Quality measurement and improvement in colonoscopy

Colonoscopy is now a widely accepted method of screening and surveillance of the colon for neoplastic lesions in patients over 50 years of age. The main advantage of colonoscopy as opposed to other screening tests is the ability to remove precancerous polyps at the time of their detection. However, colonoscopy may miss clinically important neoplastic lesions. The effectiveness of colonoscopy in reducing colorectal cancer incidence depends on adequate visualization of the entire colon and diligence in examining the mucosa. Factors such as inadequate bowel preparation, suboptimal colonoscopy technique, rapid withdrawal, ineffective polypectomy, and failure of physicians to recognize flat lesions can potentially influence the effectiveness of colonoscopy. Considerable variation has been reported in colonoscopy performance among centers and endoscopists. In recent years, various approaches have been advocated to improve the quality of colonoscopy; however, the overall impact of these interventions is not fully known. Understanding the biological and behavioral factors that contribute to variable detection, identifying corrective measures to both failed and variable detection, developing optimal educational measures, and studying the impact of newer technologies in improvement of quality will be essential in the future to maximize the effectiveness of colonoscopy.