title: Improving the Yield of Histological Sampling in Patients With Suspected Colorectal Cancer During Colonoscopy by Introducing a Colonoscopy Quality Assurance Program.
abstract: BACKGROUND
  Masses discovered by clinical examination, imaging or endoscopic studies that are suspicious for malignancy typically require biopsy confirmation before treatment is initiated. Biopsy specimens may fail to yield a definitive diagnosis if the lesion is extensively ulcerated or otherwise necrotic and viable tumor tissue is not obtained on sampling. The diagnostic yield is improved when multiple biopsy samples (BSs) are taken. A colonoscopy quality-assurance program (CQAP) was instituted in 2003 in our institution. The aim of this study was to determine the effect of instituting a CQAP on the yield of histological sampling in patients with suspected colorectal cancer (CRC) during colonoscopy.
  
  
  METHODS
  Initial assessment of colonoscopy practice was performed in 2003. A total of five patients with suspected CRC during colonoscopy were documented in 2003. BSs confirmed CRC in three (60%) patients and were nondiagnostic in two (40%). A quality-improvement process was instituted which required a minimum six BSs with adequate size of the samples from any suspected CRC during colonoscopy. A total of 37 patients for the period 2004-2010 were prospectively assessed.
  
  
  RESULTS
  The diagnosis of CRC was confirmed with histological examination of BSs obtained during colonoscopy in 63% of patients in 2004, 60% in 2005, 50% in 2006, 67% in 2007, 100% in 2008, 67% in 2009 and 100% in 2010. The yield of histological sampling increased significantly (p<0.02) from 61% in 2004-2007 to 92% in 2008-2010.
  
  
  CONCLUSIONS
  The implementation of a quality assurance and improvement program increased the yield of histological sampling in patients with suspected CRC during colonoscopy.
authors.affiliation: Department of Medicine, Bolak Eldakror Hospital, Giza, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Gado
authors.affiliation: Department of Tropical Medicine and Infectious Diseases, Banysweef University, Banysweef, Egypt.
authors.forename: Basel
authors.initials: B
authors.lastname: Ebeid
authors.affiliation: Depertment of Public Health, National Research Center, Giza, Egypt.
authors.forename: Aida
authors.initials: A
authors.lastname: Abdelmohsen
authors.affiliation: Department of Gastroenterology, The General Infirmary at Leeds, Leeds, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Axon
keywords: Biopsy; Colorectal cancer; Yield of histological sampling