Pre- and post-procedural quality indicators for colonoscopy: A nationwide survey.
BACKGROUND
The provision of high-quality colonoscopy can be assessed by evaluating technical aspects of the procedure and, at individual center level, by comparing structural indicators and institutional policies for managing peri-procedural issues with guideline recommendations.


OBJECTIVE
To assess the colonoscopy quality (CQ) in Italy at center level.


METHODS
Gastroenterologists participating in a nationwide colonoscopy education initiative provided information on structural indicators of their centers and on institutional policies by answering 10 multiple-choice clinical scenarios. Practice variation across centers and compliance with guidelines were analyzed.


RESULTS
Data from 282 Italian centers were evaluated. Overall, a significant proportion of centers did not meet CQ standards as concerns endoscopy facilities and equipments (e.g., dedicated recovery room, dirty-to-clean path, reporting software). CQ assurance programs were implemented in only 25% of centers. Concerning peri-procedural issues, main discrepancies with guidelines were recorded in the underuse of split-dose preparation (routinely adopted by 18% of centers), the routine request of coagulation tests prior to colonoscopy (30%), the routine interruption of aspirin for polypectomy (18%), and the adoption of 3-year surveillance for low-risk adenoma (49%).


CONCLUSIONS
Present survey shows a significant variation in the CQ of endoscopy centers in Italy on many items of colonoscopy practice that should be targeted for future interventions.
Division of Gastroenterology, Valduce Hospital, Como, Italy. Electronic address: silviapagg@gmail.com.
Silvia
S
Paggi
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Arnaldo
A
Amato
Istituto Clinico Humanitas, Gastroenterology and Endoscopy Unit, Milano, Italy.
Andrea
A
Anderloni
Gastroenterology Unit, A.O. Universitaria Careggi, Firenze, Italy.
Vito
V
Annese
Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
Luca
L
Barresi
Department of Oncological Gastrointestinal Surgery, Division of Gastroenterology, S. Maria del Prato Hospital, Feltre, Italy.
Andrea
A
Buda
Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy.
Paola
P
Cesaro
Digestive Endoscopy Unit, Azienda Ospedaliera Sant'Andrea di Roma, Italy.
Emilio
E
Di Giulio
Endoscopy Unit, A.O.U. Policlinico G. Martino, Messina, Italy.
Giuseppe
G
Gullotti
Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy.
Carlo
C
Fabbri
Endoscopy Unit, Istituto Europeo di Oncologia, Milano, Italy.
Giancarla
G
Fiori
Department of Clinical Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
Lorenzo
L
Fuccio
Digestive Endoscopy Unit, AUSL Modena Northern Area, Carpi-Mirandola Hospital, Italy.
Mauro
M
Manno
Division of Gastroenterology, AOU Città della Salute e della Scienza, Torino, Italy.
Alessandro
A
Musso
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Emanuele
E
Rondonotti
Endoscopy Unit, Istituto Europeo di Oncologia, Milano, Italy.
Cristina
C
Trovato
Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Cesare
C
Hassan
Istituto Clinico Humanitas, Gastroenterology and Endoscopy Unit, Milano, Italy; Humanitas University, Milano, Italy.
Alessandro
A
Repici
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Franco
F
Radaelli
D003113:Colonoscopy / Q000592:standards*; D005762:Gastroenterology / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires
Colonoscopy; Practice guidelines; Quality