Quality indicators for colonoscopy: Current insights and caveats

Table 2 Potential measures to improve performance per quality indicator

Quality indicator	Potential intervention to improve performance	Strength of scientific evidence
Bowel preparation	Split dose bowel preparation Last ingested dose of PEG-solution 3-5 h before colonoscopy	Meta-analysis of randomized controlled trials Observational, prospective studies
Cecal intubation rate	Additional training and use of auxiliary endoscopic instruments (e.g., pediatric colonoscope)	Expert opinion
Adenoma detection rate	Endoscopy nurse participation as a second observer Perform colonoscopy in the morning or in half-day blocks High definition colonoscopy (compared to standard video colonoscopy, marginal effect) Cap-assisted colonoscopy (marginal effect) Third-Eye Retroscope Full Spectrum Endoscopy	Randomized, multicenter studies Retrospective studies Meta-analysis Meta-analysis of randomized controlled trials Randomized, multicenter study Randomized, multicenter study
Complication rate	Cold snaring of small, non-pedunculated polyps may prevent bleeding	Prospective, multicenter, observational study and small single center randomized controlled study
	Submucosal injection with saline and epinephrin prevents immediate bleeding	Randomized study
	Prophylactic placement of a detachable snare around the stalk of a pedunculated polyp prevents bleeding	Randomized studies
	Prophylactic closure of the polypectomy site with metallic clips after removal of large (> 2 cm) sessile or flat lesions may prevent bleeding	Retrospective study