Improving the quality of endoscopic polypectomy by introducing a colonoscopy quality assurance program

Abstract

Background: Colonoscopy is a routine procedure in patients who present with bowel symptoms. Polyps can be identified and removed during colonoscopy. A colonoscopy quality-assurance program (CQAP) was instituted in 2003.
Aim: The aim of the study was to determine the effect of instituting a CQAP on the quality of endoscopic polypectomy (EP) in our patients.
Patients and methods: An Initial assessment of EP practice in 2003 showed that four patients had polyps. Cecal intubation had been achieved in only two patients and a complete polyp description (CPD) had not been documented. Polypectomy was performed in two patients but the completeness of removal and retrieval of the polyps had not been assessed and histology had not been recorded. A quality improvement process was therefore instituted. This required full colonoscopy to the cecum, CPD and polypectomy to be performed for every polyp. There should be a 90% retrieval rate of all excised polyps and follow up of all histology reports. Seventy-six patients were assessed prospectively over the period 2004–2011.
Results: Cecal intubation rates increased from 65% in years 2004–2007 to 90% in years 2008–2011 (t-proportion = 2.4 & CI= 4.7, highly significant). CPD rates increased from 35% to 100% (t-proportion = 6.5 & CI= 12.7,  highly significant). EP rates increased from 59% to 100% (t-proportion = 3.5 & CI= 6.9, highly significant). Percentage of procedures in which all polyps were judged completely removed increased from 41% to 86% (t-proportion = 3.6 & CI= 7, highly significant). Polyp retrieval rates, with retrieval of P90% of all excised polyps, increased from 80% to 92% (t-proportion = 0.87 & CI= 1.7, significant). Polyp histology documentation rates increased from 41% to 88% (t-proportion =3.7 & CI= 7.3, highly significant).
Conclusion: The implementation of a quality assurance and improvement program improved the quality of EP in patients with polyp(s) detected during colonoscopy.

Keywords: Colonoscopy; Polypectomy; Quality assurance; Juvenile polyps