Colonoscopy Preparation, Premedication, and Sedation
Quality is a cornerstone of the new healthcare landscape. As endoscopists, we will be held accountable not merely for completing our procedures but also for their quality and appropriateness. Evidence-based quality measures, designed to assess the outcomes of our procedures, are being developed and will be judged accordingly. The ADR, a validated measure of quality that correlates closely with the risk of an interval carcinoma after colonoscopy, will probably remain the most important outcome measure of screening colonoscopy.
Other quality measures, such as the number of adenomas per patient and number of sessile serrated lesions per patient, are being assessed as well. Methods to improve lesion detection, including better quality bowel preparation, cap-assisted colonoscopy, water-assisted colonoscopy and image-enhanced techniques such as chromoendoscopy and autofluorescence imaging are all under active investigation.
The 'quality imperative' is also focused on the efficient utilization of resources. Better understanding of an individual's colorectal cancer risk, based upon their family and personal history will permit better stratification of patients into different surveillance intervals. We are likely to see better guidance in the management of patients with one or more sessile serrated lesions within the proximal colon.
Finally, the primacy of colonoscopy as the gold standard for colorectal cancer screening will be challenged during the next 5 years. Fecal immunochemical testing and stool DNA both pose real threats to colonoscopy, based upon their simplicity and cost. As endoscopists, we must heed the quality initiative and ensure that each of us provide high quality examinations to the right patients at the right times.
Five-year View
Quality is a cornerstone of the new healthcare landscape. As endoscopists, we will be held accountable not merely for completing our procedures but also for their quality and appropriateness. Evidence-based quality measures, designed to assess the outcomes of our procedures, are being developed and will be judged accordingly. The ADR, a validated measure of quality that correlates closely with the risk of an interval carcinoma after colonoscopy, will probably remain the most important outcome measure of screening colonoscopy.
Other quality measures, such as the number of adenomas per patient and number of sessile serrated lesions per patient, are being assessed as well. Methods to improve lesion detection, including better quality bowel preparation, cap-assisted colonoscopy, water-assisted colonoscopy and image-enhanced techniques such as chromoendoscopy and autofluorescence imaging are all under active investigation.
The 'quality imperative' is also focused on the efficient utilization of resources. Better understanding of an individual's colorectal cancer risk, based upon their family and personal history will permit better stratification of patients into different surveillance intervals. We are likely to see better guidance in the management of patients with one or more sessile serrated lesions within the proximal colon.
Finally, the primacy of colonoscopy as the gold standard for colorectal cancer screening will be challenged during the next 5 years. Fecal immunochemical testing and stool DNA both pose real threats to colonoscopy, based upon their simplicity and cost. As endoscopists, we must heed the quality initiative and ensure that each of us provide high quality examinations to the right patients at the right times.
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