| Popis: |
In this project we investigated the quality of colonoscopy in Belgium and calculated post colonoscopy colorectal cancer (PCCRC) as a key quality indicator. In Belgium until now no requirements exist to perform screening colonoscopy. First, we reviewed the literature and listed important quality parameters for colonoscopy. The most important quality parameters are the presence of interval cancer and complications. ADR is a good surrogate quality parameter. Afterwards, we assessed the quality of colonoscopy in Flanders, and performed 2 voluntary surveys among Flemish gastroenterologists. Registration of quality indicators was feasible and that the quality of colonoscopy in daily practice met the international guidelines. However, voluntary self-registration was prone to serious bias (missing data and participation of motivated endoscopists only). Our next step was to assess retrospectively the quality of colonoscopy in Belgium. We relied on the reimbursement numbers. More than 1 million colonoscopies were present in the database spanning 9 years. Polyp detection rate (PDR) was 23.7 % for all colonoscopies in all age groups. We noticed a significant correlation between PDR and the annual volume of colonoscopies. Endoscopist performance varied considerably. Next we calculated post colonoscopy colorectal cancer in Belgium. We calculated a a mean PCCRC rate of 7.6 %. There was a high variation in PCCRC rates between individual physicians and a high inter-hospital variation. Survival analysis beyond 3 years demonstrated that patients with PCCRC have a significantly worse prognosis. Next we analyzed the rate of complications of the performed colonoscopies. We demonstrated that colonoscopy was a safe procedure. Experience is important, complications are more frequent with endoscopists performing less than 299 colonoscopies a year. In the last step we investigated data concerning colorectal related medical procedures performed between 2008-2015 that were linked with data on clinical and pathological staging of colorectal cancer. There was a significant correlation between ADR and the other quality parameters, and a small but significant negatively correlation between PCCRC and the different quality parameters. The lowest PCCRC rate was reached with an ADR of 31.4 %. Further studies are necessary, since serrated lesions have a high miss rate, as well by the endoscopist as by the pathologist. PCCRC-3y was 7.28 % in our last analysis, and didn't decline comparing to the database 2002-2010. PCCRC was found more frequently in younger patients, and occurred more frequently in tumors in the middle and right hemicolon. |
