New ACG, ASGE quality indicators for colonoscopy include 3 key updates
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Key takeaways:
- Changes to ADR definition include lowering the age of patient inclusion to 45 years and raising the minimum threshold for performance to 35%.
- Sessile serrated lesion detection rate is a new detection indicator.
Revised quality indicators released by the ACG and ASGE highlight the importance of adenoma and sessile serrated lesion detection rates as well as adequate bowel preparation for improving the technical performance of colonoscopy.
“The last update of the ASGE/ACG quality indicators was in 2015 and a lot of new information has since been published,” Douglas K. Rex, MD, MASGE, MACG, Distinguished Professor Emeritus of Medicine at Indiana University School of Medicine and director of endoscopy at Indiana University Hospital, told Healio.
This document is the third iteration in the series and builds upon previous work by the ASGE/ACG Task Force on Quality Endoscopy, first published in 2006. The revision features updated data on existing quality indicators and introduces new indicators with wide-ranging clinical implications, broken down into pre-, intra- and post-colonoscopy periods.
The task force reached consensus on 15 quality indicators, including three priority updates.
“First, the adenoma detection rate, which has emerged over two decades as the most important predictor of high-quality colonoscopy, has had some changes to its definition,” Rex said. “These changes expand the number of patients eligible for ADR measurement, lower the age for patient inclusion to 45 years to be consistent with new screening guidelines and raise the minimum threshold for acceptable performance.”
The task force recommended expanding ADR calculations to incorporate screening, surveillance and diagnostic colonoscopy but not indications of positive screening tests such as fecal blood tests, multitarget stool DNA or CT colonography. In addition, they recommended a minimum ADR threshold of 35% — 40% in men and 30% in women — and noted that colonoscopists with ADRs below this threshold “are recommended to undertake remedial measures to improve and to achieve acceptable performance.”
According to Rex, the update also includes sessile serrated lesion detection rate as a new detection indicator. “This rate has been shown in several studies to provide information to the ADR regarding how effectively a colonoscopist protects patients from colorectal cancer,” he said.
The task force recommended the sessile serrated lesion detection rate as “the quality indicator of choice,” as it measures the precancerous lesion of greatest interest and is not subject to bias. They recommended a minimum threshold of 6%.
Patients excluded from this measure include those with positive non-colonoscopy screening tests, polyposis, inflammatory bowel disease or colonoscopy for therapy of known neoplasms.
Lastly, “the rate of bowel preparation adequacy for outpatient colonoscopy has been promoted to a priority indicator and the acceptable threshold raised to 90%,” Rex said.
In line with U.S. Multi-Society Task Force recommendations, Rex and colleagues noted that colonoscopy reports should include bowel-preparation descriptors of “adequate,” “excellent” or “good” or record a Boston Bowel Preparation score of at least 2 in each of three colon segments. Screening or surveillance follow-up intervals must also be consistent with existing guidelines to count toward the 90% adherence target.
“These recommendations provide evidence and consensus-based indicators and targets by which practicing colonoscopists can assess how effectively and safely they are providing colonoscopy and colorectal cancer prevention to their patients,” Rex told Healio. “These recommendations are detailed and this version, like preceding versions, will stimulate extensive research on the impact of the recommended measurements on patient outcomes, which in turn will inform future updates.”
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