The Quality in Colonoscopy metrics.

Colonoscopy is a commonly performed procedure for the diagnosis and treatment of a wide range of conditions and symptoms, and for the screening and surveillance of colorectal neoplasia.

Many studies demonstrate that colonoscopy offers substantial protection against colorectal cancer (CRC). The effectiveness of colonoscopy in reducing colorectal cancer is influenced by multiple factors, including the quality of the bowel preparation. The following criteria are increasingly used for objective evaluation and feedback:

  • Adenoma detection rate
  • Caecal intubation rate
  • Withdrawal time
  • Lowest rate of complications
  • Patient comfort

The efficacy of colonoscopy depends on its ability to detect colorectal neoplasia. In order to maximize the detection power, it is important not only to improve the examination technique and quality of bowel preparation, but also to engage advanced imaging technologies such as High-Definition endoscopy, virtual chromoendoscopy, or add on devices, such as SCOPEPILOT.

For more information also try the Quality in Colonoscopy App by PENTAX Medical. It provides the unique combination of the scientific background of Quality in Colonoscopy metrics and how PENTAX Medical supports this metrics with the latest technologies in colonoscopy.


Get it on Google Play

Adenoma detection rate (ADR)

Why is ADR an important indicator for Quality in Colonoscopy?

An adenoma is a benign "lesion" originating from glands that have a higher potential of development into a malignant lesion. The adenoma detection rate (ADR) refers to the proportion of screened subjects in which at least one adenomatous lesion is identified. ADR has emerged as a major quality indicator in colonoscopy 1. The detection and complete removal of adenomatous lesions reduce the incidence of colon cancer and mortality in screening colonoscopies 2.

How PENTAX Medical influences ADR.

HD+ endoscopes with adequate illumination facilitate the detection of suspicious lesions 3, which need to be characterized with the support of enhanced endoscopy, such as i-scan TE and Twin Mode (i-scan study) 4, to decide if they are adenomatous lesions. The endoscope withdrawal in retroversion (RetroView) or the usage of magnification endoscopes (MagniView) increase the detection of potential adenomas 5 behind or between the folds. It also characterizes those flat lesions difficult to be identified as an adenoma.

How SCOPEPILOT may influence ADR.

SCOPEPILOT aims to ensure optimal conditions for an efficient, safe and comfortable procedure. In conjunction with the information provided by the 3D image, it is easier to identify and target small polyps or adenomas during insertion. This may potentially increase the adenoma detection rate.

Caecal intubation rate (CIR)

Why is CIR an important indicator for Quality in Colonoscopy?

Caecal intubation is defined as the passage of the colonoscope tip to a point proximal to the ileocecal valve and the visualization of the entire cecum. Caecal intubation rate (CIR) refers to the proportion of complete examinations, adjusted for incomplete examinations owing to very poor bowel preparation or a stricture caused by a tumor 1. As part of European CRC screening recommendations, the caecal intubation rate is globally recognized as the main indicator of competence in colonoscopy, as a poor completion rate may be one reason why colonoscopy does not prevent cancer in the right colon 2.

How PENTAX Medical influences CIR.

Today’s colonoscopes are expected to provide a predictable flexibility profile and a balance between flexibility, pushability and torque control. All PENTAX Medical colonoscope insertion tubes are configured with i-FLEX™ and TrueTorque™ technology to overcome the daily challenges of colonoscopy.

How SCOPEPILOT may influence CIR.

  • The benefits of using a colon navigation system to improve the caecal intubation rates have been reported in several clinical studies 3.
  • High CIR may also correlate with patient comfort and a lower complication rate 4. SCOPEPILOT helps to identify loops that can easily be overcome and helps track the position of the colonoscope, enabling a more efficient procedure and greater patient comfort.
  • PENTAX Medical’s "Training for Excellence" aims to increase the colonoscopy skills (the caecal intubation rate), through professional education supported by SCOPEPILOT.

Withdrawal time

Why is withdrawal time an important indicator for Quality in Colonoscopy?

Withdrawal time means inspection time in minutes upon withdrawal from the caecal pole to the anus in negative procedures 1. In the case of a negative colonoscopy (i.e. no pathology detected), withdrawal time should take a minimum of 6 minutes 1. Two large studies have supported withdrawal times of 6 minutes or longer and demonstrate a significant variability in adenoma detection amongst experienced colonoscopists and a linear relationship between withdrawal time and adenoma detection rate 2, 3.

How PENTAX Medical influences withdrawal time.

TrueTorque™ technology, ensures predictable movement to withdraw the colonoscope efficiently.

How SCOPEPILOT may influence withdrawal time.

  • The 3D magnetic image generated by SCOPEPILOT shows how the colonoscope is progressing along the colon. This feature helps to understand the patient’s anatomy and overcome any complications, avoiding potential delays during withdrawal.
  • TrueTorque™ technology, as part of the structure of the EC38-i10N insertion tube, ensures predictable movement to withdraw the colonoscope efficiently.
  • PENTAX Medical’s "Training for Excellence" aims to increase the colonoscopy skills (withdrawal time), through professional education supported by SCOPEPILOT.

Patient comfort

Why is patient comfort an important indicator for Quality in Colonoscopy?

The relationship between patient comfort and experience is a commonly used performance indicator for colonoscopy 1. Bowel cancer screening can prevent the development of polyps in cancer, thus, it is extremely important to increase the acceptance of the program. Furthermore, if a patient undergoes a colonoscopy, they should experience a comfortable examination, minimizing the level of apprehension that is connected with the procedure1. Ideally, a colonoscopy should be safe, complete and comfortable. It should also detect and safely and completely remove all significant lesions 1.

How PENTAX Medical influences patient comfort.

The HD+ and high performance colonoscopes series aims to increase patient comfort, offering expanded therapeutic options for the operator with a short bending radius. CO2 insufflators enable a longer duration of colonoscopy and a higher level of patient comfort. The colonoscopists with the highest CIR use less sedation, cause less discomfort and achieve a better patient experience.

How SCOPEPILOT may influence patient comfort.

  • SCOPEPILOT’s true 3D image provides an additional visualization tool to understand the scope positioning and orientation for a more efficient procedure and increased patient comfort.
  • Loops formation can be anticipated with SCOPEPILOT before causing pain to the patient.
  • The i-FLEX™ and TrueTorque™ structure technology of the EC38-i10N insertion tube allows for smooth intubation and ensures a predictable movement, to reach the caecum in a safe and smooth manner.
  • Patient comfort and faster procedures reduce patient need for anesthesia and sedation 2.
  • PENTAX Medical’s "Training for Excellence" aims to increase colonoscopy skills (increasing patient comfort), through professional education supported by SCOPEPILOT.

Rate of complications

Why is the rate of complications an important indicator for Quality in Colonoscopy?

An "adverse event" is defined as preventing the completion of the planned procedure (excluding technical failure or poor preparation). Colonoscopic adverse events are unusual, but may be potentially life threatening 1. Perforation is the most serious colonoscopy-related complication in the short term, and can occur during the diagnostic phase of the exam or result from polypectomy. There is no doubt that Quality in Colonoscopy should be associated with a very low complication rate.

How PENTAX Medical influences the rate of complications.

The slim RetroView colonoscope enables the performance of interventional endoscopy in retroversion with more comfort and safety. Today’s colonoscopies are expected to provide a predictable flexibility profile together with a balance between flexibility, pushability and torque control. All PENTAX Medical colonoscope insertion tubes are configured with i-FLEX™ and TrueTorque™ technology to overcome the daily challenges of colonoscopy. CO2 insufflators enable longer colonoscopy procedures and potentially reduce the complication rates.

How SCOPEPILOT may influence the rate of complications.

  • SCOPEPILOT’s true 3D image provides an additional visualization tool to understand the scope positioning and orientation for a more efficient and safe procedure.
  • The i-FLEX™ and TrueTorque™ structure of the EC38-i10N insertion tube allows a smooth intubation, thanks to the increased flexibility in the distal part of the endoscope. This also ensures a predictable movement to minimize potential perforation risk during the procedure.
  • SCOPEPILOT’s simultaneous viewpoints allow for an anterior and superior view of the scope and a more detailed view of the loops.
  • PENTAX Medical’s "Training for Excellence" aims to increase colonoscopy skills and reduce the rate of complications through professional education supported by SCOPEPILOT.