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Original research
Quality in colonoscopy: time to ensure national standards are implemented?
  1. Laura J Neilson1,2,3,
  2. Rosie Dew4,
  3. James S Hampton1,
  4. Linda Sharp2,5,
  5. Colin J Rees1,2,3,5
  1. 1 Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
  2. 2 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Northern Region Endoscopy Group, North East England, UK
  4. 4 School of Medicine, University of Sunderland, Sunderland, UK
  5. 5 Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Professor Colin J Rees, South Tyneside and Sunderland NHS Foundation Trust, South Shields NE34 0PL, UK; colin.rees{at}


Background High-quality colonoscopy is crucial to ensure complete mucosal visualisation and to maximise detection of pathology. Previous audits showing variable quality have prompted national and international colonoscopy improvement programmes, including the development of quality assurance standards and key performance indicators (KPIs). The most widely used marker of mucosal visualisation is the adenoma detection rate (ADR), however, histological confirmation is required to calculate this. We explored the relationship between core colonoscopy KPIs.

Methods Data were collected from colonoscopists in eight hospitals in North East England over a 6-month period, as part of a quality improvement study. Procedural information was collected including number of colonoscopies, caecal intubation rate (CIR), ADR and polyp detection rate (PDR). Associations between KPIs and colonoscopy performance were analysed.

Results 9265 colonoscopies performed by 118 endoscopists were included. Mean ADR and PDR per endoscopist were 16.6% (range 0–36.3, SD 7.4) and 27.2% (range 0–57.5, SD 9.3), respectively. Mean number of colonoscopies conducted in 6 months was 78.5 (range 4–334, SD 61). Mean CIR was 91.2% (range 55.5–100, SD 6.6). Total number of colonoscopies and ADR>15% were significantly associated (p=0.04). Undertaking fewer colonoscopies and using hyoscine butylbromide less frequently was significantly associated with ADR<15%. CIR, endoscopist grade, % male patients, mean patient age and CIR were not significantly related to ADR<15%. In adjusted analyses, factors which affected ADR were PDR and mean patient age.

Conclusion Colonoscopists who perform fewer than the nationally stipulated minimum of 100 procedures per year had significantly lower ADRs. This study demonstrates that PDR can be used as a marker of ADR; providing age is also considered.


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  • Contributors All authors contributed to the paper and critically reviewed the manuscript. All authors approved the final manuscript. CJR is the guarantor for the overall content of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CR has received grant funding from ARC medical, Norgine, 3-D Matrix, Medtronic and Olympus medical. He was an expert witness for ARC medical and for Olympus medical. LS is in receipt of project grants from 3-D Matrix and Medtronic. LJN is in receipt of a project grant from Medtronic. None of the remaining authors declare any conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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