British Society of Gastroenterology national evaluation of colonoscopy quality: findings from the National Endoscopy Database

Abstract

Background and Aims

The aim of this study was to analyze national colonoscopy quality with the use of automatically uploaded data from a national database, including exploring performance variation.

Methods

Data on all colonoscopies performed in the United Kingdom from March 1, 2019, to February 29, 2020, and recorded in the National Endoscopy Database were analyzed. 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 (aORs) with 95% confidence intervals (CIs).

Results

A total of 592,764 colonoscopies were analyzed. Rates of cecal intubation (93.5%; 95% CI, 93.4-93.6), polyp detection (37.3%; 95% CI, 37.2-37.4), and moderate to severe patient discomfort (4.8%; 95% CI, 4.7-4.8) had all improved since the 2011 national audit (P < .01 for all). A total of 63.9% of endoscopists met all minimum standards for cecal intubation, polyp detection, and discomfort, but only 46.4% did so among those performing fewer than 100 colonoscopies annually. Overall, surgeons recorded lower cecal intubation and polyp detection rates than gastroenterologists (P < .01); however, those performing more than 100 annual colonoscopies achieved key performance indicators similarly 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

United Kingdom 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 emphasizing longer withdrawal times could improve overall quality.