Implementation of a program to improve the quality of colonoscopy increases the neoplasia detection rate: a prospective study

Background and study aims: Endoscopists worldwide have been encouraged to report quality indicators in order to evaluate their performance. We aimed to determine whether a program to improve the quality of colonoscopy results in better rates of neoplasia detection. Patients and methods: This is a prospective study set in a private endoscopy center. From May 2009 to March 2010, we evaluated 1573 consecutive colonoscopies (group 1). After the implementation of a quality program, from February 2011 to January 2012, we prospectively evaluated 1583 colonoscopies (group 2). Our quality-enhancing intervention consisted of instructing both patients and endoscopists. We measured the cecal intubation rate and the neoplasia detection rate. Overall neoplasias, high-risk adenomas, carcinomas, right colon adenomas, and adenomas detected in screening studies were analyzed. Results: Cecal intubation was documented in 1384 cases from group 1 (88%) and 1534 from group 2 (96.9%) (P<0.0001). The neoplasia detection rates in groups 1 and 2 were, respectively: neoplasias 288 (18.3%) and 427 (27%) (P<0.0001), high-risk adenomas 76 (4.8%) and 142 (9%) (P<0.0001), carcinomas 16 (1%) and 21 (1.3%) (P=0.52), right colon adenomas 112 (7.1%) and 154 (9.7%) (P=0.01), and adenomas 141 (16.5%) and 233 (28%) (P<0.0001). Conclusions: Implementation of a quality program improves the neoplasia detection rate. Because of the small number of cancerous lesions found in both groups, we were unable to identify differences in the carcinoma detection rate.