The Quality of Colonoscopy Services—Responsibilities of Referring Clinicians
A Consensus Statement of the Quality Assurance Task Group, National Colorectal Cancer Roundtable
First Online: 12 August 2010 Received: 09 February 2010 Revised: 09 June 2010 Accepted: 18 June 2010 DOI:
10.1007/s11606-010-1446-2 Cite this article as: Fletcher, R.H., Nadel, M.R., Allen, J.I. et al. J GEN INTERN MED (2010) 25: 1230. doi:10.1007/s11606-010-1446-2 Abstract
Primary care clinicians initiate and oversee colorectal screening for their patients, but colonoscopy, a central component of screening programs, is usually performed by consultants. The accuracy and safety of colonoscopy varies among endoscopists, even those with mainstream training and certification. Therefore, it is a primary care responsibility to choose the best available colonoscopy services. A working group of the National Colorectal Cancer Roundtable identified a set of indicators that primary care clinicians can use to assess the quality of colonoscopy services. Quality measures are of actual performance, not training, specialty, or experience alone. The main elements of quality are a complete report, technical competence, and a safe setting for the procedure. We provide explicit criteria that primary care physicians can use when choosing a colonoscopist. Information on quality indicators will be increasingly available with quality improvement efforts within the colonoscopy community and growth in the use of electronic medical records.
KEY WORDS primary care clinicians colorectal screening endoscopist colonoscopist References
Levin B, Lieberman DA, McFarland B, Smith SA, Brooks D, Andrews KS, et al.
Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130–60.
U.S Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force Recommendations Statement. Ann Intern Med. 2008;149(9):627–37.
Successful colorectal cancer screening starts with primary care. Reviews in Gastroenterological Disorders. 2002;2(Suppl 1):S27–34.
Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL.
Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–41.
Cotton PB, Connor P, McGee D, Jowell P, Nickl N, Schutz S, et al.
Colonoscopy: practice variation among 69 hospital-based endoscopists. Gastorintestinal Endoscopy. 2003;57(3):352–7.
Rex DK, Bond JH, Winawer S, Burt LTR, DA RW J, et al. Quality in the technical performance of colonoscopy in the continuous quality improvement process for colonoscopy: Recommendations of the Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002;97(6):1294–308.
Lieberman D, Nadel M, Smith R, Atkin W, Duggirala SB, Fletcher RH, et al.
Standardized colonoscopy reporting and data system (CO-RADS): Report of the Quality Assurance Task Force Group of the National Colorectal Cancer Roundtable. Gastrointestinal Endoscopy. 2007;65(6):757–66.
National Colorectal Cancer Roundtable.
(Accessed June, 2010)
Winawer S, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al.
Guidelines for colonoscopy surveillance after polypectomy: a consensus update of the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.
Mysliweic PA, Brown ML, Klabunde CN, Ransohoff DF. Are clinicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med. 2004;141(4):264–71.
Zauber A, Winawer SJ, Lansdorp-Vogelaar I, van Ballegooijen M, O’Brien MJ.
Effect of initial polypectomy versus surveillance polypectomy on colorectal cancer mortality reduction: micro-simulation modeling of the national Polyp Study. Am J Gastroenterol. 2007;102:S558.
Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G, et al.
Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med. 2000;343(3):162–8.
Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF.
Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med. 2002;346(23):1781–5.
Schoenfeld P, Cash B, Flood A, Dobhan R, Eastone J, Coyle W, et al.
Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med. 2005;352:2061–8.
Regula J, Rupinsky M, Kraszewska E, Polkowsky M, Pachlewski J, Orlowska J, et al.
Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355(18):1863–72.
Aslinia F, Uradomo L, Steele A, Greenwald BD, Raufman J-P.
Quality assessment of colonoscopic cecal intubation: An analysis of 6 years of continuous practice at a university hospital. Am J Gastroenterol. 2006;101:721–31.
Niv Y, Hazazi R, Levi Z, Fraser G.
Screening colonoscopy for colorectal cancer in asymptomatic people: A meta-analysis. Dig Dis Sci. 2008;53(12):3049–54.
NHS Bowel Screening Programme. Accreditation of Screening Colonoscopists. BCSP Implementation Guide No. 3, Version 3, 18 May 2007.
Bowles CJA, Leicester R, Romaya C, Swarbrick E, Williams CB, Epstein O.
A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut. 2004;53:277–83.
Ball JE, Osborne J, Jowett S, Pellen M, Welfare MR.
Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study. BMJ. 2004;329:665–7.
Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, et al.
Colonoscopy miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112(1):24–8.
Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, et al.
Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy. 2008;40(4):284–90.
Kaminski MF, Regula J, Kraszewska E, Polkowski M, et al.
Quality indicators for colonoscopy and risk of interval cancers. N Engl J Med. 2010;362(19):1795–803.
American Gastroenterological Association. The American Gastroenterological Association standards for gastrointestinal endoscopy services. Gastroenterology. 2001;121:440–3.
Sharma VK, Coppola AG, Raufman JP.
A survey of credentialing practices of gastrointestinal endoscopy centers in the United States. J Clin Gastroenterol. 2005;39(6):501–7.
Lee TH, Bodenheimer T, Goroll AH, Starfield B, Treadway K.
Perspective roundtable: redesigning primary care. N Engl J Med. 2008;359(20):e24.
Wilkins T, LeCLair B, Smolkin M, Davies K, Thomas A, Taylor ML, et al.
Screening colonoscopies by primary care clinicians: A meta-analysis. Ann Family Med. 2009;7(1):56–62.
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