Performance measures for colonoscopy in inflammatory bowel disease patients: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Authors: Evelien Dekker*, Karlijn J. Nass*, Marietta Iacucci, AlbertoMurino, João Sabino, Marek Bugajski, Cristina Carretero, George Cortas, Edward J. Despott, James E. East, Michal F. Kaminski, John Gásdal Karstensen, Martin Keuchel, Mark Löwenberg, Ashraf Monged, Olga M. Nardone, Helmut Neumann, Mahmoud Omar, Maria Pellisé, Laurent Peyrin-Biroulet, Matthew D. Rutter, Raf Bisschops

* Equal first authors

ABSTRACT

The European Society of Gastrointestinal Endoscopy (ESGE) presents a short list of performance measures for colonoscopy in inflammatory bowel disease (IBD) patients. Current performance measures for colonoscopy mainly focus on detecting (pre)malignant lesions. However, these performance measures are not relevant for all colonoscopy indications in IBD patients. Therefore, our aim was to provide endoscopy services across Europe and other interested countries with a tool for quality monitoring and improvement in IBD colonoscopy. Eight key performance measures and one minor performance measure were recommended for measurement and evaluation in daily endoscopy practice.

INTRODUCTION

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have identified monitoring and evaluation of the quality of endoscopy as a major priority [1]. To this aim, the ESGE and UEG have developed several performance measures for different types and aspects of gastrointestinal (GI) endoscopy over the past few years [2–6]. Current performance measures for colonoscopy have mainly focused on optimal detection of (pre)malignant lesions [4]. However, the detection of (pre)malignant lesions is not the primary aim in colonoscopies performed in patients with a clinical suspicion of inflammatory bowel disease (IBD), nor when assessing endoscopic disease activity in known IBD patients. To date, no endoscopy performance measures have been identified for IBD patients. Furthermore, the current performance measures for colonoscopy do not include surveillance of longstanding IBD patients. Although several recommendations have been published for surveillance colonoscopy in IBD patients [7–9], these recommendations are numerous and not consistently measurable in community endoscopy practices.

The aim of the IBD taskforce within the colonoscopy working group of the ESGE Quality Improvement Committee was to identify performance measures for colonoscopy in IBD patients that are widely applicable to endoscopy services throughout Europe and other interested countries. These performance measures would ideally meet the following criteria: have a proven impact on clinical outcomes; be well-defined, reliable, simple, and userfriendly; provide an opportunity for improvement; and bewidely applicable to all levels of endoscopy services.

This paper reports the consensus-based list of key performance measures for colonoscopy in IBD patients and describes the methodological process applied in the development of these measures. Performance measures are divided into key performance measures and minor performance measures.