title: Quality of colonoscopy in an emerging country: A prospective, multicentre study in Russia.
abstract: BACKGROUND
  The quality of colonoscopy has been related to a higher risk of interval cancer, and this issue has been addressed extensively in developed countries. The aim of our study was to explore the main quality indicators of colonoscopy in a large emerging country.
  
  
  METHODS
  Consecutive patients referred for colonoscopy in 14 centres were prospectively included between July and October 2014. Before colonoscopy, several clinical and demographic variables were collected. Main quality indicators (i.e. caecal intubation rate, (advanced) adenoma detection rate, rate of adequate cleansing and sedation) were collected. Data were analysed atper patientandper centrelevel (only for those with at least 100 cases). Factors associated with caecal intubation rate and adenoma detection rate were explored at multivariate analysis.
  
  
  RESULTS
  A total of 8829 (males: 35%; mean age: 57 + 14 years) patients were included, with 11 centres enrolling at least 100 patients. Screening (including non-alarm symptoms) accounted for 59% (5188/8829) of the indications. Sedation and split preparation were used in 26% (2294/8829) and 25% (2187/8829) of the patients. Caecal intubation was achieved in 7616 patients (86%), and it was ≥85% in 8/11 (73%) centres. Adenoma detection rate was 18% (1550/8829), and it was higher than 20% in five (45%) centres, whilst it was lower than 10% in four (33%) centres. At multivariate analysis, age (OR: 1.020, 95% CI: 1.015-1.024), male sex (OR: 1.2, 95% CI: 1.1-1.3), alarm symptoms (OR: 1.8, 95% CI: 1.7-2), split preparation (OR: 1.4, 95% CI: 1.2-1.6), caecal intubation rate (OR: 1.6, 95% CI: 1.3-1.9) and withdrawal time measurement (OR: 1.2, 95% CI: 1.6-2.1) were predictors of a higher adenoma detection rate, while adequate preparation (OR: 3.4: 95% CI: 2.9-3.9) and sedation (OR: 1.3; 95% CI: 1.1-1.6) were the strongest predictors of caecal intubation rate.
  
  
  CONCLUSIONS
  According to our study, there is a substantial intercentre variability in the main quality indicators. Overall, the caecal intubation rate appears to be acceptable in most centres, whilst the overall level of adenoma detection appears low, with less than half of the centres being higher than 20%. Educational and quality assurance programs, including higher rates of sedation and split regimen of preparation, may be necessary to increase the key quality indicators.
authors.affiliation: Mariinsky Hospital, St Petersburg, Russia.
authors.forename: Mariya
authors.initials: M
authors.lastname: Antipova
authors.affiliation: European Clinic, Moscow, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Burdyukov
authors.affiliation: Clinical Regional Hospital after prof. Ochapovsky, Krasnodar, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Bykov
authors.affiliation: Municipal Clinical Hospital n. 50, Moscow, Russia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Domarev
authors.affiliation: Moscow University Hospital n. 31, Moscow, Russia.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Fedorov
authors.affiliation: Regional Clinical Hospital n. 2, Krasnodar, Russia.
authors.forename: Sergey
authors.initials: S
authors.lastname: Gabriel
authors.affiliation: Municipal Clinical Hospital n. 15, n.n. O.M. Filatov, Moscow, Russia.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Glebov
authors.affiliation: Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia.
authors.forename: Sergey
authors.initials: S
authors.lastname: Kashin
authors.affiliation: Federal Medical Enterprise Polyclinic n. 2 of the Ministry of Economic Development, Moscow, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Knyazev
authors.affiliation: Municipal Clinical Hospital n. 29, Novokuznetsk, Russia.
authors.forename: Aleksey
authors.initials: A
authors.lastname: Korotkevich
authors.affiliation: Municipal Clinical Hospital n. 15, n.n. O.M. Filatov, Moscow, Russia.
authors.forename: Andrey
authors.initials: A
authors.lastname: Kotovsky
authors.affiliation: Samara Regional Cancer Center, Samara, Russia.
authors.forename: Irina
authors.initials: I
authors.lastname: Kruglova
authors.affiliation: Regional Clinical Hospital n. 2, Krasnodar, Russia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Krushelnitsky
authors.affiliation: Moscow University Hospital n. 31, Moscow, Russia.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Mayat
authors.affiliation: Kemerovo Regional Hospital, Kemerovo, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Merzlyakov
authors.affiliation: State Scientific Centre of Coloprovtology, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Mtvralashvili
authors.affiliation: Consultative Diagnostic Center 'Vivea', Khabarovsk, Russia.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Pyrkh
authors.affiliation: Medical Care Unit n. 41 of the Federal Biomedical Agency, Glazov, Udmurtia, Russia.
authors.forename: Oleg
authors.initials: O
authors.lastname: Sannikov
authors.affiliation: Municipal Clinical Hospital n. 50, Moscow, Russia.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Shitikov
authors.affiliation: Hospital n. 13, Nizhny, Novgorod, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Subbotin
authors.affiliation: Clinical Regional Hospital after prof. Ochapovsky, Krasnodar, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Taran
authors.affiliation: State Scientific Centre of Coloprovtology, Russia.
authors.forename: Viktor
authors.initials: V
authors.lastname: Veselov
authors.affiliation: Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Zavyalov
authors.affiliation: Humanitas Institute, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Valduce Hospital, Como, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.affiliation: Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.affiliation: Humanitas Institute and Humanitas University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.affiliation: Mariinsky Hospital, St Petersburg, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Korolev
keywords: Quality; adenoma detection rate; caecal intubation rate; colonoscopy; screening