ABSTRACT
INTRODUCTION AND AIMS: Colonoscopy quality is measured by the degree in which the examination increases the likelihood of obtaining adequate results on health. Our aim was to develop an instrument for evaluating the quality of screening colonoscopies, taking into account the performance of endoscopists and endoscopy units. MATERIALS AND METHODS: Mixed methodology was employed. The first stage (qualitative) consisted of a Medline search, from which a group of experts developed the quality score items. The second stage (quantitative) utilized a modified Delphi technique to reach consensus (3 rounds). We evaluated the psychometric properties of the instrument (reliability and construct validity) in elective screening colonoscopies (in patients ≥ 50 years of age), performed within the January-April 2017 time frame. RESULTS: A final instrument with 8 items was produced: (1) the Boston Bowel Preparation Scale score; (2) cecal intubation rate; (3) colonoscopy withdrawal time; (4) image documentation; (5) adenoma detection rate; (6) endoscopic surveillance planning; (7) perforation rate, and (8) continuous improvement programs. The instrument was evaluated in 323 colonoscopies performed by 31 endoscopists and found to be one-dimensional and reliable (Cronbach's alpha 0.76). Performance was compared between endoscopists (center 1) and an expert endoscopist from another center (center 2): Boston Bowel Preparation Scale score 8.3 vs. 7.36 (P < .001), cecal intubation rate 93.5 vs. 96%, colonoscopy withdrawal time 14.8 vs. 8.4 min (P < .001), and adenoma detection rate 34 vs. 52.2% (P < .001), respectively. CONCLUSION: The Colonoscopy Quality Score is a reliable and valid instrument for evaluating screening colonoscopy quality. Its results could be adapted to the usual endoscopic report to adjust monitorization frequency post-colonoscopy.
Subject(s)
Adenoma , Colorectal Neoplasms , Adenoma/diagnosis , Cecum , Colonoscopy/methods , Colorectal Neoplasms/diagnosis , Humans , Psychometrics , Reproducibility of ResultsABSTRACT
INTRODUCTION AND AIMS: Colonoscopy quality is measured by the degree in which the examination increases the likelihood of obtaining adequate results on health. Our aim was to develop an instrument for evaluating the quality of screening colonoscopies, taking into account the performance of endoscopists and endoscopy units. MATERIALS AND METHODS: Mixed methodology was employed. The first stage (qualitative) consisted of a Medline search, from which a group of experts developed the quality score items. The second stage (quantitative) utilized a modified Delphi technique to reach consensus (3 rounds). We evaluated the psychometric properties of the instrument (reliability and construct validity) in elective screening colonoscopies (in patients≥50 years of age), performed within the January-April 2017 time frame. RESULTS: A final instrument with 8 items was produced: 1) the Boston Bowel Preparation Scale score; 2) cecal intubation rate; 3) colonoscopy withdrawal time; 4) image documentation; 5) adenoma detection rate; 6) endoscopic surveillance planning; 7) perforation rate, and 8) continuous improvement programs. The instrument was evaluated in 323 colonoscopies performed by 31 endoscopists and found to be one-dimensional and reliable (Cronbach's alpha 0.76). Performance was compared between endoscopists (center 1) and an expert endoscopist from another center (center 2): Boston Bowel Preparation Scale score 8.3 vs. 7.36 (P<.001), cecal intubation rate 93.5 vs. 96%, colonoscopy withdrawal time 14.8 vs. 8.4min (P<.001), and adenoma detection rate 34 vs. 52.2% (P<.001), respectively. CONCLUSION: The Colonoscopy Quality Score is a reliable and valid instrument for evaluating screening colonoscopy quality. Its results could be adapted to the usual endoscopic report to adjust monitorization frequency post-colonoscopy.
Subject(s)
Esophageal Diseases/diagnosis , Lichen Planus/diagnosis , Biopsy , Endosonography , Esophagoscopy , Female , Humans , Middle AgedABSTRACT
El cáncer colorrectal (CCR) es una de las tres primeras causas de muerte por cáncer en nuestro país, con una amplia repercusión socioeconómica. Es por ello que la Comisión Directiva de la Sociedad de Gastroenterología del Uruguay (SGU) consideró oportuno tomar medidas tendientes a disminuir su morbimortalidad. Con este fin se creó en el año 2001 una Comisión que tuvo a su cargo la revisión de los consensos internacionales de diagnóstico precoz y seguimiento del CCR para adecuarlos a nuestro medio. Surgen así las "Recomendaciones de la SGU para la detección precoz y seguimiento del CCR". En ellas se propone aplicar un programa de screening y de seguimiento para CCR, clasificando a la población en 4 grupoos de riesgo en base a la edad, los antecedentes personales y familiares de enfermedades con riesgo aumentado para CCR. La técnica a utilizar en el caso de screening variará de acuerdo al grupo, aunque de ser posible se optará por la fibrocolonoscopía como técnica ideal. El seguimiento se aplica a aquellos pacientes con antecedentes personales de pólipos adenomatosos, CCR o enfermedad inflamatoria intestinal, siendo la fibrocolonoscopía la técnica de elección. Estas recomendaciones fueron puestas a consideración y arbitraje en asamblea extraordinaria de la SGU.
