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AUDIT OF COLONOSCOPY UTILIZATION IN A TEACHING HOSPITAL IN A FOUR YEAR PERIOD
J Lai, J Louw
GI Division, Hotel Dieu Hospital and Queen’s University, Kingston, Ontario
Background: Colonoscopy is the end point of most screening programs for colorectal cancer. Colonoscopic capacity is limited and should be impacted significantly by screening/surveillance programs.
AIMs: To determine: (i) the impact of colonoscopic screening/surveillance on outpatient colonoscopy utilization over a four year period; (ii) the quality of colonoscopies performed with respect to completion rates and diagnostic yield.
Methods: An anonymized colonoscopic database, recording pre-specified information, was maintained for the period 2003-2006. Data collected included demographics, primary indication, technical aspects of procedure (eg. initiated by trainee or attending staff), cecal intubation rates, findings, and anatomical location of findings. Findings were grouped into 3 categories: carcinoma and/or advanced adenoma (C/AD) (adenomatous polyp >=1cm, or adenoma with villous features), non-advanced adenoma (NAD) (adenomatous polyp <1cm without villous features), and non-precancerous lesions (NPL) (hyperplastic polyps and other lesions, including no abnormal findings). “Indicated for diagnosis” colonoscopies were procedures performed after a positive fecal occult blood test, abnormal barium enema or CT scan, or abnormal flexible sigmoidoscopy. Statistical analysis was performed using SPSS. The study was approved by the Institutional Research Ethics Board.
Results: A total of 4500 colonoscopies were available for analysis. The mean age of patients undergoing colonoscopy was 56.2 years, with 55.8% being females, and 44.2% males. The procedures were performed by indication as follows: indicated for diagnosis 4.6%, screening 28.4%, symptomatic 29.8% and surveillance 37.2%. The most common reason for a screening colonoscopy was a family history of colorectal cancer - 66.1%. The overall cecal intubation rate was 94% with no significant difference between trainee and attending initiated procedures. The overall adenomatous polyp detection rate was 28.2%. Polyp detection rates by colonoscopy indication and polyp category are included in the table. The majority of polyps were found in the rectosigmoid region during screening, with 65.4% of C/AD and 43.3% of NAD found here.
Conclusions: Screening and surveillance is responsible for two-thirds of the endoscopic load in this survey. Adenomatous polyp detection rates (28%) and cecal intubation rates (94%) conform to proposed quality assurance guidelines, and appear not to be influenced by trainee involvement. Polyp detection rates are surprisingly similar for “high risk” and “average risk” indication.
Polyp Detection Rates
| |
Screening |
Screening |
Screening |
|
|
| |
All |
Average Risk |
Fam Hx of Colon Cancer |
Surveillance |
All Colonoscopies |
| All Adenomatous Polyps |
25.9% |
28.8% |
27.5% |
33.2% |
28.2% |
| C/AD |
6.4% |
4.6% |
7.2% |
10.2% |
9.4% |
| NAD |
19.5% |
24.2% |
20.3% |
23.0% |
18.8% |
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