Subscribe to RSS
DOI: 10.1055/s-1999-54
Quality Assurance and Colonoscopy
Publication History
Publication Date:
31 December 1999 (online)
![](https://www.thieme-connect.de/media/endoscopy/199907/lookinside/thumbnails/10.1055-s-1999-54-1.jpg)
Background and Study Aims: Little is known concerning the usefulness and feasibility of quality assurance programs in gastrointestinal departments. The aim of this study was to identify the indicators of quality in colonoscopy, to check their use in clinical practice, and to identify their threshold values.
Materials and Methods: A prospective study was performed in four endoscopic units. In the first phase, a questionnaire was used to identify the indicators that were considered important and easy to record; in the second phase, the selected items were prospectively recorded.
Results: Data from 603 colonoscopies were evaluated. The selected indicators were: rate of cecal intubation, rate of examinations with normal findings, rates of complications, appropriateness of indications, use of a washing machine for disinfection, duration of the disin-fection procedure, rate of procedures repeated due to poor colon cleansing, rate of operative procedures, length of waiting time, rate of procedures performed for follow-up of known disease, experience of the operator, and rate of procedures performed with the patient under conscious sedation. A striking difference emerged between the technical standards at three centers, which were fairly good, and the standard at the fourth center, which was less satisfactory. The length of the waiting time was high in all centers, as well as the rate of examinations conducted with an inappropriate indication. The rate of procedures performed under conscious sedation varied widely between the centers.
Conclusions: The study of the indicators of quality of colonoscopy is feasible and easy to perform in clinical practice, and can be useful for quality assurance programs.
References
- 1 Schroeder KW. Quality assurance in gastrointestinal endoscopy. Endosc Clin N Am. 1993; 3 571-580
-
2 American Society for Gastrointestinal Endoscopy Standards of Practice Committee.
Quality assurance of gastrointestinal endoscopy. Manchester, MA; ASGE, 1988 -
3 Lombardia SIED, Minoli G, Comin U, et al.
Identificazione di alcuni indicatori di qualità in endoscopia digestiva. In: Atti XV. Congresso Nazionale della Società di Endoscopia Digestiva. Bologna; Monduzzi, 1993: 33-39 - 4 Hogan WJ. Hospital credentialing standards for physicians who perform endoscopies. Gastroenterology. 1993; 104 1563-1565
- 5 American Society for Gastrointestinal Endoscopy Standards of Training and Practice Committee. Methods of granting hospital privileges to perform gastrointestinal endoscopy. Gastrointest Endosc. 1992; 38 765-767
- 6 Sapienza PE, Levine GM, Pomerantz S, et al. Impact of a quality assurance program on gastrointestinal endoscopy. Gastroenterology. 1992; 102 387-393
- 7 Mai HD, Sanowsky RA, Waring JP. Improved patient care using the ASGE guidelines on quality assurance: a prospective comparative study. Gastrointest Endosc. 1991; 37 597-599
- 8 Hsu CW, Imperiale TF. Metaanalysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation. Gastrointest Endosc. 1998; 48 276-282
- 9 Hogan WJ. What constitutes endoscopic competence?. Gastroenterology. 1993; 104 1564-1565
- 10 Cass OW, Freeman ML, Peine CJ, et al. Objective evaluation of endoscopy skills during training. Ann Intern Med. 1993; 118 40-44
-
11 American Society for Gastrointestinal Endoscopy.
Methods of granting hospital privileges to perform gastrointestinal endoscopy. Manchester, MA; ASGE (ASGE publication 1012), 1992 - 12 European Board of Gastroenterology. Specialist training in gastroenterology in the European Community: the case for the European Boards. Gut. 1994; 35 135-138
-
13 Union Européenne des Médecins Spécialistes (UEMS) Specialist Section, Gastroenterology/European Board of Gastroenterology.
Charter on training of medical specialists in the EU: requirements for the specialty gastroenterology. Brussels; UEMS, 1995 - 14 Chak A, Cooper GS, Blades EW, Canto M, Sivak MV. Prospective assessment of colonoscopic intubation skills in trainees. Gastrointest Endosc. 1996; 44 54-57
-
15 Keefe BK, Schrock TR.
Complications of gastrointestinal endoscopy. In: Sleisenger MH, Fordtran JS. Gastrointestinal disease. Philadelphia; Saunders, 1993 5th ed.: 301-308 - 16 Minoli G, Prada A, Gambetta G, et al. The AGSE guidelines for the appropriate use of upper gastrointestinal endoscopy in an open access system. Gastrointest Endosc. 1995; 42 387-389
- 17 Froehlich F, Pache I, Burnand B, et al. Performance of panelbased criteria to evaluate the appropriateness of colonoscopy: a prospective study. Gastrointest Endosc. 1998; 48 128-136
- 18 Keeffe EB, O'Connor KW. 1989 ASGE survey of endoscopic sedation and monitoring practices. Gastrointest Endosc. 1990; 36 S13-S18
- 19 [Anon]. Sedation and monitoring of patients undergoing gastrointestinal endoscopic procedures. Gastrointest Endosc. 1995; 42 626-629
- 20 Bianchi-Porro G, Lazzaroni M. Preparation, premedication and surveillance. Endoscopy. 1992; 24 1-8
- 21 Cataldo PA. Colonoscopy without sedation. Dis Colon Rectum. 1996; 39 257-261
- 22 Phillips MS. Drugs and sedation for colonoscopy. Prim Care. 1995; 22 433-443
- 23 Offman MS, Butler TW, Shraver T. Colonoscopy without sedation. J Clin Gastroenterol. 1998; 26 279-282
- 24 Knapp DA, Michocki RJ, Mays DA. Endoscopists need to clean up their act - literally. Arch Intern Med. 1997; 22 1919-1920
- 25 American Society for Gastrointestinal Endoscopy. Infection control during gastrointestinal endoscopy. Guidelines for clinical application. Gastrointestinal Endoscopy. 1999; 49 836-841
- 26 Tremain SC. Cleaning and disinfection of lower gastrointestinal endoscopes. Prim Care. 1995; 22 471-478
- 27 Kaczmarec RG, Moore RM, McCrohan J, et al. Multistate investigation of the actual disinfection/sterilization of endoscopes in health care facilities. Am J Med. 1992; 92 257-261
- 28 Fraser VJ, Zuckerman G, Clouse RE, et al. A prospective randomized trial comparing manual and automated endoscope disinfection methods. Infect Control Hosp Epidemiol. 1993; 14 383-389
- 29 Van Gossum A, Loriers M, Serruys E, Cremer M. Methods of disinfecting endoscopic material: results of an international survey. Endoscopy. 1989; 21 247-250
G. MinoliM.D.
II Divisione di Medicina
Ospedale Generale di Zona Valduce
Via Dante 11
22100 Como
Italy
Phone: +39-031-308047
Email: gminoli@valduce.it