RESEARCH – September

Quality of colonoscopy at a large endoscopy centre in Estonia


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The incidence of colorectal cancer is rising in Estonia. A fraction of colorectal cancers are diagnosed as interval cancers – the diagnosis of cancer is made within 3-5 years of a colonoscopy. Thus, the quality of the procedure is critical for increasing the proportion of detected lesions. In 2017, the European Association of Gastrointestinal Endoscopy (ESGE) released a document on performance measures for lower gastrointestinal endoscopy.
The aim of this study was to evaluate the quality of colonoscopies performed at East Tallinn Central Hospital in 2020 against the standards set by ESGE. The data gathered for the cross-sectional study was queried from the clinical database at East Tallinn Central Hospital (eHealth®) and included all colonoscopies performed between 01.01.2020 and 31.12.2020. The data queried included referral information, procedure descriptions, and histological diagnosis according to SNOMED.
The analysis showed that colonoscopies performed at East Tallinn Central Hospital met international standards in three major criteria: caecal intubation rate (94.0% (93.0– 94.9), 95% CI), withdrawal time (average 11.8 min (11.5–12.2), 95% CI) and adenoma detection rate (ADR) (3.,3% (32.2–36.4), 95% CI). The quality standard for adequate colon preparation prior to procedure was not met (84.6% (83.2–86.0), 95% CI).
Based on this analysis, East Tallinn Central Hospital implemented a new colonoscopy preparation guide for the inpatient population (adequate preparation 72.9% (68.6–76.9), 95% CI) which includes a splitdose bowel preparation regimen. A followup analysis to evaluate the effect of the new regimen is planned for the first half of 2024.
The quality of bowel preparation for ambulatory patients varied (adequate preparation 88.2% (85.7–88.5), 95% CI) depending on the referring specialist, and was also inadequate. The possible causes were unclear, and a patient survey is planned to improve the measures and to clarify the reasons.