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Quality Criteria for Colonoscopy in a Digestive Endoscopy Unit in Abidjan

Soro Dramane*, Al Vera VDM, Ouattara A, Lah Bi R

Aim: to assess the quality criteria of colonoscopy in an endoscopy unit. Patients and methods: descriptive and analytical cross sectional study with retrospective and prospective recruitment including all diagnostic and or therapeutic colonoscopies performed in a Polyclinic between June 2017 and June 2020.
Material and methods: Colonoscopies whose reports had missing data were excluded and any colonoscopy interrupted, rescheduled within 48 hours. The Chi2 test was used to compare the different variables. The odds ratio (OR) and 95% confidence intervals (CI) were calculated to assess the strength of association between the major indicators and the different independent variables. The significance level was set at p<0.05. 
Results: Out of a total of 1194 colonoscopies performed by 04 endoscopies, 1098 colonoscopies were retained. The average age was 51.7 years (02 to 86), with a sex ratio of 1.12. Abdominal pain (25%), rectal bleeding (20.8%) and transit disorders (11%) were the main indications. Screening colonoscopy accounted for 10.7%. The diagnostic yield of colonoscopy was 77.2%. The most frequent organic lesions were polyps (18.11%, n=173) followed by hemorrhoidal disease (17%, n=162) and colonic diverticulosis (11.51%, n=110). There were 23 cases of colorectal tumor of malignant appearance. The rate of adequate bowel preparation was 82% and 25 colonoscopies were assessed according to the BBPS, 80% of which had a Boston score ≥ 6. The complete colonoscopy rate was 99.3%. The TDP was 15.82%; the overall ADD was 10.6%, varied according to the endoscopist from 3.92 to 16.12%; with an ADHD of 2.91%. In univariate analysis, good colonic preparation (p=0.019), age ≥ 40 years (p=0.01) and the indication for CRC screening (p=0.01) were factors correlated with the detection of polyps. In multivariate analysis, age ≥ 40 years (OR: 1.95; 95% CI: 1.12-3.40; p: 0.017) and good co-lonic preparation (OR: 2.19; 95% CI: 1, 10-5.38; p: 0.04) were independently associated with the detection of polyps. Factors independently associated with adequate bowel preparation were absence of diabetes (OR: 17.37; 95% CI: 6.50-46.38; p: 0.001) absence of pelvic surgery (OR: 6.02; 95% CI: 2.17-16.7; p: 0.001) and the absence of arterial hypertension (OR: 3.38; 95% CI: 1.56-7.30; p: 0.02). The factor associated with the detection of adenomas were age ≥ 40 years (OR: 10.08; 95% CI: 1.2-82.60; p: 0.01).
 Conclusion: the quality of colonoscopy is still suboptimal compared to the required international standards. Age >40 years, absence of comorbidities and adequate colonic preparation were factors associated with major indicators of colposcopy quality Key words: Colonoscopy, Quality indicators, Adenoma, Colorectal cancer.