New Recommendations, Quality Indicators for Colonoscopy Released

The latest recommendations on quality indicators for colonoscopy were released on August 22, 2024, by the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE).¹ The new outlines highlight important aspects of colonoscopy that need to be measured in order to give patients getting a colonoscopy the highest quality screening for colorectal cancer (CRC).

CRC is the second leading cause of cancer death in the US, with more than 150,000 patients diagnosed and treated for the cancer. However, CRC is a preventable cancer, as early detection can mean a good prognosis for many patients. Although an estimated 50,000 people will die from CRC this year, approximately 64% of those deaths could be prevented through screening.

New guidelines indicate how best to perform colonoscopies for CRC screening | Image credit: romaset - stock.adobe.com

Colonoscopy is the primary source of screening for CRC and is the first-line treatment for many doctors. Research shows that incidence and mortality due to CRC have decreased when colonoscopies are performed in patients on a regular basis. Patients who have had colonoscopy screening were found to have a 31% reduction in the incidence of CRC and a 50% reduction in mortality due to CRC compared with patients who did not undergo screening.² Timely colonoscopies also can be beneficial for patients in the long term, as long as important factors are considered when doctors perform the procedures.

The updated guidelines were first introduced in 2006 and revised in 2015 following the release of new research. The authors of the guidelines are physician leaders in gastroenterology who are working to define what factors of endoscopy indicate its quality. Over the last 18 years, these factors have been used to assess the patterns of care compared with best practices.

Priority quality indicators are emphasized in the new guidelines, with importance placed on determining and measuring such indicators. These priority indicators were created to help highlight important factors that will be given focus in the future, in order to address time, cost, and staffing constraints that plague hospitals nationwide. Colonoscopists are encouraged to measure all indicators, but priority indicators are deemed essential to measure to understand any deficiencies in performance that could lead to critical outcomes.

All guidelines are separated into preprocedure, intraprocedure, and postprocedure quality indicators. The new guidelines highlight several priority indicators for colonoscopy, which include adenoma detection rate (ADR), sessile serrated lesion detection rate, rate of using recommended screening and surveillance intervals, cecal intubation rate, and bowel preparation adequacy rate. Of these, only sessile serrated lesion detection rate and bowel preparation adequacy rate are new priority indicators.

“ADR plays a critical role in evaluating the performance of the colonoscopists. It is recommended that ADR calculations include screening, surveillance, and diagnostic colonoscopy but exclude indications of a positive noncolonoscopy screening test and therapeutic procedures for resection or treatment of known neoplasia, genetic cancer syndromes, and inflammatory bowel disease,” Douglas K. Rex, MD, MACG, MASGE, the lead author of the guidelines, said in a press release.¹

The new guidelines for colonoscopies will act as a method to making sure that colonoscopies are done at the highest level and don’t lead to major discrepancies in what should be included and what measurements should be taken during a colonoscopy. Following the new guidelines should provide all patients with the highest quality colonoscopy that will best screen them for CRC.

References

1. ASGE and ACG release updated quality indicators for colonoscopy. News release. News release. ASGE. August 21, 2024. Accessed August 22, 2024. https://www.asge.org/home/about-asge/newsroom/news-list/2024/08/21/asge-and-acg-release-updated-quality-indicators-for-colonoscopy

2. Rex DK, Anderson JC, Betterly LF, et al. Quality indicators for colonoscopy. Am J Gastroenterol. Published online August 21, 2024. doi:10.14309/ajg.0000000000002972