Guideline for Colonoscopy Quality Assurance in Ontario

Guideline Objective

To provide the basis for a quality assurance program for all colonoscopy procedures done in the province of Ontario, including those conducted as part of the fecal occult blood test (FOBT)-based colorectal cancer (CRC) screening program. This guideline is intended to provide recommendations that are based on an up-to-date systematic review of the evidence on the following three key aspects of colonoscopy: training and maintenance of competency for physician endoscopists, institutional quality assurance parameters, and performance indicators for colonoscopy.

Clinical practice recommendations for how to perform colonoscopy or recommendations designed to improve the skill level of individual endoscopists are beyond the scope of this guideline. This Evidence-Based Series (EBS) provides an update to the 2007 PEBC document EBS #15-5 Colonoscopy Standards.

Patient Population

To provide guidance on quality colonoscopy for adult patients undergoing this procedure in Ontario.

Intended Guideline Users

Clinicians involved in the delivery of colonoscopy to patients in Ontario and for policy makers and program planners involved in quality assurance at Cancer Care Ontario and in hospitals and clinics.

Colonoscopy may be performed for a variety of indications, specifically: follow-up to a positive fecal occult blood test, screening for those who have a family history of colorectal cancer in a first-degree relative, investigation for symptomatic patients, surveillance of those with a history of adenomatous or serrated polyps, inflammatory bowel disease or CRC, and other screening (e.g., average-risk screening).

Research Question(s)

Physician endoscopist training and maintenance of competency

1. What primary training is required for physicians performing colonoscopy?
2. What are the requirements for maintenance of competency for physicians performing colonoscopy?

Institutional quality assurance parameters

What, if any, are acceptable quality assurance parameters for:

• Patient assessment prior to the procedure;
• Infection control, including colonoscope washing procedures and the use of highpowered washers;
• Monitoring during and after the administration of conscious sedation;
• Resuscitation capability;
• Acceptable endoscope quality.

Colonoscopy quality indicators and auditable outcomes

What, if any, are appropriate targets for the following indicators of quality colonoscopy?

• Adenoma detection rate (ADR);
• Polypectomy rate (PR);
• Cecal intubation rate (CIR);
• Colonoscope withdrawal time;
• Bowel preparation;
• Postcolonoscopy colorectal cancer (PCCRC);
• Bleeding rate after polypectomy;
• Perforation rates.