Colonoscopist key performance indicators in patients with a family history of colorectal cancer undergoing surveillance

Benjamin Norton1,2, James Coultas2, Thomas Wright2, Rebecca Brown2, Victoria Nicholas2, Kevin Monahan2,3

1Imperial College London, London, United Kingdom. 2West Middlesex University Hospital, London, United Kingdom. 3St Mark’s Hospital, London, United Kingdom

Abstract

Introduction

Patients at hereditary risk of colorectal cancer (CRC) undergo colonoscopic surveillance to reduce CRC incidence and mortality. High quality colonoscopy, measured by key performance indicators (KPIs) may enhance surveillance outcomes. We assessed colonoscopist KPIs in patients at hereditary risk of CRC undergoing surveillance at West Middlesex University Hospital (WMUH).

Methods

Prospective colonoscopic surveillance data among risk-stratified patients was analysed at the Family History of Bowel Cancer Registry at WMUH between 2010-2019. Patient demographics were collated alongside colonoscopist data including adenoma detection rate (ADR), caecal intubation rate (CIR), and polyp recovery rate (PRR). Using linear regression on SPSS software, we compared findings to colonoscopist KPIs in non-surveillance patients.

Results

During surveillance, 752 colonoscopies were performed among 12 colonoscopists. The average ADR across all surveillance colonoscopies was 22.8% (8.6-38.1%) with no significant difference between risk groups. Adequate bowel preparation and CIR across all colonoscopists was 89.2% and 98.0%, respectively. In the non-surveillance cohort ADR was 29.5% (13.3-40.7%), CIR 93.5% (78.8-95.7%) and PRR 95.2% (86.9-98.2%). Colonoscopist ADRs during surveillance correlated with both ADRs (R20.738, P<0.01) and PRRs (R20.695, P<0.01) in non-surveillance cohorts.

Conclusion

ADR is the main indicator of efficacy during colonoscopy and a consistent independent risk factor for interval CRCs. Colonoscopists ADRs in patients undergoing surveillance correlated with their ADRs and PRRs during colonoscopies in a non-surveillance cohort. We suggest all surveillance colonoscopies are performed by endoscopists consistently achieving BSG colonoscopy KPI minimum standards.

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