A multi-centre North Italian prospective survey on some quality parameters in lower gastrointestinal endoscopy

Background and aim. To record prospectively, in a multi-centre survey, the adherence to some quality parameters of lower digestive endoscopy in everyday practice, focusing in particular on sedation and monitoring; choice of extension of endoscopic examination by the operator and relative performance in intubation of the caecum; behaviour in some particular clinical circumstances, such as fresh haematochezia, screening and surveillance situations, functional symptoms, management of polyps. Patients and Methods. Twenty-five centres located in Lombardia, Italy took part in the study; the duration of the survey was 2 weeks. 1406 consecutive cases were recorded. Results. The main indications to colonoscopy were fresh haematochezia (21%), abdominal pain (11.7%) and surveillance after surgery for tumours or endoscopic polyp removal (24.3%). Screening examinations accounted for 7.1% of all examinations. Conscious sedation was administered in 63.9% of patients; pulse oxymetry and cardiac frequency monitoring was used in 44.2% of cases. Total colonoscopy was planned in 84.2% of cases; the actual rate of intubation of the caecum in the cases submitted to the procedure was 84.1%. Normal results were obtained in 24.3%. In 24.3% of patients, one or more polyps were identified; 84.2% of these were removed during the first examination. Four complications (accounting for 0.28% of cases) were recorded, all after polypectomy and all successfully treated conservatively. Conclusions. The present study has shown that some attitudes in lower digestive endoscopy are sub-optimal: in particular, screening examinations are still infrequent; conscious sedation and monitoring have probably been used too rarely; intubation of the caecum was achieved in <90% of cases; the endoscopic removal of many polyps has been delayed for unexplained reasons. On the other hand, timing of surveillance after surgery for tumours or endoscopic removal of polyps has, overall, been adequate; the I-ate of normal examinations and the rate of complications have been satisfactorily low.