Adoption of colonoscopy quality measures across Europe: the European Colonoscopy Quality Investigation (ECQI) Group experience

We read with interest the paper by Kaminski et al.,¹ who evaluated performance measures for lower gastrointestinal endoscopy, released by the European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. Kaminski et al. recommend that endoscopy services across Europe adopt performance measures in seven domains for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a centre and endoscopist level.

The European Colonoscopy Quality Investigation (ECQI) Group welcomes the provision of information on how best to calculate these measures. The ECQI Group comprises expert colonoscopists and investigators from Europe with the aim of raising colonoscopy standards across Europe. ECQI does not wish to create any particular quality criteria, but rather, document how the recent ESGE guidelines are considered in daily practice and assess the quality of colonoscopy in current clinical practice throughout Europe. At the inaugural meeting of the ECQI Group, convened in 2013, to discuss quality in colonoscopy, the Group recommended that a clinical practice questionnaire be devised to enable colonoscopists to evaluate their own current practice. The online questionnaire was developed with consideration of the ESGE quality standards.² It was validated in November 2014 and May 2015 during two pilot phases, via a collaborative iteration process to ensure pertinent information was being recorded and data on 1861 patient procedures were collected.^3,4

Between June 2016 and April 2017, a further 2094 colonoscopies were documented across 8 European countries by 47 practitioners.⁵ Data recorded in the ECQI database indicate that some important performance measures recommended by ESGE are not currently being achieved in daily practice across Europe. Thus, vital ESGE minimum standards such as ≥90% adequate bowel preparation (defined as Boston Bowel Preparation Scale score ≥6), and ≥90% visualisation of the whole colon are currently not achieved. In this large-scale multicentre audit, only 81% adequate bowel preparation was attained. It was interesting to note that only 55% of practitioners who participated in the ECQI survey routinely recorded caecal intubation rate. Furthermore, for all colonoscopies where the caecum was the intended endpoint, 93% reached the endpoint but only 70% had this endpoint photo-documented. Finally, ESGE recommends that adenoma detection rate (ADR) should be used as a measure of adequate inspection at screening or diagnostic colonoscopy in patients aged 50 years or more. Nevertheless, ADR is routinely recorded by only 18% of practitioners. The ECQI questionnaire is currently being refined to align with the latest performance measures,¹ and the new version should be available in early 2018. These preliminary data suggest that the ECQI questionnaire can provide an efficient method to monitor colonoscopy quality measures at a centre and endoscopist level with the final aim to improve clinical practice standards.

ECQI is exploring cooperation with GIQuIC, the US-based GI Quality Improvement Consortium, which to date includes assessments from 4500 physicians of 5,500,000 colonoscopies.

The online questionnaire is available for completion by any fully qualified colonoscopist at www.ECQIGroup.eu. It should help to establish which quality measures are already in place, and how effective they are in driving standards.