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A multicenter pragmatic study of an evidence-based intervention to improve adenoma detection: The Quality Improvement in Colonoscopy (QIC) study

Lookup NU author(s): Dr Michael Bramble, Professor Matt Rutter, Emeritus Professor Amritpal Hungin


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© Georg Thieme Verlag KGStuttgart. New York. Background and study aims: Low adenoma detection rates (ADRs) at colonoscopy are linked to significantly higher interval cancer rates, and vary between colonoscopists. Studies demonstrate that lesion detection is improved by: withdrawal time of ≥ 6 minutes; use of hyoscine butylbromide; position change; and rectal retroflexion. We evaluated the feasibility of implementing the above bundle of interventions into colonoscopy practice, and the effect on ADR. Materials and methods: A longitudinal cohort design was used. Implementation combined central training, local promotion, and feedback. The uptake marker was change in hyoscine butylbromide use. Comparisons were between the 3 months before and the 9 months after the implementation phase, globally, by endoscopy unit and by quartile when colonoscopists were ranked according to baseline ADR. Chi-squared or Fisher's tests were used to evaluate significance. Results: 12 units participated. Global and quartile analyses included data from 118 and 68 colonoscopists and 17 508 and 14 193 procedures respectively. A significant increase in hyoscine butylbromide use was observed globally (54.4 % vs. 15.8 %, P < 0.001), in all endoscopy units (P < 0.001) and quartiles (P < 0.001). A significant increase in ADR was observed globally (18.1 % vs. 16.0 %, P = 0.002) and in the lower two colonoscopist quartiles (P < 0.001), with a nonsignificant increase in the upper middle quartile and a significant fall to 21.5 %. in the upper quartile. The significant variations in ADR among the upper three quartiles disappeared. Conclusion: In routine clinical practice, introduction of a simple, inexpensive, evidence-based bundle of measures is feasible and is associated with higher global ADR, driven by improvements amongst the poorest performing colonoscopists.

Publication metadata

Author(s): Rajasekhar PT, Rees CJ, Bramble MG, Wilson DW, Rutter MD, Saunders BP, Hungin APS, East JE

Publication type: Article

Publication status: Published

Journal: Endoscopy

Year: 2015

Volume: 47

Issue: 3

Pages: 217-224

Online publication date: 12/02/2015

Acceptance date: 28/12/2014

ISSN (print): 0013-726X

ISSN (electronic): 1438-8812

Publisher: Georg Thieme Verlag


DOI: 10.1055/s-0034-1391563

PubMed id: 25675176


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