Published online Dec 16, 2014. doi: 10.4253/wjge.v6.i12.571
Revised: September 21, 2014
Accepted: October 28, 2014
Published online: December 16, 2014
Colonoscopy is the diagnostic modality of choice for investigation of symptoms suspected to be related to the colon and for the detection of polyps and colorectal cancer (CRC). Colonoscopy with removal of detected polyps has been shown to reduce the incidence and mortality of subsequent CRC. In many countries, population screening programs for CRC have been initiated, either by selection of patients for colonoscopy with fecal occult blood testing or by offering colonoscopy directly to average-risk individuals. Several endoscopy societies have formulated quality indicators for colonoscopy. These quality indicators are almost always incorporated as process indicators, rather than outcome measures. This review focuses on the quality indicators bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, patient comfort, sedation and complication rate, and discusses the scientific evidence supporting them, as well as their potential shortcomings and issues that need to be addressed. For instance, there is still no clear and generally accepted definition of adequate bowel preparation, no robust scientific evidence is available supporting a cecal intubation rate ≥ 90% and the association between withdrawal time and occurrence of interval cancers has not been clarified. Adenoma detection rate is currently the only quality indicator that has been shown to be associated with interval colorectal cancer, but as an indicator it does not differentiate between subjects with one or more adenoma detected.
Core tip: Many endoscopy societies have formulated guidelines on quality indicators for colonoscopy, including bowel preparation, cecal intubation rate, withdrawal time and adenoma detection rate. These are mostly consensus-based process indicators, rather than outcome measures. The scientific evidence on which they are based is limited. Adenoma detection rate is currently the only quality indicator that has been shown to be directly associated with interval colorectal cancer, but also has its shortcomings.