6. Lower GI Endoscopy KPI

Bowel Preparation for Colonoscopy

ESGE Guidelines (2019 Update):

  • Split-Dose Regimen:
    • Preferred method for elective colonoscopies.
    • For morning procedures, split doses the evening before and 4-5 hours before the procedure.
    • For afternoon procedures, a same-day regimen may be used.
    • Ensure the last dose is completed at least 2 hours prior to the procedure.
  • Preparation Solutions:
    • High-volume (>3L) and low-volume polyethylene glycol (PEG)-based solutions are recommended.
    • Avoid high-volume PEG in patients with congestive cardiac failure (CCF).
    • Non-PEG-based agents (e.g., sodium picosulfate) are acceptable but require individualized consideration.
  • Special Populations:
    • Chronic kidney disease (CKD) with CrCl <30: Avoid ascorbate, citrate, or trisulfate preparations.
    • Phenylketonuria (PKU) or G-6-PD deficiency: Avoid ascorbate-containing solutions (e.g., Plenvu).
    • Avoid oral sodium phosphate, especially post-renal transplant.
  • Adjunctive Measures:
    • Oral simethicone may improve mucosal visibility.
    • Clear liquids are advised the day before the procedure.
    • Low-fiber diet the day before is recommended.
  • Medications:
    • Non-critical medications should be taken 1 hour before bowel prep or require IV/patch alternatives.
    • Oral contraceptive pills (OCPs) are presumed ineffective for 1 week post-prep.

 

Comprehensive Notes for Gastroenterology Registrars Preparing for the European Certification Examination

Endoscopy Quality Standards

KPI

UK Guidelines (BSG/JAG)

European Guidelines (ESGE)

Adenoma Detection Rate (ADR)

≥15% (general population), >35% (screening)

≥15% (general population); higher targets for screening.

Cancer Detection Rate (CDR)

>11% (screening population)

Not specifically mentioned.

Caecal Intubation Rate

≥90% (unadjusted rate)

≥90% (adjusted for incomplete cases).

Withdrawal Time

≥6 minutes

≥6 minutes for thorough mucosal inspection.

Rectal Biopsies in Diarrhea

100% in cases presenting with diarrhea

Not specified.

Tattooing of Lesions

100% for lesions ≥2 cm or suspected malignancies

All suspected malignant lesions must be tattooed.

Polyp Retrieval Rate

100% of removed polyps

Emphasis on complete polyp retrieval but no percentage given.

Serious Complications

<3 per 1,000 colonoscopies

Not specifically quantified; focus on minimizing complications.

Post-Polypectomy Bleeding

<1 in 200 cases (intermediate/severe)

<1 in 200 cases (consistent with UK).

Perforation Rate

Minimized; specific targets not mentioned

Rare and actively monitored; specific rates not detailed.

Correct Identification of Colonic Segment

>90%

Emphasized but no numerical target specified.

Adequate Bowel Prep

≥90%

≥90% (consistent with UK).

Rectal Retroversion

Routinely performed where appropriate

Emphasized but no numerical target specified.

Additional Notes:

  • Screening-specific benchmarks:
    • Adenoma detection rates (ADR): >0.6% for low-risk individuals; >0.2% for high-risk individuals.
    • Cancer detection rates (CDR): >11% in screened populations.
  • 100% rectal biopsies in patients presenting with diarrhea to ensure accurate diagnosis.
  • Tattooing: Reliant on clinical suspicion of malignancy, emphasizing the importance of careful lesion assessment.
  • Serious complications: Must remain below <3 per 1,000 colonoscopies to meet stringent safety standards.