Brief Article
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World J Gastroenterol. Jul 21, 2012; 18(27): 3551-3557
Published online Jul 21, 2012. doi: 10.3748/wjg.v18.i27.3551
Quality audit of colonoscopy reports amongst patients screened or surveilled for colorectal neoplasia
Daphnée Beaulieu, Alan Barkun, Myriam Martel
Daphnée Beaulieu, Alan Barkun, Myriam Martel, Division of Gastroenterology, The McGill University Health Center, McGill University, Montreal H3G 1A4, Canada
Alan Barkun, Clinical Epidemiology, the McGill University Health Center, McGill University, Montreal H3G 1A4, Canada
Author contributions: Beaulieu D, Barkun A and Martel M contributed to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content and made the final approval of the version to be published.
Supported by The Research Scholar (Chercheur National) of the Fonds de la Recherche en Santé du Québec
Correspondence to: Dr. Alan Barkun, MD, CM, FRCP(C), FACP, FACG, FAGA, MSc (Clinical Epidemiology), Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital site, 1650 cedar Avenue, room D7-346, Montréal H3G 1A4, Canada. alan.barkun@muhc.mcgill.ca
Telephone: +51-4-9348309 Fax: +51-4-8348531
Received: September 26, 2011
Revised: March 9, 2012
Accepted: May 6, 2012
Published online: July 21, 2012
Abstract

AIM: To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable.

METHODS: Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional database providing pathological results. Required documentation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a standardized glossary with 10% independent data validation. Sample size calculations determined the number of reports needed.

RESULTS: Two hundreds and fifty patients (63.2 ± 10.5 years, female: 42.8%, average risk: 38.5%, personal/family history of CRN: 43.3%/20.2%) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice: 17.1 ± 8.5 years). Procedural indication and informed consent were always documented. 14% provided a previous colonoscopy date (past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness). Most procedural indicators were recorded (exam date: 98.4%, medications: 99.2%, difficulty level: 98.8%, prep quality: 99.6%). All reports noted extent of visualization (cecum: 94.4%, with landmarks noted in 78.8% - photodocumentation: 67.2%). No procedural times were recorded. One hundred and eleven had polyps (44.4%) with anatomic location noted in 99.1%, size in 65.8%, morphology in 62.2%; removal was by cold biopsy in 25.2% (cold snare: 18%, snare cautery: 31.5%, unrecorded: 20.7%), 84.7% were retrieved. Adenomas were noted in 24.8% (advanced adenomas: 7.6%, cancer: 0.4%) in this population with varying previous colonic investigations.

CONCLUSION: This audit reveals lacking reported items, justifying additional research to optimize quality of reporting.

Keywords: Colonic-disorders; Endoscopy-general; Oncology-clinical; Colonoscopy; Endoscopic reporting system