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Northern Region Endoscopy Group

Quality Improvement at Colonoscopy (QIC) Study Summary

Investigators: James East, Brian Saunders, Matt Rutter, Colin Rees, supported by the BSG Endoscopy Research Committee.

Background: Polyp and adenoma detection rates vary 10-fold between operators. High quality colonoscopy (measured through adenoma detection rates) is fundamental to colorectal cancer prevention through colonoscopic polypectomy, and the success of national bowel cancer screening programmes. Optimising elements of basic colonoscopic withdrawal technique may reduce variation in operator performance and improve quality.

Objective: To assess whether a “bundle” of four evidence based changes to colonoscopic withdrawal technique can effect an initial and durable improvement in adenoma detection rates in “routine” colonoscopic practice

Design: Prospective service development cohort study in 6-8 regional endoscopy centres

Setting: Northern Regional Endoscopy Group (NREG) endoscopy research network

Patients: All patients attending for routine colonoscopy

Interventions: “Bundle”: Four evidence based changes to optimise withdrawal technique to be applied to all colonoscopy performed in the study period: 1. Withdrawal time >8minutes; 2. Use of antispasmodic (hyoscine butylbromide); 3. Patient position changes (supine in transverse); 4. Rectal retroflexion. These will be introduced by “team leaders”, a consultant and senior nurse from each endoscopy unit, after central training by the investigators, with ongoing support.

Main Outcome Measure: Polyp detection rates on a per patient basis at baseline (current practice), three months post intervention (effectiveness) and 12 month post intervention (durability). Estimated 3-4000 patients / assessment endpoint.

Funding: £52,000 from NHS North East SHA “Good Ideas” fund along with local funding - to support a research fellow and some data analyst support.

Ethics: A waiver from the local ethics committee chair has been obtained.

Status: Funding has been received. Eight participant units have been identified. Baseline data collection is to start in July 2010. Central training of team leaders will be in September 2010, and the intervention will commence October 2010. A research fellow is being sought with a plan to be in post for October 2010 (QIC will contribute to MD). An application for research nurse funding and additional data analyst time to support the fellow and manage baseline data collection is in progress. Expected completion date September 2011.