Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period
- Ajay Mark Verma1,
- Nadine McGrath1,
- Paula Bennett2,
- John de Caestecker3,
- Andrew Dixon1,
- Jayne Eaden2,
- Peter Wurm3,
- Andrew Chilton1
- 1Department of Gastroenterology, Kettering General Hospital NHS Foundation Trust, Kettering, UK
- 2Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- 3Department of Gastroenterology, University Hospitals Leicester NHS Trust, Leicester, UK
- Correspondence to Dr Ajay Mark Verma, Department of Gastroenterology, Kettering General Hospital NHS Foundation Trust, Kettering NW1 2BU, UK;
Contributors The concept for this audit, analysis and interpretation of data, and co-drafting of the paper was undertaken by Dr Ajay Verma (guarantor). Andrew Chilton co-drafted the paper and gave final approval. Jayne Eaden, John de Caestecker and Peter Wurm contributed to critical revisions of the paper. Data collection was arranged by Nadine McGrath, Andrew Dixon, Paula Bennett, Jayne Eaden, John de Caestecker and Peter Wurm.
- Received 20 January 2012
- Accepted 8 March 2012
- Published Online First 1 May 2012
Objective Colonoscopy is the ‘gold standard’ assessment for large bowel mucosal pathology, but a complete examination is essential. The first national colonoscopy audit carried out in 1999 demonstrated caecal intubation rates (CIRs) of 56.9%. As a result, the Joint Advisory Group (JAG) on gastrointestinal endoscopy launched a programme of continuous quality improvement. JAG recommends that practitioners undertake 100+ procedures per annum with a target CIR of 90%. This current audit provides an assessment of performance against this quality standard.
Design Data were collected from all procedures undertaken in 2008–2009 from six hospitals across three English regions.
Results 16064 colonoscopies performed: CIR = 90.57% (95% CI 90.11% to 91.01%). Operators doing 100+ procedures per annum, CIR=91.76% (91.24% to 92.25%). Operators doing <100 procedures per annum, CIR=87.77% (86.82% to 88.67%). Gastroenterologists, CIR=91.01% (90.32% to 91.70%). Surgeons, CIR=91.03% (90.27% to 91.79%). Other practitioners, CIR=81.51% (78.79% to 84.22%). Bowel cancer screening programme (BCSP) colonoscopies, CIR=97.71% (97.07% to 98.34%). Non-screening colonoscopies, CIR=88.31% (95% CI 87.68% to 88.94%).
Conclusion This audit of 16064 colonoscopies across three regions demonstrates aggregated achievement of the CIR quality standard. However, there is a significant performance gap when comparing BCSP colonoscopists with non-screening colonoscopists and the overall CIR of >90% is supported by the volume of BCSP colonoscopy.
Endoscopists performing low volume colonoscopy (<100 per annum), have CIR of <90%. Endoscopists with low volume practice who do not meet the quality standards should engage in skills augmentation plus further training and increase volume of colonoscopy with local mentorship, or stop performing colonoscopy.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.