| Popis: |
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the western world. High quality colonoscopy has the potential to reduce CRC mortality by detecting carcinomas in early stages and reduce its incidence by detecting and removing its main precursor lesions, adenomas. Variability in quality of colonoscopy can lead to colonoscopy interval carcinomas; carcinomas that are detected within a proposed surveillance-interval. In an effort to optimize the quality of colonoscopy, several quality indicators have been established. The research reported in this thesis covers a wide range of issues, all related to monitoring and improving the quality of colonoscopy. In chapter 2 we describe the development of a structured colonoscopy reporting system with coded terminology, facilitating quality reports on the cecal intubation rate and adenoma detection rate (ADR). In chapter 3 we assessed the interobserver agreement of the Paris classification of colonic polyps among Western expert endoscopists. In chapter 4 we compared adenoma detection in colonoscopy with the use of an Endocuff, a new endoscope cap, with conventional colonoscopy. Because ADR is known to vary largely among endoscopists, we evaluated whether this variance is already present during colonoscopy training of gastroenterology fellows (GI-fellows) in chapter 5. Research from the last decade suggests that serrated polyps (SPs) are responsible for 15-30% of all CRCs. In chapter 6 we observed a range in detection rates of proximal SPs and relevant SPs among endoscopists. In chapter 7 we evaluated the effect of a lecture-based training course about colonic polyps and polypectomy techniques on polypectomy skills of GI-fellows. |
