Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2018; 24(9): 1013-1021
Published online Mar 7, 2018. doi: 10.3748/wjg.v24.i9.1013
Quality indicators in pediatric colonoscopy in a low-volume center: Implications for training
Way-Seah Lee, Chun-Wei Tee, Zhong-Lin Koay, Tat-Seng Wong, Fatimah Zahraq, Hee-Wei Foo, Sik-Yong Ong, Shin-Yee Wong, Ruey-Terng Ng
Way-Seah Lee, Chun-Wei Tee, Zhong-Lin Koay, Tat-Seng Wong, Fatimah Zahraq, Hee-Wei Foo, Sik-Yong Ong, Shin-Yee Wong, Ruey-Terng Ng, Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia
Way-Seah Lee, Paediatric and Child Health Research Group, University Malaya, Kuala Lumpur 50603, Malaysia
Author contributions: Lee WS conceived the idea of the research; Lee WS, Ng RT, Ong SY and Foo HW provided the clinical data; Tee CW, Koay ZL, Wong TS and Zahraq F collected the data; Wong SY performed the statistical analysis; Lee WS and Tee CW analyzed the data; Lee WS wrote the first draft; All authors contributed equally to writing of the final draft; All authors authorized the final version of the manuscript.
Supported by Research grant from Ministry of Higher Education, Malaysia, No. UM.C/625/HIR/MOHE/CHAN/13/1.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the University Malaya Medical Centre (MEC reference: 902.15).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis performed used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Way-Seah Lee, MBBS, FRCPCH, MD, Professor, Department of Paediatrics, Level 9, Women’s and Children’s Block, University Malaya Medical Center, Kuala Lumpur 59100, Malaysia. leews@ummc.edu.my
Telephone: +60-3-79492065 Fax: +60-3-79494704
Received: November 24, 2017
Peer-review started: November 25, 2017
First decision: December 27, 2017
Revised: January 15, 2018
Accepted: January 19, 2018
Article in press: January 19, 2018
Published online: March 7, 2018
Abstract
AIM

To study implications of measuring quality indicators on training and trainees’ performance in pediatric colonoscopy in a low-volume training center.

METHODS

We reviewed retrospectively the performance of pediatric colonoscopies in a training center in Malaysia over 5 years (January 2010-December 2015), benchmarked against five quality indicators: appropriateness of indications, bowel preparations, cecum and ileal examination rates, and complications. The European Society of Gastrointestinal Endoscopy guideline for pediatric endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition training guidelines were used as benchmarks.

RESULTS

Median (± SD) age of 121 children [males = 74 (61.2%)] who had 177 colonoscopies was 7.0 (± 4.6) years. On average, 30 colonoscopies were performed each year (range: 19-58). Except for investigations of abdominal pain (21/177, 17%), indications for colonoscopies were appropriate in the remaining 83%. Bowel preparation was good in 87%. One patient (0.6%) with severe Crohn’s disease had bowel perforation. Cecum examination and ileal intubation rate was 95% and 68.1%. Ileal intubation rate was significantly higher in diagnosing or assessing inflammatory bowel disease (IBD) than non-IBD (72.9% vs 50.0% P = 0.016). Performance of four trainees was consistent throughout the study period. Average cecum and ileal examination rate among trainees were 97% and 77%.

CONCLUSION

Benchmarking against established guidelines helps units with a low-volume of colonoscopies to identify area for further improvement.

Keywords: Pediatric colonoscopies, Quality indicators, Performance

Core tip: Competency in colonoscopy is an essential component in the training for pediatric gastroenterology worldwide. We measured the performance of pediatric colonoscopy from a low-volume training center on quality indicators against established guidelines. The unit, which performed an average of 30 colonoscopies each year, performed well in clear indication for colonoscopy, good bowel preparation, safety and high rate of cecal examination (95%) but needs improvement for ileal intubation (at 68%). Benchmarking against established guidelines helps units with a low volume of colonoscopies to identify area for improvement.