title: Implementation of a program to improve the quality of colonoscopy increases the neoplasia detection rate: a prospective study.
abstract: OBJECTIVE
  Endoscopists worldwide have been encouraged to report quality indicators in order to evaluate their performance. We aimed to determine whether a program to improve the quality of colonoscopy results in better rates of neoplasia detection.
  
  
  METHODS
  This is a prospective study set in a private endoscopy center. From May 2009 to March 2010, we evaluated 1573 consecutive colonoscopies (group 1). After the implementation of a quality program, from February 2011 to January 2012, we prospectively evaluated 1583 colonoscopies (group 2). Our quality-enhancing intervention consisted of instructing both patients and endoscopists. We measured the cecal intubation rate and the neoplasia detection rate. Overall neoplasias, high-risk adenomas, carcinomas, right colon adenomas, and adenomas detected in screening studies were analyzed.
  
  
  RESULTS
  Cecal intubation was documented in 1384 cases from group 1 (88 %) and 1534 from group 2 (96.9 %) (P < 0.0001). The neoplasia detection rates in groups 1 and 2 were, respectively: neoplasias 288 (18.3 %) and 427 (27 %) (P < 0.0001), high-risk adenomas 76 (4.8 %) and 142 (9 %) (P < 0.0001), carcinomas 16 (1 %) and 21 (1.3 %) (P = 0.52), right colon adenomas 112 (7.1 %) and 154 (9.7 %) (P = 0.01), and adenomas 141 (16.5 %) and 233 (28 %) (P < 0.0001).
  
  
  CONCLUSIONS
  Implementation of a quality program improves the neoplasia detection rate. Because of the small number of cancerous lesions found in both groups, we were unable to identify differences in the carcinoma detection rate.
authors.affiliation: Centro Integral de Gastroenterología, Buenos Aires, Argentina.
authors.forename: Luis Alberto
authors.initials: LA
authors.lastname: Viola
authors.affiliation: Centro Integral de Gastroenterología, Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Cassella
authors.affiliation: Centro Integral de Gastroenterología, Buenos Aires, Argentina.
authors.forename: Andrés
authors.initials: A
authors.lastname: Wonaga
authors.affiliation: Centro Integral de Gastroenterología, Buenos Aires, Argentina.
authors.forename: Gloria
authors.initials: G
authors.lastname: Arnao Dellamea
authors.affiliation: Centro Integral de Gastroenterología, Buenos Aires, Argentina.
authors.forename: Leandro
authors.initials: L
authors.lastname: Di Paola
authors.affiliation: Centro Integral de Gastroenterología, Buenos Aires, Argentina.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ubeira Salim
authors.affiliation: Centro Integral de Gastroenterología, Buenos Aires, Argentina.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Fernández