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Significance of this study
What is already known about this subject?
Concerns have previously been raised regarding the quality of colonoscopy in England.
A number of strategies over the last 10 years have aimed to improve the quality of colonoscopy.
Adenoma detection rate (ADR) is widely used as the key indicator of colonoscopic quality.
What are the new findings?
A large national screening programme can deliver high standards of colonoscopy quality and safety.
Variation in colonoscopic performance exists within the programme.
ADR is an important marker of colonoscopic practice; however, measures of total numbers of adenomas detected (mean adenomas per procedure (MAP) and mean adenomas per positive procedure (MAP+)) provide additional information.
How might it impact upon clinical practice in the foreseeable future?
Quality of colonoscopy should be assessed in three domains: technical quality, patient safety and patient experience.
Assessment of MAP and MAP+ in addition to ADR provides additional information about colonoscopy performance.
Colonoscopy adverse events should be stratified according to severity for quality assurance purposes.
These data can be used to inform patient consent and procedure-related risk.
Investigation of the factors accounting for variations in colonoscopic practice is required to minimise these variations in the future.
Introduction
Screening for colorectal cancer (CRC) is undertaken in many countries worldwide. One widely used strategy is biennial faecal occult blood (FOB) testing followed by colonoscopy for those with a positive FOB test. 1 The main aim of CRC screening is to reduce mortality by early detection and treatment of cancer. A secondary aim is to detect and remove adenomas in order to prevent progression to cancer. Adenoma detection is known to vary widely both between and within screening programmes. 2-6 Much of this variation may be explained by factors relating to quality of the colonoscopy. The importance of ensuring high-quality colonoscopy within screening programmes has been emphasised in a number of recent studies and guidelines. 7-9
Adenoma detection rate (ADR) is a widely used indicator of colonoscopy quality 10 ; it is a marker of both the technical quality of the procedure and the efficacy of the screening strategy. Other domains of quality assessment including safety and patient experience are also crucial. A UK audit of colonoscopy published in 2004 raised concerns about the quality...