The 'ins and outs' of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit
In South Africa, there are no national guidelines for the conduct or quality assessment of colonoscopy, the gold standard for investigation and diagnosis of bowel pathology. To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at t...
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| Veröffentlicht in: | SAMJ: South African Medical Journal 2020-12, Vol.110 (12), p.1186-1190 |
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| creator | Bouter, C Barrow, P Bizos, D Bobat, B Devar, J Harran, N Joseph, C Mahomed, A Oettle, J Ramos, J Seabi, M Kgabage, G Gaylard, P Surridge, D Etheredge, H Fabian, J Lutrin, D Karlsson, K |
| description | In South Africa, there are no national guidelines for the conduct or quality assessment of colonoscopy, the gold standard for investigation and diagnosis of bowel pathology.
To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at the Wits Donald Gordon Medical Centre (WDGMC) outpatient endoscopy unit (OEU).
We conducted a prospective, clinical practice audit of colonoscopies performed on adults (≥18 years of age). A total of 1 643 patients were included in the study and variables that were collected enabled the assessment of adequacy of bowel preparation, length of withdrawal time and calculation of caecal intubation rate (CIR), polyp detection rate (PDR) and adenoma detection rate (ADR). We stratified PDR and ADR by sex, age, population group, withdrawal time and bowel preparation. CIR, PDR and ADR estimates were compared between patient groups by the χ2 test; Fisher's exact test was used for 2 × 2 tables. A p-value |
| doi_str_mv | 10.7196/SAMJ.2020.v110i12.14419 |
| format | Article |
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To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at the Wits Donald Gordon Medical Centre (WDGMC) outpatient endoscopy unit (OEU).
We conducted a prospective, clinical practice audit of colonoscopies performed on adults (≥18 years of age). A total of 1 643 patients were included in the study and variables that were collected enabled the assessment of adequacy of bowel preparation, length of withdrawal time and calculation of caecal intubation rate (CIR), polyp detection rate (PDR) and adenoma detection rate (ADR). We stratified PDR and ADR by sex, age, population group, withdrawal time and bowel preparation. CIR, PDR and ADR estimates were compared between patient groups by the χ2 test; Fisher's exact test was used for 2 × 2 tables. A p-value <0.05 was used. Benchmark recommendations by the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) Task Force on Colorectal Cancer (CRC) were used in this audit to assess individual endoscopist performance and that of the endoscopy unit as a whole.
The mean age of patients was 55.7 (standard deviation (SD) 14.4; range 18 - 91) years, ~60% were female, and the majority (75.5%) were white. Of the outpatients, 77.6% had adequate bowel preparation (ASGE/ACG benchmark ≥85%). The CIR was 97.0% overall, and screening colonoscopy was 96.3% (ASGE/ACG benchmark ≥90% overall and ≥95% for screening colonoscopies). The median withdrawal time for negative-result screening colonoscopies was 5.7 minutes (interquartile range (IQR) 4.2 - 9.3; range 1.1 - 20.6) (ASGE/ACG benchmark ≥ 6minutes), and PDR and ADR were 27.6% and 15.6%, respectively (ASGE/ACG benchmark ADR ≥25%). We demonstrated a 23.7% increase in PDR and 14.1% increase in ADR between scopes that had mean withdrawal times of ≥6 minutes and <6 minutes, respectively. Although the number of black Africans in the study was relatively small, our results showed that they have similar ADRs and PDRs to the white population group, contradicting popular belief.
The WDGMC OEU performed reasonably well against the international guidelines, despite some inadequacy in bowel preparation and lower than recommended median withdrawal times on negative-result colonoscopy. Annual auditing of clinical practice and availability of these data in the public domain will become standard of care, making this audit a baseline for longitudinal observation, assessing the impact of interventions, and contributing to the development of local guidelines.</description><identifier>ISSN: 0256-9574</identifier><identifier>ISSN: 2078-5135</identifier><identifier>EISSN: 2078-5135</identifier><identifier>DOI: 10.7196/SAMJ.2020.v110i12.14419</identifier><identifier>PMID: 33403963</identifier><language>eng</language><publisher>South Africa: Health & Medical Publishing Group</publisher><subject>Adenoma - diagnosis ; Adenoma - epidemiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; Ambulatory surgery ; Benchmarking ; Colonic Polyps - diagnosis ; Colonic Polyps - epidemiology ; Colonoscopy ; Colonoscopy - standards ; Colonoscopy - statistics & numerical data ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - epidemiology ; Early Detection of Cancer - methods ; Female ; Health Care Sciences & Services ; Health Policy & Services ; Humans ; Male ; Mass Screening - methods ; Medical Audit ; Medical Ethics ; Medicine, General & Internal ; Medicine, Legal ; Medicine, Research & Experimental ; Methods ; Middle Aged ; Outpatient Clinics, Hospital ; Practice ; Practice Guidelines as Topic ; Prospective Studies ; Quality Indicators, Health Care ; Quality management ; South Africa ; Young Adult</subject><ispartof>SAMJ: South African Medical Journal, 2020-12, Vol.110 (12), p.1186-1190</ispartof><rights>COPYRIGHT 2020 Health & Medical Publishing Group</rights><rights>This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c515t-23d020faa2c5ada0817190ff90d7649b23b20e1c223627662636da93eb31e1dc3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33403963$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bouter, C</creatorcontrib><creatorcontrib>Barrow, P</creatorcontrib><creatorcontrib>Bizos, D</creatorcontrib><creatorcontrib>Bobat, B</creatorcontrib><creatorcontrib>Devar, J</creatorcontrib><creatorcontrib>Harran, N</creatorcontrib><creatorcontrib>Joseph, C</creatorcontrib><creatorcontrib>Mahomed, A</creatorcontrib><creatorcontrib>Oettle, J</creatorcontrib><creatorcontrib>Ramos, J</creatorcontrib><creatorcontrib>Seabi, M</creatorcontrib><creatorcontrib>Kgabage, G</creatorcontrib><creatorcontrib>Gaylard, P</creatorcontrib><creatorcontrib>Surridge, D</creatorcontrib><creatorcontrib>Etheredge, H</creatorcontrib><creatorcontrib>Fabian, J</creatorcontrib><creatorcontrib>Lutrin, D</creatorcontrib><creatorcontrib>Karlsson, K</creatorcontrib><title>The 'ins and outs' of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit</title><title>SAMJ: South African Medical Journal</title><addtitle>S Afr Med J</addtitle><description>In South Africa, there are no national guidelines for the conduct or quality assessment of colonoscopy, the gold standard for investigation and diagnosis of bowel pathology.
To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at the Wits Donald Gordon Medical Centre (WDGMC) outpatient endoscopy unit (OEU).
We conducted a prospective, clinical practice audit of colonoscopies performed on adults (≥18 years of age). A total of 1 643 patients were included in the study and variables that were collected enabled the assessment of adequacy of bowel preparation, length of withdrawal time and calculation of caecal intubation rate (CIR), polyp detection rate (PDR) and adenoma detection rate (ADR). We stratified PDR and ADR by sex, age, population group, withdrawal time and bowel preparation. CIR, PDR and ADR estimates were compared between patient groups by the χ2 test; Fisher's exact test was used for 2 × 2 tables. A p-value <0.05 was used. Benchmark recommendations by the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) Task Force on Colorectal Cancer (CRC) were used in this audit to assess individual endoscopist performance and that of the endoscopy unit as a whole.
The mean age of patients was 55.7 (standard deviation (SD) 14.4; range 18 - 91) years, ~60% were female, and the majority (75.5%) were white. Of the outpatients, 77.6% had adequate bowel preparation (ASGE/ACG benchmark ≥85%). The CIR was 97.0% overall, and screening colonoscopy was 96.3% (ASGE/ACG benchmark ≥90% overall and ≥95% for screening colonoscopies). The median withdrawal time for negative-result screening colonoscopies was 5.7 minutes (interquartile range (IQR) 4.2 - 9.3; range 1.1 - 20.6) (ASGE/ACG benchmark ≥ 6minutes), and PDR and ADR were 27.6% and 15.6%, respectively (ASGE/ACG benchmark ADR ≥25%). We demonstrated a 23.7% increase in PDR and 14.1% increase in ADR between scopes that had mean withdrawal times of ≥6 minutes and <6 minutes, respectively. Although the number of black Africans in the study was relatively small, our results showed that they have similar ADRs and PDRs to the white population group, contradicting popular belief.
The WDGMC OEU performed reasonably well against the international guidelines, despite some inadequacy in bowel preparation and lower than recommended median withdrawal times on negative-result colonoscopy. Annual auditing of clinical practice and availability of these data in the public domain will become standard of care, making this audit a baseline for longitudinal observation, assessing the impact of interventions, and contributing to the development of local guidelines.</description><subject>Adenoma - diagnosis</subject><subject>Adenoma - epidemiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory Care</subject><subject>Ambulatory surgery</subject><subject>Benchmarking</subject><subject>Colonic Polyps - diagnosis</subject><subject>Colonic Polyps - epidemiology</subject><subject>Colonoscopy</subject><subject>Colonoscopy - standards</subject><subject>Colonoscopy - statistics & numerical data</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - epidemiology</subject><subject>Early Detection of Cancer - methods</subject><subject>Female</subject><subject>Health Care Sciences & Services</subject><subject>Health Policy & Services</subject><subject>Humans</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Medical Audit</subject><subject>Medical Ethics</subject><subject>Medicine, General & Internal</subject><subject>Medicine, Legal</subject><subject>Medicine, Research & Experimental</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Outpatient Clinics, Hospital</subject><subject>Practice</subject><subject>Practice Guidelines as Topic</subject><subject>Prospective Studies</subject><subject>Quality Indicators, Health Care</subject><subject>Quality management</subject><subject>South Africa</subject><subject>Young Adult</subject><issn>0256-9574</issn><issn>2078-5135</issn><issn>2078-5135</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkl2L1DAUhoMo7rDuX9CA4Hpha7479a6Muiq7eDErXoY0SZ1IJqlNKuwv8G-b7owfQyCBw_uck_PyAvAMo7rBrXi97W4-1QQRVP_EGDlMaswYbh-AFUHNuuKY8odghQgXVcsbdgYuUnI9IqRpOGvZY3BGKUO0FXQFft3uLLx0IUEVDIxzTpcwDlBHH0NMOo53UGX41eUE38agvIFXcTIxwBtrnFYebmzIk30Ft4XdwW6YSvUN7OA4KZ2dtlDNxuWlZy6TimhU2RUG2mCOA-bg8hPwaFA-2Yvjew6-vH93u_lQXX---rjprivNMc8VoabsPShFNFdGoTUujqBhaJFpBGt7QnuCLNaEUEEaIYigwqiW2p5ii42m56A-9E3aWR_l9zhPZa0kt4tfcvFrcRYhfH-tC_DyAIxT_DHblOXeJW29V8HGOUnCGs7Jul2jIn1-kH5T3koXhpiLCYtcdoJRzjBh4t8PTlTlGLt3OgY7uFI_AV78B-ys8nmXop-ziyGdCpuDUE8xpckOcpzcXk13EiO5JEcuyZHLfvKYHHmfnEI-PS4593tr_nJ_ckJ_A7p9um0</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Bouter, C</creator><creator>Barrow, P</creator><creator>Bizos, D</creator><creator>Bobat, B</creator><creator>Devar, J</creator><creator>Harran, N</creator><creator>Joseph, C</creator><creator>Mahomed, A</creator><creator>Oettle, J</creator><creator>Ramos, J</creator><creator>Seabi, M</creator><creator>Kgabage, G</creator><creator>Gaylard, P</creator><creator>Surridge, D</creator><creator>Etheredge, H</creator><creator>Fabian, J</creator><creator>Lutrin, D</creator><creator>Karlsson, K</creator><general>Health & Medical Publishing Group</general><general>South African Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>GPN</scope></search><sort><creationdate>20201201</creationdate><title>The 'ins and outs' of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit</title><author>Bouter, C ; Barrow, P ; Bizos, D ; Bobat, B ; Devar, J ; Harran, N ; Joseph, C ; Mahomed, A ; Oettle, J ; Ramos, J ; Seabi, M ; Kgabage, G ; Gaylard, P ; Surridge, D ; Etheredge, H ; Fabian, J ; Lutrin, D ; Karlsson, K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c515t-23d020faa2c5ada0817190ff90d7649b23b20e1c223627662636da93eb31e1dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adenoma - diagnosis</topic><topic>Adenoma - epidemiology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory Care</topic><topic>Ambulatory surgery</topic><topic>Benchmarking</topic><topic>Colonic Polyps - diagnosis</topic><topic>Colonic Polyps - epidemiology</topic><topic>Colonoscopy</topic><topic>Colonoscopy - standards</topic><topic>Colonoscopy - statistics & numerical data</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - epidemiology</topic><topic>Early Detection of Cancer - methods</topic><topic>Female</topic><topic>Health Care Sciences & Services</topic><topic>Health Policy & Services</topic><topic>Humans</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Medical Audit</topic><topic>Medical Ethics</topic><topic>Medicine, General & Internal</topic><topic>Medicine, Legal</topic><topic>Medicine, Research & Experimental</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Outpatient Clinics, Hospital</topic><topic>Practice</topic><topic>Practice Guidelines as Topic</topic><topic>Prospective Studies</topic><topic>Quality Indicators, Health Care</topic><topic>Quality management</topic><topic>South Africa</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bouter, C</creatorcontrib><creatorcontrib>Barrow, P</creatorcontrib><creatorcontrib>Bizos, D</creatorcontrib><creatorcontrib>Bobat, B</creatorcontrib><creatorcontrib>Devar, J</creatorcontrib><creatorcontrib>Harran, N</creatorcontrib><creatorcontrib>Joseph, C</creatorcontrib><creatorcontrib>Mahomed, A</creatorcontrib><creatorcontrib>Oettle, J</creatorcontrib><creatorcontrib>Ramos, J</creatorcontrib><creatorcontrib>Seabi, M</creatorcontrib><creatorcontrib>Kgabage, G</creatorcontrib><creatorcontrib>Gaylard, P</creatorcontrib><creatorcontrib>Surridge, D</creatorcontrib><creatorcontrib>Etheredge, H</creatorcontrib><creatorcontrib>Fabian, J</creatorcontrib><creatorcontrib>Lutrin, D</creatorcontrib><creatorcontrib>Karlsson, K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SciELO</collection><jtitle>SAMJ: South African Medical Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bouter, C</au><au>Barrow, P</au><au>Bizos, D</au><au>Bobat, B</au><au>Devar, J</au><au>Harran, N</au><au>Joseph, C</au><au>Mahomed, A</au><au>Oettle, J</au><au>Ramos, J</au><au>Seabi, M</au><au>Kgabage, G</au><au>Gaylard, P</au><au>Surridge, D</au><au>Etheredge, H</au><au>Fabian, J</au><au>Lutrin, D</au><au>Karlsson, K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The 'ins and outs' of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit</atitle><jtitle>SAMJ: South African Medical Journal</jtitle><addtitle>S Afr Med J</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>110</volume><issue>12</issue><spage>1186</spage><epage>1190</epage><pages>1186-1190</pages><issn>0256-9574</issn><issn>2078-5135</issn><eissn>2078-5135</eissn><abstract>In South Africa, there are no national guidelines for the conduct or quality assessment of colonoscopy, the gold standard for investigation and diagnosis of bowel pathology.
To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at the Wits Donald Gordon Medical Centre (WDGMC) outpatient endoscopy unit (OEU).
We conducted a prospective, clinical practice audit of colonoscopies performed on adults (≥18 years of age). A total of 1 643 patients were included in the study and variables that were collected enabled the assessment of adequacy of bowel preparation, length of withdrawal time and calculation of caecal intubation rate (CIR), polyp detection rate (PDR) and adenoma detection rate (ADR). We stratified PDR and ADR by sex, age, population group, withdrawal time and bowel preparation. CIR, PDR and ADR estimates were compared between patient groups by the χ2 test; Fisher's exact test was used for 2 × 2 tables. A p-value <0.05 was used. Benchmark recommendations by the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) Task Force on Colorectal Cancer (CRC) were used in this audit to assess individual endoscopist performance and that of the endoscopy unit as a whole.
The mean age of patients was 55.7 (standard deviation (SD) 14.4; range 18 - 91) years, ~60% were female, and the majority (75.5%) were white. Of the outpatients, 77.6% had adequate bowel preparation (ASGE/ACG benchmark ≥85%). The CIR was 97.0% overall, and screening colonoscopy was 96.3% (ASGE/ACG benchmark ≥90% overall and ≥95% for screening colonoscopies). The median withdrawal time for negative-result screening colonoscopies was 5.7 minutes (interquartile range (IQR) 4.2 - 9.3; range 1.1 - 20.6) (ASGE/ACG benchmark ≥ 6minutes), and PDR and ADR were 27.6% and 15.6%, respectively (ASGE/ACG benchmark ADR ≥25%). We demonstrated a 23.7% increase in PDR and 14.1% increase in ADR between scopes that had mean withdrawal times of ≥6 minutes and <6 minutes, respectively. Although the number of black Africans in the study was relatively small, our results showed that they have similar ADRs and PDRs to the white population group, contradicting popular belief.
The WDGMC OEU performed reasonably well against the international guidelines, despite some inadequacy in bowel preparation and lower than recommended median withdrawal times on negative-result colonoscopy. Annual auditing of clinical practice and availability of these data in the public domain will become standard of care, making this audit a baseline for longitudinal observation, assessing the impact of interventions, and contributing to the development of local guidelines.</abstract><cop>South Africa</cop><pub>Health & Medical Publishing Group</pub><pmid>33403963</pmid><doi>10.7196/SAMJ.2020.v110i12.14419</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; African Journals Online (Open Access); Sabinet African Journals Open Access Collection; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adenoma - diagnosis Adenoma - epidemiology Adolescent Adult Aged Aged, 80 and over Ambulatory Care Ambulatory surgery Benchmarking Colonic Polyps - diagnosis Colonic Polyps - epidemiology Colonoscopy Colonoscopy - standards Colonoscopy - statistics & numerical data Colorectal Neoplasms - diagnosis Colorectal Neoplasms - epidemiology Early Detection of Cancer - methods Female Health Care Sciences & Services Health Policy & Services Humans Male Mass Screening - methods Medical Audit Medical Ethics Medicine, General & Internal Medicine, Legal Medicine, Research & Experimental Methods Middle Aged Outpatient Clinics, Hospital Practice Practice Guidelines as Topic Prospective Studies Quality Indicators, Health Care Quality management South Africa Young Adult |
| title | The 'ins and outs' of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit |
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