Quality in Colonoscopy: Experience in an Endoscopy Center in Boyacá, Colombia
DOI:
https://doi.org/10.52787/agl.v53i1.289Keywords:
Colonoscopy, colonoscopy quality indicators, polyp detection rateAbstract
Introduction. Colorectal cancer ranks the third place in incidence in Colombia by 2020. Screening programs, such as colonoscopy, help to reduce deaths related to colorectal cancer deaths by 18 to 26%. Quality indices can be classified into pre-procedure, trans-procedure and post-procedure. For this reason, all endoscopist and institutions should have quality indicators.
Aim. To evaluate the quality of colonoscopy and its predictors in an outpatient endoscopy center.
Materials and methods. A cross-sectional study in patients over 18 years of age undergoing colonoscopy between February 2017 to March 2022 in a specialized endoscopy center based in Boyacá, Colombia, using a real-time instrument. The polyp detection rate and predictors of colonoscopy quality were determined. Results. 9760 records were collected, the rate of cecal intubation was 94.6%, while the detection rate of polyps was 17.1%. The time of removal of the endoscope (OR: 2.35; 95% CI: 1.92-2.88 p = 0.001), a Boston rating greater than 6 (OR 1.4 95% CI 1.1- 1.7 p < 0.005), sex (OR: 1.42; 95% CI: 1.27-1.59; p = 0.001) and age (OR: 2.24; 95% CI: 1.91-2.4; p = 0.001) were predictors for polyp detection. A Boston rating greater than 6 (OR: 37.8;
95% CI: 29.7-48; p < 0.05), sedation (OR: 7.87; 95% CI: 3.07-20.01; p < 0.05) and age (OR: 1.31; 95% CI: 1.03-1.67; p = 0.026) were predictors for cecal arrival.
Conclusions. Predictors of good quality colonoscopy are good preparation, male sex, age under 60 years and use of sedation.
References
-1. Globocan CC. Colombia fact sheets [Internet]. 2021;509;2020-1 [citado el 15 de noviembre de 2021]. https://gco.iarc.fr/today/data/factsheets/populations/170-colombia-fact-sheets.pdf
-2. Cuenta de alto costo. Situación del cáncer en la población adulta atendida en el SGSSS de Colombia 2020. 2021:1-396. https://cuentadealtocosto.org/site/wp-content/uploads/2021/11/CAC.Co_2021_11_3_Libro_Sit_cancer2020_v5.pdf
-3. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG 2nd, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81(1):31-53. DOI: 10.1016/j.gie.2014.07.058. Epub 2 de diciembre de 2014. PMID: 25480100.
-4. Luis F, Moncayo G. Guías para mejorar la calidad en endoscopía digestiva. Soc Interam Endosc Dig. 2009;1:43.
-5. Gohel TD, Burke CA, Lankaala P, Podugu A, Kiran RP, Thota PN, Lopez R, Sanaka MR. Polypectomy rate: a surrogate for adenoma detection rate varies by colon segment, gender, and endoscopist. Clin Gastroenterol Hepatol. 2014;12(7):1137-42. DOI: 10.1016/j.cgh.2013.11.023. Epub 4 de diciembre de 2013. PMID: 24315881.
-6. Shine R, Bui A, Burgess A. Quality indicators in colonoscopy: an evolving paradigm. ANZ J Surg [Internet]. 2020;90(3):215-21. Disponible en: 10.1111/ans.15775
-7. Otero W, Rodríguez H, Gómez M. Pertinencia de la colonoscopía en dos unidades de gastroenterología de Bogotá, Colombia. Rev Colomb Gastroenterol [Internet]. 2008;23(2):101-10. www.redalyc.org/articulo.oa?id=337731587003
-8. Germán CP, Diego AM, Carlos CO, Carlos G, Carlos GS, Javier PA. A randomized controlled clinical trial of the efficacy and safety of colonoscopy preparation using a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG. Rev Colomb Gastroenterol [Internet]. 2019;34(2):144-51. DOI: 10.22516/25007440.393
-9. Lai EJ, Doros G, Fix OK, Jacobson BC. The Boston bowel preparation scale: A valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc [Internet]. 2009;65(5): AB361. http://dx.doi.org/10.1016/j.gie.2008.05.057
-10. Asociación Médica Mundial. Declaración de Helsinki - Principios éticos para las investigaciones médicas en seres humanos. Asoc Médica Mund [Internet]. 2013;1-8. www.redsamid. net/archivos/201606/2013-declaracion-helsinki-brasil. pdf?1
-11. Ministerio de Salud de Colombia. Resolución 8430 de 1993 [Internet]. Ministerio de Salud Bogotá. 1993. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
-12. Rizk MK, Sawhney MS, Cohen J, Pike IM, Adler DG, Dominitz JA, et al. Quality indicators common to all GI endoscopic procedures. Gastrointest Endosc [Internet]. 2015;81(1):3-16. DOI: 10.1016/j.gie.2014.07.055
-13. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016-30. DOI: 10.1038/ajg.2017.174. Epub 6 de junio de 2017. PMID: 28555630.
-14. Keswani RN, Crockett SD, Calderwood AH. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology [Internet]. 2021;161(2):701-11. https://doi.org/10.1053/j.gastro.2021.05.041
-15. Gómez Rodríguez A, Marrugo Padilla KT. Caracterización clínica y endoscópica de los pacientes llevados a colonoscopía en el Hospital Universitario Samaritana 2017-2018 [Internet]. Universidad del Rosario. 2020. https://repository.urosario.edu.co/handle/10336/20967
-16. Waldmann E, Gessl I, Sallinger D, Jeschek P, Britto-Arias M, Heinze G. Trends in quality of screening colonoscopy in Austria. Endoscopy [Internet]. 2016;48(12):1102-9. DOI: 10.1055/s-0042-113185
-17. Rodríguez JA. Prevalencia de pólipos de colon, adenomas y cáncer colorrectal en pacientes con colonoscopía total de tamización en una institución universitaria de Bogotá. 2018. https://repositorio.unal.edu.co/handle/unal/62905
-18. Portillo I, Idigoras I, Bilbao I, Arana-Arri E, Fernández-Landa MJ, Hurtado JL, Sarasaqueta C, Bujanda L; EUSKOLON study investigators. Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type. Endosc Int Open. 2018;6(9):E1149-E1156. DOI: 10.1055/a-0655-1987. Epub 11 de septiembre de 2018. PMID: 30211306; PMCID: PMC6133681.
-19. Kim SY, Kim HS, Park HJ. Adverse events related to colonoscopy: Global trends and future challenges. World J Gastroenterol [Internet]. 2019;25(2):190-204. DOI: 10.3748/wjg.v25. i2.190
-20. Díaz-Tasende J. Colonoscopía: cuando la calidad importa. Rev Española Enfermedades Dig [Internet]. 2022;114(19):314-6. DOI: 10.17235/reed.2022.8942/2022
-21. Roldán-Molina LF, León-Ramírez SM, Roldán-Delfino LM, Márquez-Molina S, Núñez-Cabarcas EE, Pérez-Useche HM, et al. Can We Use the Indication for a Colonoscopy as a Predictor of the Adenoma Detection Rate? Rev Colomb Gastroenterol [Internet]. 2022;37(1):41-7. DOI: 10.22516/25007440.743
-22. Inra JA, Nayor J, Rosenblatt M, Mutinga M, Reddy SI, Syngal S, Kastrinos F. Comparison of Colonoscopy Quality Measures Across Various Practice Settings and the Impact of Performance Scorecards. Dig Dis Sci. 2017;62(4):894-902. DOI: 10.1007/s10620- 016-4410-0. Epub 19 de diciembre de 2016. PMID: 27995405.
-23. Rembacken B, Hassan C, Riemann JF, Chilton A, Rutter M, Dumonceau JM, et al. Quality in screening colonoscopy: Position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy [Internet]. 2012;44(10):957-68. http://doi.org/10.1055/s-0032-1325686
-24. Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, Kirk LM, Litlin S, Lieberman DA, Waye JD, Church J, Marshall JB, Riddell RH; U.S. Multi-Society Task Force on Colorectal Cancer. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002;97(6):1296-308. DOI: 10.1111/j.1572-0241.2002.05812.x. PMID: 12094842.
-25. Le Clercq CMC, Bouwens MWE, Rondagh EJA, Bakker CM, Keulen ETP, De Ridder RJ, et al. Postcolonoscopy colorectal cancers are preventable: A population-based study. Gut [Internet]. 2014;63(6):957-63. DOI: 10.1136/gutjnl-2013-304880
-26. Anderson R, Burr NE, Valori R. Causes of Post-Colonoscopy Colorectal Cancers Based on World Endoscopy Organization System of Analysis. Gastroenterology [Internet]. 2020;158(5):1287-1299.e2. DOI: 10.1053/j.gastro.2019.12.031
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