Mullen, P.J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA76
Academic Journal
Background: An initial audit of 357 colonoscopies demonstrated what was thought, at the time, to be a well below par overall completion rate of 73.9%, adjusted to 80.5% if operator independent failures (eg poor bowel preparation, stricture, obstructing tumour) were excluded. Action undertaken: Efforts were made to improve by: more frequent alteration of patient position; better loop avoidance; the use of "jiggling"; earlier and repeated de-looping manoeuvres; and increased use of manual abdominal pressure. Methods: The records of all procedures performed by the same operator over the 4 years following the previous audit were reviewed retrospectively. The prime data collected were patient demographics, completion rate type of colonoscope used, and total procedural time ("door-to-door"). Results: There was no significant difference in patient demographics of the 653 procedures. The completion rate was significantly improved to 85.9% overall and 90.2% adjusted (p < 0.005). This improvement was still seen when comparing only procedures done with a CF230L colonoscope: 85.9% cf. 74.5% overall (p < 0.001) and 89.7% cf. 81.3% adjusted (p < 0.005). There were significantly more procedures taking 40 min or more (21.6% cf. 14.2%, p < 0.05) in the second audit period. Conclusion: While certain aspects of technique are clearly important, it may be that workload constraints are primarily responsible tar Iow completion rates. More acceptable standards appear feasible if time is made available for the difficult cases.


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