부산대학교 도서관

Background. In South Africa, there are no national guidelines for the conduct or quality assessment of colonoscopy, the gold standard for investigation and diagnosis of bowel pathology. Objectives. To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at the Wits Donald Gordon Medical Centre (WDGMC) outpatient endoscopy unit (OEU). Methods. We conducted a prospective, clinical practice audit of colonoscopies performed on adults ([greater than or equal to] 18 years of age). A total of 1 643 patients were included in the study and variables that were collected enabled the assessment of adequacy of bowel preparation, length of withdrawal time and calculation of caecal intubation rate (CIR), polyp detection rate (PDR) and adenoma detection rate (ADR). We stratified PDR and ADR by sex, age, population group, withdrawal time and bowel preparation. CIR, PDR and ADR estimates were compared between patient groups by the [chi square] test; Fisher's exact test was used for 2 * 2 tables. A p-value Results. The mean age of patients was 55.7 (standard deviation (SD) 14.4; range 18-91) years, ~60% were female, and the majority (75.5%) were white. Of the outpatients, 77.6% had adequate bowel preparation (ASGE/ACG benchmark [greater than or equal to] 85%). The CIR was 97.0% overall, and screening colonoscopy was 96.3% (ASGE/ACG benchmark [greater than or equal to] 90% overall and >95% for screening colonoscopies). The median withdrawal time for negative-result screening colonoscopies was 5.7 minutes (interquartile range (IQR) 4.2-9.3; range 1.1-20.6) (ASGE/ACG benchmark [greater than or equal to] 6 minutes), and PDR and ADR were 27.6% and 15.6%, respectively (ASGE/ACG benchmark ADR [greater than or equal to] 25%). We demonstrated a 23.7% increase in PDR and 14.1% increase in ADR between scopes that had mean withdrawal times of [greater than or equal to] 6 minutes and Conclusions. The WDGMC OEU performed reasonably well against the international guidelines, despite some inadequacy in bowel preparation and lower than recommended median withdrawal times on negative-result colonoscopy. Annual auditing of clinical practice and availability of these data in the public domain will become standard of care, making this audit a baseline for longitudinal observation, assessing the impact of interventions, and contributing to the development of local guidelines. https://doi.org/10.7196/SAMJ.2020.v110i12.14419
Colonoscopy is regularly used for investigation of bowel pathology and has become the gold standard for screening and diagnosis of colorectal cancer (CRC). [1] The procedure has diagnostic and therapeutic [...]