The American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE) have issued latest recommendations on quality indicators for colonoscopy, the gold standard for colorectal cancer screening (CRC). This marks the latest update of efforts that began two decades ago to ensure consistently high-quality standards for colonoscopy.
Colorectal cancer (CRC) is known as the “most preventable yet least prevented” form of cancer.[1],[2] As the second leading cause of cancer death in the United States, CRC remains a significant public health challenge. Just this year, more than 150,000 patients will be diagnosed and treated, and 50,000 patients will die from colorectal cancer.[3] It is estimated 64 percent of these deaths could be prevented through early detection and screening.[4]
This latest set of guidelines, published online and in the September print issues of The American Journal of Gastroenterology (AJG) and GIE Gastrointestinal Endoscopy, emphasize the importance of determining, and measuring, priority quality indicators. While quality measurements related to all indicators may not always be feasible given time, cost and staffing constraints, a set of extremely important measures, called priority indicators, have been developed to guide practices in where to focus. Based on clinical relevance, evidence of variable performance, and feasibility of measurement, the priority indicators for colonoscopy outlined are:
- Adenoma detection rate (ADR), or how often the endoscopist finds an adenoma, which is a precancerous growth in the colon
- Sessile serrated lesion detection rate, or how often the endoscopist finds a sessile serrated lesion, which is another precancerous growth in the colon
- Rate of using recommended screening and surveillance intervals
- Bowel preparation adequacy rate
- Cecal intubation rate, or what proportion of the time the endoscopist is able to view the entire colon
“ADR plays a critical role in evaluating the performance of the colonoscopists,” said Douglas K. Rex, MD, MACG, MASGE, the lead author. “It is recommended that ADR calculations include screening, surveillance, and diagnostic colonoscopy but exclude indications of a positive noncolonoscopy screening test and therapeutic procedures for resection or treatment of known neoplasia, genetic cancer syndromes, and inflammatory bowel disease.”
Co-author Nicholas J. Shaheen, MD, MPH, MACG, MASGE added, “Endoscopy teams now have an updated set of guidelines which can be used to enhance the quality of their colonoscopies, and should certainly use these current quality measures to ‘raise the bar’ on behalf of their patients.” He added, “Understanding deficiencies in performance is only possible through quality measurement, and this has an important impact on critical outcomes including cancer development. One way endoscopy units can do so is to participate in GIQuIC.”
GIQuIC (GI Quality Improvement Consortium, Inc.) is a medical specialty registry designed by gastroenterologists for gastroenterologists to collect, organize and display digestive healthcare data for multiple purposes, such as research, quality improvement initiatives and providing quality measure data to CMS’ Merit-based Incentive Payment System (MIPS). ACG and ASGE are collaborators in GIQuIC.
Read “Quality Indicators for Colonoscopy” Rex, et al., jointly published by ACG and ASGE
AJG - The American Journal of Gastroenterology
GIE - Gastrointestinal Endoscopy
About the ASGE/ACG GI Colonoscopy Quality Indicators
As a product of the ASGE/ACG Task Force on Quality in Endoscopy, this document was reviewed and approved by the governing boards of the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. The present update integrates new data pertaining to previously proposed quality indicators. Gastroenterologists should review this updated guidance with their healthcare teams and create a plan for evolving their quality improvement programs to align with priority indicators set forth in the document.
About the ASGE/ACG Task Force on Quality in Endoscopy
In the early 2000s, physician leaders in gastroenterology started a movement to define aspects of quality for endoscopy. As leaders in promoting excellence in gastrointestinal endoscopy, ASGE and ACG formed a Task Force, comprised of nationally recognized endoscopic experts, to identify objective measures that could be used to define high-quality endoscopic services for the diagnosis and treatment of diseases and conditions of the digestive tract. Published in April 2006 and updated in 2015, the ACG-ASGE Gastrointestinal Endoscopic Quality Indicators established the foundation for assessing prevailing patterns of care against best practices, revolutionizing the area of quality in endoscopy. These indicators have guided measure development for use not only in continuous quality improvement activities, but for inclusion in government reporting programs such as the Medicare Quality Payment Program (QPP) and its Merit-based Incentive Payment System (MIPS).
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Contacts:
Anne-Louise Oliphant
ACG
301-263-9000
mediaonly@gi.org
Andrea Lee
ASGE
(630) 570-5603
alee@asge.org
[1] Itkowitz SH. Incremental advances in excremental cancer detection tests. J Natl Cancer Inst. 2009 Sep 16;101(18):1225-7. doi: 10.1093/jnci/djp273. Epub 2009 Aug 21. PMID: 19700654.
[2] Brenner H, Chen C. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. Br J Cancer. 2018 Oct;119(7):785-792. doi: 10.1038/s41416-018-0264-x. Epub 2018 Oct 4. PMID: 30287914; PMCID: PMC6189126.
[3] Seigel RL et al. CA Cancer J Clin. Cancer statistics,2023;1-22. Cancer Stats facts: colorectal cancer. National Cancer Institute Accessed Oct 30, 2022
[4] Meester RG, Doubeni CA, Lansdorp-Vogelaar I, Goede SL, Levin TR, Quinn VP, Ballegooijen Mv, Corley DA, Zauber AG. Colorectal cancer deaths attributable to nonuse of screening in the United States. Ann Epidemiol. 2015 Mar;25(3):208-213.e1. doi: 10.1016/j.annepidem.2014.11.011. Epub 2014 Dec 5. PMID: 25721748; PMCID: PMC4554530.