Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Authors: Michal F. Kaminski, Siwan Thomas-Gibson, Marek Bugajski , Michael Bretthauer, Colin J. Rees, Evelien Dekker, Geir Hoff, Rodrigo Jover, Stepan Suchanek, Monika Ferlitsch, Jon Anderson, Thomas Roesch, Rolf Hultcranz, Istvan Racz, Ernst J. Kuipers, Kjetil Garborg, James E. East, Maciej Rupinski, Birgitte Seip, Cathy Bennett, Carlo Senore, Silvia Minozzi, Raf Bisschops, Dirk Domagk, Roland Valori, Cristiano Spada, Cesare Hassan, Mário Dinis-Ribeiro, Matthew D. Rutter

Abstract

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level:

1 Rate of adequate bowel preparation (minimum standard 90 %);
2 Cecal intubation rate (minimum standard 90%);
3 Adenoma detection rate (minimum standard 25%);
4 Appropriate polypectomy technique (minimum standard 80%);
5 Complication rate (minimum standard not set);
6 Patient experience (minimum standard not set);
7 Appropriate post-polypectomy surveillance recommendations (minimum standard not set).

Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.

Introduction

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have identified quality of endoscopy as a major priority. We described our rationale for this priority in a recent manuscript that also addressed the methodology of the current quality initiative process [1].

Because of the variation in physicians’ performance and the introduction of nationwide colorectal cancer (CRC) screening programs, lower gastrointestinal (LGI) endoscopy was the first area of endoscopy to address quality [2 - 4]. Over more than a decade, several potential measures of quality in LGI endoscopy have been identified. In consequence, many professional societies have published recommendations on performance measures for LGI endoscopy [5 - 7]. These recommendations are however numerous (44 different performance measures) [5 - 7], country specific, and not always evidence based, which has limited their wider adoption in Europe.

The aim of the ESGE LGI working group was to identify a short list of key performance measures for LGI endoscopy that were widely applicable to endoscopy services throughout Europe. This list would ideally consist of performance measures with the following requirements: proven impact on significant clinical outcomes or quality of life; a well-defined, reliable, and simple method/approach for measurement; susceptibility for improvement; and application to all levels of endoscopy services.
This paper reports the agreed list of key performance measures for LGI endoscopy and describes the methodological process applied in the development of these measures.