Quality of colonoscopy practice: a single-center experience in Egypt Ahmed S. Gado a , Basel A. Ebeid d , Aida M. Abdelmohsen b , Tarek S. Gado c , Anthony T. Axon e a Department of Medicine, Bolak Eldakror Hospital, b Department of Community Medicine, National Research Center, c Department of Medicine, Cairo University, Giza, d Department of Tropical Medicine and Infectious Diseases, Beny Suef University, Beny Suef, Egypt, e Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK Correspondence to Ahmed S. Gado, MD, Department of Medicine, Bolak Eldakror Hospital, Bolak Eldakror, Giza 2019, Egypt; Tel: +20 235 837 644; fax: +20 235 702 164/357 212 25; e-mail: agado1954@yahoo.com Received 6 November 2016 Accepted 4 December 2016 The Egyptian Journal of Internal Medicine 2016, 28:108–115 Background Colonoscopy is a technically demanding procedure with the potential to cause harm if its performance is suboptimal. It is incumbent on endoscopists, therefore, to evaluate their practices and to make improvements wherever possible. Bolak Eldakror Hospital is a secondary-care governmental hospital in Egypt in which we set up an endoscopy quality-assurance program in 2003. Aim The aim of this study was specifically to evaluate the quality of colonoscopy practice in our endoscopy unit and by publishing our experience to encourage others to develop a quality-improvement program. Patients and methods Predetermined international quality indicators for colonoscopy were employed to monitor the standard of endoscopic procedures between 2010 and 2014. Recorded information included all medical and technical details. Results A total of 286 colonoscopies were assessed. The main indication of colonoscopy was hematochezia (58.7%). Polyps were the main endoscopic findings (34.6%). Conscious sedation was used in 56.6%. Cecal intubation was achieved in 77.6%. The adjusted cecal intubation was 94%. Image documentation of cecal intubation was achieved in 92.3% examinations reaching the cecum. Mean cecal intubation time was 17.4±10 min. Mean withdrawal time was 6.6±4 min. The main reasons for unsuccessful cecal intubation were impassable mass or stricture in 23 (8%) colonoscopies and poor bowel preparation in 23 (8%). Colon preparation was rated adequate in 66.4%. Diagnostic colorectal biopsies for those with persistent diarrhea were obtained in 97%. Polyp detection rate was 36.1% and adenoma detection rate was 5.3%. Polypectomy was carried out in 89 (93.6%) patients with detected polyp/s. Retrieval of all excised polyps was successful in 84.3%. Postpolypectomy perforation occurred in one (0.4%) patient. Conclusion A high standard of colonoscopy can be achieved by the rigorous application of quality-assurance measures. Keywords: colonoscopy, quality assurance, quality Egypt J Intern Med 28:108–115 © 2017 The Egyptian Journal of Internal Medicine 1110-7782 Introduction Colonoscopy has become an essential investigation for screening, diagnosing, and treating colorectal problems. However, it is a technically demanding procedure with the potential to cause harm if its performance is suboptimal. Because the procedure is highly operator dependent, standards vary greatly both between individuals and endoscopy units [1]. High- quality colonoscopy maximizes its benefit but poor quality is associated with increased interval cancer rates [2]. A high cecal intubation rate is commonly regarded as a surrogate marker for good quality [3]. The United States Multi-Society Task Force on Colorectal Cancer has recommended that clinicians should achieve a cecal intubation rate of at least 90% overall and 95% in screening colonoscopies. Reported rates, however, range from 76 to 99% [2]. This wide variation suggests that the quality of colonoscopy provided in some centers is poor [4]. The skill and performance of the individual endoscopist is the most important determinant for successful cecal intubation [5]. Professional societies have recommended that a system of continuous quality improvement should be part of every colonoscopy service [6]. A study in the UK in 2004 showed that the crude colonoscopy completion rate (CCR) improved from 60 to 88% after the implementation of a quality-improvement program This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms. 108 Original article © 2017 The Egyptian Journal of Internal Medicine | Published by Wolters Kluwer - Medknow DOI: 10.4103/1110-7782.200968