British Society of Gastroenterology National Evaluation of Colonoscopy Quality: Findings from the National Endoscopy Database.

Abstract

Background and aims: Analysis of national colonoscopy quality using automatically uploaded data from a national database, including exploring performance variation.

Methods: Data on all colonoscopies performed in the UK 01/03/2019-29/02/2020 and recorded in the National Endoscopy Database were analysed. Unadjusted key performance indicators were calculated and proportions of endoscopists achieving national standards were determined. Regression models tested associations between case-mix (patient age, sex, indication) and colonoscopy quality. Endoscopist factors (specialty, annual procedure numbers, withdrawal times) were added to case-mix adjusted models, with results presented as adjusted odds ratios (aOR) with 95% confidence intervals.

Results: 592,764 colonoscopies were analysed. Rates of caecal intubation (93.5%, 95% CI 93.4-93.6), polyp detection (37.3%, 95% CI 37.2-37.4), and moderate/severe patient discomfort (4.8%, 95% CI 4.7-4.8) had all improved since the 2011 national audit (p<0.01 for all). 63.9% of endoscopists met all minimum standards for caecal intubation, polyp detection, and discomfort, but only 46.4% did so among those performing fewer than 100 colonoscopies annually. Overall, surgeons recorded lower caecal intubation and polyp detection rates than gastroenterologists (p<0.01); however, those performing over 100 annual colonoscopies achieved KPIs similar to gastroenterologists. Endoscopists with longer withdrawal times were almost twice as likely to identify polyps (aOR 1.9, 95% CI 1.7-2.2) and detected more large polyps (aOR 1.6, 95% CI 1.3-2.0).

Conclusions: UK colonoscopy quality has improved, yet almost 40% of endoscopists still fell short of minimum standards. Variation in quality was strongly associated with endoscopist procedure volumes; mandating minimum annual procedures and emphasising longer withdrawal times could improve overall quality.