Current Colorectal Cancer Reports

, Volume 6, Issue 1, pp 38–43 | Cite as

Quality Criteria for a Good Screening Colonoscopy



Screening for bowel cancer has been shown to reduce mortality from colorectal cancer by up to 15%. Colonoscopy is the key investigation, not only for diagnosis but also for removal of precancerous polyps. Hence, the quality of screening colonoscopy is of paramount importance for a successful screening program. In this article, we discuss the criteria that serve as benchmarks for a good screening colonoscopy, taking into account procedural details, colonoscopist skills, and accreditation.


Colonoscopy Bowel cancer Screening Quality criteria 


Papers of particular interest, published recently, have been highlighted as:• Of importance •• Of major importance

  1. 1.
    Yoshimi I, Kaneko S: Comparison of cancer mortality (rectal cancer) in five countries: France, Italy, Japan, UK and USA from WHO mortality database (1960–2000). Jpn J Clin Oncol 2005, 35:224–227.CrossRefPubMedGoogle Scholar
  2. 2.
    Hol L, Van Leerdam ME, Van Ballegooijen M, et al.: Screening for colorectal cancer; randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 2009 Aug 10 (Epub ahead of print).Google Scholar
  3. 3.
    Levin B, Lieberman DA, McFarland B, 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, 58:130–160.CrossRefPubMedGoogle Scholar
  4. 4.
    Mandel JS, Bond JH, Church TR, et al.: Reducing mortality from colorectal cancer by screening for faecal occult blood. N Engl J Med 1993, 328:1365–1371.CrossRefPubMedGoogle Scholar
  5. 5.
    Hardcastle JD, Chamberlain JO, Robinson MH, et al.: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996, 348:1472–1477.CrossRefPubMedGoogle Scholar
  6. 6.
    Kronberg O, Fenger C, Olsen J, et al.: Randomised study of screening for colorectal cancer with faecal occult blood test. Lancet 1996, 348:1467–1471.CrossRefGoogle Scholar
  7. 7.
    Becker F, Nusko G, Welke J, et al.: Benefit-risk analysis of different risk-related surveillance schedules following colorectal polypectomy. Hepatogastroenterology 2007, 54:2249–2258.PubMedGoogle Scholar
  8. 8.
    Rex DK, Petrini JL, Baron TH, et al.: Quality indicators for colonoscopy. Am J Gastroenterol 2006, 101:873–885.PubMedGoogle Scholar
  9. 9.
    Joint Advisory Group on Gastrointestinal Endoscopy (JAG): Guidelines for the training, appraisal and assessment of trainees in gastrointestinal endoscopy. Available at Accessed June 2009.
  10. 10.
    Neary P, Cahill RA, Kirwan WO, et al.: What a signature adds to the consent process. Surg Endosc 2008, 22:2698–2704.CrossRefPubMedGoogle Scholar
  11. 11.
    Coombes JM, Steiner JF, Bekelman DB, et al.: Clinical outcomes associated with attempts to educate patients about lower endoscopy: a narrative review. J Community Heath 2008, 33:149–157.CrossRefGoogle Scholar
  12. 12.
    Radaelli F, Menucci G, Teruzzi V, et al.: Single bolus of midazolam versus bolus midazolam plus meperidine for colonoscopy. A prospective randomised, double blind trial. Gastrointest Endosc 2003, 57:329–335.CrossRefPubMedGoogle Scholar
  13. 13.
    Heuss LT, Drewe J, Schnieper P, et al.: Patient controlled versus nurse administered sedation with propofol during colonoscopy. A prospective randomized trial. Am J Gastroenterol 2004, 99:511–518.CrossRefPubMedGoogle Scholar
  14. 14.
    Liao WC, Chiu HM, Chen CC, et al.: A prospective evaluation of the feasibility of primary screening with unsedated colonoscopy. Gastrointest Endosc 2009, 70:724–731.CrossRefPubMedGoogle Scholar
  15. 15.
    Petrini JL, Egan JV, Hahn WV: Unsedated colonoscopy: patient characteristics and satisfaction in a community-based endoscopy unit. Gastrointest Endosc 2009, 69:567–572.CrossRefPubMedGoogle Scholar
  16. 16.
    Bretthauer M, Lynge AB, Thiis-Evenson E, et al.: Carbon dioxide insufflation in colonoscopy: safe and effective in sedated patients. Endoscopy 2005, 37:706–709.CrossRefPubMedGoogle Scholar
  17. 17.
    Wong JC, Yau KK, Cheung HY, et al.: Towards painless colonoscopy: a randomized controlled trial on carbon dioxide-insufflating colonoscopy. ANZ J Surg 2008, 78:871–874.CrossRefPubMedGoogle Scholar
  18. 18.
    Wexner SD, Forde KA, Sellers G, et al.: How well can surgeons perform colonoscopy? Surg Endosc 1998, 12:1410–1414.CrossRefPubMedGoogle Scholar
  19. 19.
    Wexner SD, Garbus JE, Singh JJ: The SAGES Colonoscopy Outcomes Study Group: A prospective analysis of 13,580 colonoscopies. Reevaluation of credentialing guidelines. Surg Endosc 2001, 15:251–261.CrossRefPubMedGoogle Scholar
  20. 20.
    Edwards JK, Norris TE: Colonoscopy in rural communities: can family physicians perform the procedure with safe and efficacious results? J Am Board Fam Pract 2004, 17:3553–3558.CrossRefGoogle Scholar
  21. 21.
    Saito Y, Fukuzawa M, Matsuda T, et al.: Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc Jun 2009 (Epub ahead of print).Google Scholar
  22. 22.
    Barclay RL, Vicari JJ, Doughty AS, et al.: Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006, 355:2533–2541.CrossRefPubMedGoogle Scholar
  23. 23.
    •• Simmons DT, Harewood GC, Baron TH, et al.: Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time. Aliment Pharmacol Ther 2007, 24:965–971. This study, along with the older one by Barclay et al. [22], has been used as a benchmark in the assessment of the quality of withdrawal and correlation with mucosal visualization during colonoscopy.Google Scholar
  24. 24.
    Barkun A, Chiba N, Enns R, et al.: Commonly used preparations for colonoscopy: efficacy, tolerability and safety—a Canadian Association of Gastroenterology position paper. Can J Gastroenterol 2006, 20:699–710.PubMedGoogle Scholar
  25. 25.
    NHS National Patient Safety Agency: Rapid response report NPSA/2009/RRR012: reducing risk of harm from oral bowel cleansing solutions. Available at Accessed October 2009.
  26. 26.
    Froehlich F, Wietlisbach V, Gonvers J, et al.: Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005, 61:378–384.CrossRefPubMedGoogle Scholar
  27. 27.
    Harewood GC, Sharma VK, de Garmo P: Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003, 58:76–79.CrossRefPubMedGoogle Scholar
  28. 28.
    East JE, Suzuki N, Arebi N, et al.: Position changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial. Gastrointest Endosc 2007, 65:263–269.CrossRefPubMedGoogle Scholar
  29. 29.
    Harrison M, Singh N, Rex DK: Impact of proximal colon retroflexion on adenoma miss rates. Am J Gastroenterol 2004, 99:519–522.CrossRefPubMedGoogle Scholar
  30. 30.
    East JE, Stavrindis M, Thomas-Gibson S, et al.: A comparative study of standard vs high definition colonoscopy for adenoma and hyperplastic polyp detection with optimized withdrawal technique. Aliment Pharmacol Ther 2008, 28:768–776.CrossRefPubMedGoogle Scholar
  31. 31.
    Huneberg R, Lammert F, Rabe C, et al.: Chromocolonoscopy detects more adenomas than white light colonoscopy or narrow band imaging in hereditary nonpolyposis colorectal cancer screening. Endoscopy 2009, 41:316–322.CrossRefGoogle Scholar
  32. 32.
    Brown SR, Baraza W, Hurlstone P: Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum. Cochrane Database Syst Rev 2007, CD006439.Google Scholar
  33. 33.
    Togashi K, Hewett DG, Radford-Smith GL, et al.: The use of indigocarmine spray increases the colonoscopic detection rate of adenomas. J Gastroenterol 2009, 44:826–833.CrossRefPubMedGoogle Scholar
  34. 34.
    Park SY, Lee SK, Kim BC, et al.: Efficacy of chromoendoscopy with indigocarmine for the detection of ascending colon and cecum lesions. Scand J Gastroenterol 2008, 43:878–885.CrossRefPubMedGoogle Scholar
  35. 35.
    Adler A, Pohl H, Papanikolau IS, et al.: A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect? Gut 2008, 57:59–64.CrossRefPubMedGoogle Scholar
  36. 36.
    Katagiri A, Fu KI, Sano Y, et al.: Narrow band imaging with magnifying colonoscopy as a diagnostic tool for predicting histology of early colorectal neoplasia. Aliment Pharmacol Ther 2008, 27:1269–1274.PubMedCrossRefGoogle Scholar
  37. 37.
    Shaukat A, Oancea C, Bond JH, et al.: Variation in detection of adenomas and polyps by colonoscopy and change over time with a performance improvement program. Clin Gastroenterol Hepatol 2009 Aug 7 (Epub ahead of print).Google Scholar
  38. 38.
    Rex DK, Bond JH, Winawer S, et al.: Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2002, 97:1296–1308.CrossRefPubMedGoogle Scholar
  39. 39.
    Rex DK, Cutler CS, Lemmel GT, et al.: Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997, 112:24–28.CrossRefPubMedGoogle Scholar
  40. 40.
    Leaper M, Johnston MJ, Barclay M, et al.: Reasons for failure to diagnose colorectal carcinoma at colonoscopy. Endoscopy 2004, 36:499–503.CrossRefPubMedGoogle Scholar
  41. 41.
    Garbay JR, Suc B, Rotman N, et al.: Multicentre study of surgical complications of colonoscopy. Br J Surg 1996, 83:42–44.CrossRefPubMedGoogle Scholar
  42. 42.
    Minoli G, Meucci G, Prada A, et al.: Quality assurance and colonoscopy. Endoscopy 1999, 31:522–527.CrossRefPubMedGoogle Scholar
  43. 43.
    Regula J, Rupinski M, Krawzewska E, et al.: Colonoscopy in colorectal cancer screening for detection of advanced neoplasia. N Engl J Med 2006, 355:1863–1872.CrossRefPubMedGoogle Scholar
  44. 44.
    Zubarik R, Fleischer DE, Mastropietro C, et al.: Prospective analysis of complications 30 days after outpatient colonoscopy. Gastrointest Endosc 1999, 50:322–328.CrossRefPubMedGoogle Scholar
  45. 45.
    Rabeneck L, Paszat LF, Hilsden RJ, et al.: Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008, 135:1899–1906.CrossRefPubMedGoogle Scholar
  46. 46.
    Fu KI, Sano Y, Kato S, et al.: Chromoendoscopy using indigo carmine dye spraying with magnifying observation is the most reliable method for differential diagnosis between non-neoplastic and neoplastic colorectal lesions: a prospective study. Endoscopy 2004, 36:1089–1093.CrossRefPubMedGoogle Scholar
  47. 47.
    Matsuda T, Fujii T, Saito Y, et al.: Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008, 103:2700–2706.CrossRefPubMedGoogle Scholar
  48. 48.
    •• Swan MP, Bourke MJ, Alexander S, et al.: Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service. Gastrointest Endosc 2009 Sep 11 (Epub ahead of print). This is an interesting study assessing the clinical and economic impact of advanced endoscopic therapy.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Nottingham Digestive Diseases Center, National Institute for Health Research Biomedical Research Unit, Queens Medical Centre CampusNottingham University Hospitals National Health Service TrustNottinghamUK

Personalised recommendations