How Good Really Is Colonoscopy? How good is it at Digestive Health in Durango?
All colonoscopies are not the same...
"Patients who want the best results should pick an outstanding colonoscopist" -New York Times editorial, December 19, 2008
"Patients who opt for a colonoscopy — which lets doctors detect and remove polyps in one procedure — should look for the most skilled gastroenterologist possible" -Robert Smith, American Cancer Society, from USA Today, December 21, 2008
CORI Excellence Report: Quality Measures for Adult Colonoscopy
Digestive Health's gastroenterologists and staff are committed to providing our patients with high quality colonoscopy services. We continuously measure what we do and we compare our outcomes to those of other experts in our field. This process is called "benchmarking." In its Excellence Report project, CORI, the Clinical Outcomes Research Initiative, gathers standardized data from endoscopy facilities that participate in its research consortium and allows each facility to compare itself against the large universe of all CORI endoscopists. In considering these comparisons of our work with that of others it is important to recognize that the reference group is comprised of other university and private practice gastroenterologists who similarly are striving for excellence in their work and are willing to share information regarding their outcomes with others in an effort to improve the quality of the care they provide and that of endoscopic care in general through research.
The data below reflect colonoscopy examinations performed by Digestive Health physicians compared to the CORI reference group for procedures performed during 2011.
Southwest Endoscopy
All CORI Providers
Total colonoscopies (1 year)
2,382
66,084
Cecal intubation rate
99.2%
97.7%
Average withdrawal time (screening exams)
9.1 minutes
8.9 minutes
Polyp detection rate
47.3%
42.8%
What These Data Mean and Why These Measures Matter
Number of procedures performed (total colonoscopies) This shows the number of colonoscopies we performed at the Southwest Endoscopy Center over a one year period of time, comparing our procedures to the number performed by the CORI research consortium at large. These data exclude the procedures that we perform at Mercy Regional Medical Center. When you choose a physician to perform your colonoscopy you should ensure that the doctor not only has the appropriate specialty training to perform high quality colonoscopy, but also that he or she devotes a major part of their practice to doing colonoscopy and performs a sufficient volume of these procedures to support an ongoing level of expertise.
Cecal intubation rate The cecum is the upper end of the colon. An examination that fails to reach the cecum is incomplete. While it is not always possible to reach the cecum in every patient, a high cecal intubation rate reflects a high level of technical expertise in the performance of colonoscopy. It is appropriate to ask the physician planning your colonoscopy what his or her cecal intubation rate is.
Average withdrawal time While it might seem that a fast colonoscopy is a good one, the opposite is true. Once we reach the cecum we begin a careful meticulous examination of the entire colon lining, which takes time. The time necessary to perform a high quality examination varies from patient to patient, but most of us use timers to help us perform a well structured withdrawal. Withdrawal times that are short have been associated with both a low adenoma (polyp) detection rate (meaning a high miss rate) and a higher rate of "interval" (some of which are missed) colon cancers. Ask your doctor how fast he or she withdraws the instrument.
Polyp detection rate This measure really reflects the opposite of a "miss rate." Colonoscopy is not perfect and even expert colonoscopy doctors can miss "lesions." The real worry is missing a cancer (or having a patient in whom no polyp or cancer was found return within a short period of time with a cancer, suggesting that the growth may have been missed during the first examination). The most important measure of effectiveness and quality that we have is our polyp detection rate. A high rate means a low "miss rate." Ask your doctor about his or her polyp detection rate.
"Patients who want the best results should pick an outstanding colonoscopist, cleanse their bowels scrupulously and probably take the final laxative dose shortly before the procedure. Colonoscopies have helped reduce the death rate from colorectal cancer. The main problem with colonoscopies is that too few people bother to get them."
What can I do to be sure that my colonoscopy is as good as it can be?
-Do your colon cleanse properly. We understand that this is the most difficult part of your exam. It is critical though that you do your part properly, so that we can provide you with the best examination possible.
-Pick an expert doctor to do your colonoscopy A well-trained gastroenterologist is the best doctor to perform your colonoscopy. Gastroenterologists undergo more extensive training in endoscopic procedures than doctors in any other specialty, and they devote a majority of their practice to performing colonoscopy. They are the specialists best prepared to provide you with a complete examination, and they have the experience necessary to identify subtle abnormalities, such as flat neoplasms, from which many right-sided colon cancers may arise. They are also best prepared to remove these growths at the time of your procedure.
-Schedule your colonoscopy at an expert endoscopy facility A well-trained and experienced staff and dedicated facility systems are essential. Nurses and technicians who assist with colonoscopy procedures every day are of critical importance and are necessary to help the colonoscopy doctor provide a safe, comfortable and effective examination. An expert colonoscopy doctor is only as good as the facility's support staff. Endoscopy facilities should continuously evaluate the performance of the facility and its endoscopist physicians. Avoid facilities in which colonoscopy seems to be an afterthought or hobby, rather than its central purpose.
-Return for your next examination when advised.
Questions you may want to ask a doctor before choosing him or her to perform your colonoscopy...
How many colonoscopies do you do? Digestive Health's gastroenterologists each perform over 750 colonoscopies annually.
Does colonoscopy represent a large percentage of your procedural practice? Colonoscopy makes up over 60% of the procedures that each of Digestive Health's gastroenterologists perform.
Do you monitor your adenoma detection rate, and does it exceed currently accepted continuous quality improvement (CQI) measures? This is important because a rate of finding adenomas (potentially premalignant growths) that is lower than the known expected rate for adenomas to occur in a general population suggests that the doctor is missing lesions (higher "miss rate"). Endoscopists who have a low adenoma detection rate have a higher rate of "incident cancers" detected in the patients in whom they have performed colonoscopy. Digestive Health monitors adenoma detection rates for its gastroenterologists for procedures performed at the Southwest Endoscopy Center, and each gastroenterologist's rates exceed current performance measures.
Do you monitor your colonoscopy withdrawal times, and do your withdrawal times exceed currently accepted CQI performance measures? This is important because doing a colonoscopy using standardized and slow withdrawal of the instrument has been shown to lead to a higher rate of finding lesions (lower "miss rate"). Digestive Health monitors colonoscopy withdrawal times for its gastroenterologists for procedures performed at the Southwest Endoscopy Center, and each gastroenterologist's rates exceed current performance measures.
Questions you may want to ask a facility before choosing it as a place to have your colonoscopy...
How many colonoscopies do you do? The Southwest Endoscopy Center performs approximately 2,200 colonoscopies yearly.
Does colonoscopy represent a large percentage of the procedures you perform? Colonoscopy procedures make up over 70% of the procedures performed at the Southwest Endoscopy Center.
Board Certified Specialists in Gastroenterology Recognized by the American Society for Gastrointestinal Endoscopy for promoting quality in endoscopy | AAAHC-accredited Endoscopy Center
The material provided on this website is for general informational purposes only. If you need specific medical advice, please contact our office for an appointment.
