How we can measure quality in colonoscopy?

Table 1 Quality metrics for colonoscopy as proposed by ESGE’s guidelines and BCSP in United Kingdom

When to measure	Outcome to measure	Standard
Pre-procedure	Appropriateness	100% indicated
	Pre-assessment–bowel prep to use	100% of cases
	Patient information	100% of cases
	Awaiting time when positive test	< 4 wk (< 2 wk desirable)
On the day of procedure	Review of comorbidities, check of vital signs	100% on admission
	Informed consent	100% signed
	Decontamination of endoscopes	100% agreement with local policy
	Appropriate function and availability of endoscopes/equipment	100% checked by competent staff
	Equipment for resuscitation and monitoring	100% regular checks
	CO2 insufflation	100% availability
	CIR	> 90% unadjusted
	Use of reversal agents	< 1/500 cases
	Bowel cleansing	good/excellent > 90%
	Patient comfort	NA
	Polyp detection rate	Dependent on case mix
	Polyp retrieval rate	> 90%
	Time of scope withdrawal	> 6 min
	Complication rates	Bleeding < 1/100
		Perforation < 1/1000 (diagnostic)
		< 1/500 (therapeutic)
	Electronically based endoscopy report	100% attached to histology request
	Aftercare plan	100% provided at recovery area
	Time for recovery	NA
Post-procedure	Annual number of procedures/endoscopist	> 150 ( > 300 desirable)
	Adenoma detection rate	> 15% unadjusted to race or gender
	Time of histopathology report	< 15 d post-colonoscopy
	Patient feedback/delayed AEs	100% at 30 d
	Endoscopic Surveillance needed	100% agreement with guidelines

CIR: Caecal intubation rate; AEs: Adverse events; NA: Not available.

Table 2 Groups of patients in whom polyethylene glycol bowel-preparation is considered as safer and thus should be preferred

Candidates for polyethylene glycol bowel preparation for colonoscopy
1GFR < 60 mL/min per 1.73 m2
Electrolyte imbalance
Cardiac failure
Liver cirrhosis
Hypertension with arteriosclerosis
Patients on diuretics
(when cannot be stopped 24 h prior to colonoscopy)
Patients on ACE inhibitors
(when cannot be stopped 72 h prior to colonoscopy)
Patients on NSAIDs
(when cannot be stopped 72 h prior to colonoscopy)

¹Estimated glomular filtration rate (GFR) from serum creatinine concentration. NSAIDs: Nonsteroidal antiinflammatory drugs; ACE: Angiotensin-converting enzyme.