; caecum intubation rate; colonoscopy; polyp detection rate; quality assurance; quality indicator

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