A review of quality metrics in colonoscopy

Colonoscopy is a commonly performed procedure with increasing use across medical specialties including gastroenterology, general surgery, colorectal surgery, and primary care. Over the past several decades, studies have demonstrated variation in colonoscopy quality with regard to adenoma detection rate and missed colorectal cancers among endoscopists within the same specialty and more significantly, across specialties. There is mixed literature suggesting that gastroenterologists may have better adenoma detection rates and colonoscopy completion rates than other specialists including surgeons, possibly related to practice volume and training. In an effort to standardize colonoscopy and improve overall outcomes, the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology Task Force on Quality in Endoscopy (ASGE/ACG) published a list of pre-, intra-, and post-procedure quality metrics in colonoscopy with associated performance targets. Surgeon endoscopists should be prepared to evaluate their performance based on these quality metrics. There is ongoing investigation into various new possible performance metrics in an effort to define exactly which metrics best correlate with clinical outcomes. In addition, the method to most accurately and efficiently document colonoscopy performance metrics and outcomes is not standardized, but the use of video recording especially in the era of the electronic medical record may be of value.