PTH-010 Cecal withdrawal time: assessing standards of colonoscopy in district general hospital

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The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. However, studies have suggested that high variations in the quality of colonoscopy among different endoscopists are reflected in surrogate measures such as adenoma detection, cecal intubation rates, withdrawal times, and incidence of complications. This documents identifies the unacceptable variation in practice and measures adopted to improve quality of care.


A prospective, observational colonoscopy practice audit was conducted of cecal withdrawal time at Glangwili General Hospital, Carmarthem for patients who presented for colonoscopy between August 2017 to January 2018. Diagnostic procedures were included in the study comprising two cycles 8 months apart. Patients with history of colonic surgery were eliminated. Same endoscopy nurse manually collected the data from 5 different endoscopist using stopwatch without them knowing. Both the cycles were 3 months apart during which different measures were taken to improve withdrawal time including sending individual feedback to endoscopists, one to one discussions between endoscopy consultant lead and involved endoscopist and keeping a timer in endoscopy room to keep tract of time.


We reviewed 10 colonoscopies performed by each endoscopist in each cycle of audit and mean cecal withdrawal time is shown below.


After taking appropriate measure to improve quality of care following results were obtained.


Following graph shows variation in mean withdrawal time between two cycles compared against set standards.


Below shows the comparison of 1 st and 2nd cycle showing rectal retroflexion performed and imaging of cecal landmarks recording done by each endoscopist


Practice among endoscopists varied with majority providing good standard of care. Weak points identified during 1 st stem of audit cycle and changes implemented lead to improvement in quality of care but still there is further room for improvement. Regular audits are important to make sure that colonoscopy practice meets key performance indicators outlined by JAG and BSG in order to increase polyp detection rate.


1. UK key performance indicators and quality assurance standards for colonoscopy -the British Society of Gastroenterology, the Joint Advisory Group on GI Endoscopy, the Association of Coloproctology of Great Britain and Ireland.


2. Point-of-care, peer-comparator colonoscopy practice audit: The Canadian Association of Gastroenterology Quality Program – Endoscopy.

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