3 ‘undesirable’ trends in GI endoscopy

Some improvement has occurred in gastrointestinal endoscopy quality measures in the last year but there has been deterioration in three clinical indicators, a new report shows.

Released by the Australian Council on Healthcare Standards, the latest clinical indicator report shows there were deteriorations in measures of “aspiration following endoscopy” and “oesophageal dilatation – possible perforation” in the most recent year.

There was also a deterioration for the clinical indicator “failure to reach caecum for any other reason”, the report showed.

The figures that cover up to the end of 2017 are based on data provided by 79 healthcare organisations for clinical indicators introduced in 2006 as a measure of variation in endoscopy quality “to assess and compare the performance of endoscopy, as well as to identify potential areas for improvement.”

The report showed there were improvements in quality indicators for

  • Failure to reach caecum due to instrument failure;
  • Treatment for possible perforation post-polypectomy;
  • Treatment for possible perforation post-colonoscopy;
  • Post-polypectomy haemorrhage.

There was deterioration in the colon cancer detection clinical indicator: “Malignancies diagnosed at Colonoscopy” but this likely reflected poor data validity based on fewer than 200 colonoscopy patients, the report said.

The rate of malignancies diagnosed with colonoscopy slightly declined from 1.2% to 0.9% from 2013 to 2017.

“It is inherently difficult to access previous colonoscopy records, especially those performed at another facility,” the report stated.

“Furthermore, malignancies can occur at any time and over short time frames, so the clinical relevance of malignancies not detected at another colonoscopy within the previous five years is questionable.”

Commenting in the report, GESA representative Associate Professor William Tam noted that adenoma detection rate was to be adopted as a more robust and valuable quality indicator to monitor the efficacy of colonoscopy from 2018 onwards.

“The revised clinical indicator set aims to reflect contemporary GI practice, with the introduction of two new indicators in the areas of ‘Adenoma Detection Rate (ADR)’ and ‘Sedation in Endoscopy’ in 2018,” he wrote.

A revised GI Endoscopy User Manual endorsed by GESA has been released for data collection from January 2019, he added.

The report showed that for aspiration following endoscopy, the rate of patients transferred or admitted for an overnight stay as a result of aspiration had deteriorated from 0.017 to 0.041 per 100 patients over the last eight years. The aggregated rate increased by approximately 1.5 times.

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