Colonoscopy Quality Data

At Atlanta Gastroenterology Associates, our physicians and staff are dedicated to providing the most accurate diagnoses and best possible treatments to our patients who suffer from digestive and liver conditions. Delivering high quality care in a professional and caring environment takes commitment from each person on our staff – and it is a commitment we take very seriously.

To achieve our goal of improving the health and well-being of each patient, the practice has incorporated a continuous quality improvement program. As part of this process, we compare our colonoscopy performance measures to industry standards in order to maintain our high standards of care and identify any areas that may need additional focus. 

Collectively, AGA physicians performed more than 60,000 colonoscopies in 2016, and we are proud to report that we consistently outperformed national standards in each metric of colonoscopy quality. 

You can find our full report below:

The Value of Screening
Experience Matters
Quality Measures
Adenoma Detection Rate
Cecal Intebation 
Scope Withdrawal Time
Perforation Rates

Safety
Summary

The Value of Screening

Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer related deaths in both men and women. It is also one of the most preventable. 

The Centers for Disease Control recommends that everyone over the age of 50 get regular screenings for colorectal cancer. If you have a family history of the disease or other risk factors you may need to be screened starting at an earlier age. 

In a 2014 report, the American Cancer Society noted that in the last decade, colorectal cancer rates have declined by over 30% in people over the age of 50. During this same time period, colorectal cancer screenings have nearly tripled.1 While it is apparent that a direct correlation exists, only about half of the population in the U.S. who should be screened have had the procedure. 

Currently, there are several methods of colorectal cancer screening available. They include colonoscopy, flexible sigmoidoscopy, stool blood testing, barium enema with air contrast, and CT colonography. While each one has pros and cons, only colonoscopy is widely considered to be the “gold standard.”

Colonoscopy is rated above all other colorectal cancer screening methods by the American Cancer Society, as well as the three leading gastroenterology associations.2  It is the only colorectal cancer screening method that allows a physician to visualize the entire colon and remove most polyps at the same time.  

A polyp is tissue that can grow in the lining of the colon or rectum. While most polyps are not cancerous, certain types – known as adenomas – are highly likely to become cancerous and should be removed. 

Experience Matters

Polyps are diminutive in size and can hide in the many bends and folds of the colon. Unfortunately, there is no way to guarantee that all polyps will be located during a colonoscopy. Research does show, however, that an experienced endoscopist is more likely to discover and remove smaller polyps, which can be very hard to locate.

AGA’s physicians have quantifiable experience in performing colonoscopies. While the American Society for Gastrointestinal Endoscopy (ASGE) recommends that a physician perform at least 100 colonoscopies a year to maintain their ability to perform a high quality procedure,4  the full-time physicians of AGA performed an average of approximately 725 colonoscopies each in 2016. 

Quality Measures

AGA is committed to continuous quality improvement in all aspects of patient care. By comparing our colonoscopy performance measures to industry standards, we can determine if any steps need to be taken to improve our performance and see how our practice compares to other GI groups across the country in terms of patient care and outcomes. Among the colonoscopy quality measures that AGA tracks are adenoma detection rates, cecal intubation rates, scope withdrawal times, and perforation rates. 


Adenoma Detection Rate 

No one knows exactly what causes adenomatous (precancerous) polyps.  Most people who have them are asymptomatic. The goal of the screening colonoscopy is to locate and retrieve these polyps.

The adenoma detection rate (ADR) is defined as the percentage of screening colonoscopies in which a precancerous polyp is located. This rate can vary greatly by the thoroughness and skill of the endoscopist.

While studies show that there is no real differentiation between sex and incidences of colon cancer, men are more likely than women to have adenomatous polyps. 

The national benchmark for ADR is 30% for men and 20% for women.6 AGA well exceeds these benchmarks with an ADR of 44.40% for men and 34.42% for women in 2015 and an ADR of 54.67% for men and 40.93% for women in 2016.

Cecal Intubation

A colonoscopy is considered “complete” when the endoscopist is able to examine the entire length of the colon, extending from the rectum to the cecum. When the tip of the endoscope is extended into the cecum, this is referred to as ‘cecal intubation.

The colon measures approximately five feet in length and has many turns and folds and precancerous polyps can appear anywhere in the colon. The goal of the endoscopist is to examine the entire colon all the way to the cecum, which is the point where the colon and small intestine meet. While adenomatous polyps also can occur in the small intestine, it is rare. 

There are several reasons why an endoscopist may not be able to reach the cecum.  For example, the colon may be inflamed or have excessive looping, which keeps the colonoscope from passing through an area. Additionally there  may be a stricture or an abnormal medical condition which could restrict further movement. Another common cause of an incomplete colonoscopy is as a result of poor bowel preparation by the patient. Proper pre-procedure preparation is essential to a thorough screening. 

National standards recommend a cecal intubation rate in excess of 95% for screening colonoscopies.6 AGA’s cecal intubation rate well exceeds this with rates of 99.38% in 2015 and 99.50% in 2016.

Scope Withdrawal Time

Simply put, a more thorough procedure is a better procedure. While the length of time taken to perform a colonoscopy is not a tell-all, it does give some indication as to the diligence of the endoscopist.

Scope withdrawal time is defined as the length of time that it takes the endoscopist to withdraw the endoscope from the cecum until it is fully removed from the rectum. The majority of polyps are removed during this “withdrawal” process.  

In general, a slower withdrawal time is better. Studies have shown a direct correlation between a longer withdrawal time and the likelihood of locating precancerous polyps.5 This allows the endoscopist to thoroughly examine the entire length of the colon in order to locate and remove polyps, as well as any other abnormalities.

The national standard for scope withdrawal time for negative result screenings is 6:00 (six minutes).6 When considering all negative result screening colonoscopies, AGA physicians surpass this averaging a scope withdrawal time of 7:40 in 2015 and 7:19 in 2016.

Perforation Rates

It is important to note that a colonoscopy is a medical procedure and like all medical procedures, there are inherent risks. Complications are rare but a possibility.  

Some of the potential complications include abdominal discomfort, bloating, persistent post-procedure bleeding and reactions to anesthesia. While highly uncommon, one of the most severe risks of a colonoscopy is a tear or perforation in the wall of the colon. A perforation often requires surgery to repair.

The national standard for the risk of a perforation during any colonoscopy is 0.2000%.6 The risk that a perforation would occur during a screening colonoscopy is even lower. AGA’s actual perforation rate for all colonoscopies performed in its affiliated endoscopy centers is well below this standard with  0.0275% in 2015 and 0.0231% in 2016.


Safety

All AGA-affiliated endoscopy centers are fully licensed by the Georgia Department of Community Health. To further ensure that each facility adheres to high standards of patient care and safety, they are certified by the Accreditation Association for Ambulatory Health Care or the American Association for Accreditation of Ambulatory Surgery Facilities. In addition, our staff receives ongoing training relating to maintaining a professional, safe and clean environment for our patients.

Summary

The probability of being diagnosed with colorectal cancer in your lifetime is 4.7% for women and 5.0% for men.1 If the cancer is discovered in its earliest stages, there is a cure rate of up to 90% – which is why getting screened is so important.7

The physicians of AGA are well-trained, experienced, and have access to the latest technology for colon cancer screenings in our twelve accredited endoscopy centers. As a practice, we are committed to providing our patients with the highest quality services in a safe, comfortable environment. We believe that when it comes to your health, a more informed patient is not only healthier, but happier. 

We hope that you find the information contained in this report to be both helpful and informative.  If you have any questions, please do not hesitate to contact us at 1-866-GO-TO-AGA (468-6242).

 

 


Sources

1.  Siegel, R., DeSantis, C. and Jemal, A. (2014), Colorectal cancer statistics, 2014. CA: A Cancer Journal for Clinicians, 64: 104–117. doi: 10.3322/caac.21220

2. American Society for Gastrointestinal Endoscopy; “Colorectal Cancer Screening Options,” http://www.screenforcoloncancer.org/screeningoptions.asp

3. Solís-Muñoz, Pablo, Solís-Herruzo, José A., Rodríguez-Muñoz, Sarbelio, The Experience of The Endoscopist Increases Detection Rates of Smaller Size and Higher Histological Grade Polyps, Journal of Gastroenterology and Hepatology  10.1111/jgh.12537

4.  American Society for Gastrointestinal Endoscopy; “Ten questions to help you select an endoscopist for high quality colonoscopy,” http://www.asge.org/patients/patients.aspx?id=370

5. Lin OS, Kozarek RA, Arai A, Gluck M, Jiranek GC, Kowdley KV, McCormick SE, Schembre DB, Soon MS, Dominitz JA,The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detection rates, and patient satisfaction scores. Gastrointest Endosc. 2010 Jun; 71(7):1253-9  

6. Douglas K Rex, Philip S Schoenfeld, Jonathan Cohen, Irving M Pike, Douglas G Adler, M Brian Fennerty, John G Lieb, Walter G Park, Maged K Rizk, Mandeep S Sawhney, Nicholas J Shaheen, Sachin Wani and David S Weinberg.  Quality Indicators for GI Endoscopic Procedures.  American Journal of Gastroenterology 2015;110:72-90 

7. American Society for Gastrointestinal Endoscopy; “Colorectal Cancer Myths and Facts,” http://www.screenforcoloncancer.org/myths.asp