Kwaliteitsindicatoren voor coloscopie

Objective

To compare quality indicators for colonoscopy between different endoscopists at a large community hospital in order to assess the quality of care and the need for structural implementation of quality measurement.

Design

Retrospective, descriptive.

Method

Data were analysed from all colonoscopies performed by 5 experienced endoscopists (4 gastroenterologists, 1 internist) during the period November 2008-April 2009. For each endoscopist, the percentage of colonoscopies in which the caecum was intubated was established and the adenoma detection rate (ADR) scored. The ADR is the percentage of colonoscopies in which at least 1 adenomatous polyp is found. A comparison between endoscopists was performed thereafter.

Results

A total of 1006 colonoscopies had been performed of which 700 were included. Mean patient age was 61 years (SD: 16). The caecal intubation rate ranged between 88-97% and was statistically significantly different between the endoscopists (p = 0.045). The ADR for all polyps also differed significantly between endoscopists (p < 0.01). Similar differences were found when only large polyps (> 15 mm) were counted. An age of more than 50 years and caecal intubation were independently associated with a greater chance of polyp detection, with odds ratios of 4.3 (95%-CI: 2.8-6.8) and 2.6 (95%-CI: 1.5-4.6), respectively.

Conclusion

Great variation in quality indicators for colonoscopy was found between endoscopists at a large community hospital. The outcome of this study stresses the need for structural implementation of transparent and measurable quality indicators for colonoscopy.

Conflict of interest: the institute where M.G.H. van Oijen is employed has received research grants and payment for consultancy from AstraZeneca, Pfizer and Janssen. Financial support for this publication: none declared.