An analysis of quality in screening colonoscopy

Background: Colonoscopy is the preferred tool in screening programs for the early detection of colorectal cancer. The limitations of colonoscopy – the macroscopic features of some polyps and improper bowel preparation – generate the risk of some abnormalities in the large intestine, including cancer, being overlooked. To analyze the quality of screening colonoscopy performed between 2000 and 2009 by evaluating the frequency of adenomas detected and caecal intubation achieved.
Material and Methods: We examined 1442 participants ages 40–65 years. A day before the colonoscopy, the patients took a cleansing agent based on polyethylene glycol. Most examinations were performed under anaesthetic, with the use of midazolam, a sedative. The degree of bowel preparation was assessed using a 4-degree scale of very good, good, sufficient, and poor.
Results: Caecal intubation was achieved in 1330 cases (92.2%). Adenomas were removed in 125 women (14.2% of the total number of women) and 125 men (22.4% of the total number of men). The caecum was more frequently achieved in men and in those participants whose intestine had been very well or well cleansed, who did not find the preparation bothersome, and who tolerated the examination better. The level of successful cecal intubation and adenoma detection significantly increased over time.
Conclusions: The most important factor influencing the quality of screening colonoscopy is the human factor as regards both the screening examination participants and their attitude towards the examination, in addition to the endoscopist, who should possess sufficient knowledge, experience, and manual ability to perform screening colonoscopy.

Keywords: the quality of colonoscopy, caecal intubation, adenoma detection, screening colonoscopy, colerectal cancer