ABSTRACT
Background and study aims To compare the quality of colonoscopy in a population-based coordinated program of colorectal cancer screening according to type of hospital (academic or non-academic). Patients and methods Consecutive patients undergoing colonoscopy after positive FIT (≥â20âug Hb/g feces) between January 2009 and September 2016 were prospectively included at five academic and seven non-academic public hospitals. Screening colonoscopy quality indicators considered were adenoma detection rate, cecal intubation rate, complications and bowel preparation quality. Results A total of 48,759 patients underwent colonoscopy, 34,616 (80â%) in academic hospitals and 14,143 in non-academic hospitals. Among these cases, 19,942 (37.1â%) advanced adenomas and 2,607 (5.3â%) colorectal cancers (CRCs) were detected, representing a total of 22,549 (46.2 %) cases of advanced neoplasia. The adenoma detection rate was 64â%, 63.1â% in academic hospitals and 66.4â% in non-academic hospitals ( P â<â0.001). Rates of advanced adenoma detection, cecal intubation and adequate colonic preparation were 45.8â%, 96.2â% and 88.3â%, respectively, and in all cases were lower (implying worse quality care) in academic hospitals (45.3â% vs 48.7â%; odds ratio [OR] 0.87, 95â% confidence interval [CI] 0.84â-â0.91; 95.9â% vs 97â%; OR 0.48, 95â% CI 0.38â-â0.69; and 86.4â% vs 93â%; OR 0.48, 95â% CI 0.45â-â0.5; respectively; P â<â0.001 in all cases). In 13 patients, all in the academic hospital group, CRC was diagnosed after colonoscopy (0.26 casesâ×â1000 colonoscopies). Rates of CRC treated by endoscopy were similar in both types of hospital (30â%). The rate of severe complication was 1.2â% (602 patients), with no significant differences by hospital type: bleeding occurred in 1/147 colonoscopies and perforation in 1/329.âOne patient died within 30 days after screening colonoscopy. Conclusions The quality of colonoscopy was better in non-academic hospitals. The rate of detection of advanced neoplasia was higher in non-academic hospitals and correlated with the rate of post-colonoscopy CRC.