Screening Colonoscopy Best Practices Released

By Jessica Pyhtila, PharmD, BCGP, BCPS

The American Gastroenterological Association recently released a set of best practices to improve screening and surveillance colonoscopies. The best practices consist of 15 recommendations to help guide care at both the provider and facility levels:

1. The quality of bowel preparation quality should be measured in both screening and surveillance colonoscopies.

2. A split-dose bowel preparation should be the standard preparation strategy prior to colonoscopy.

3. Instructions for bowel preparation should be written in the patient’s native language at a sixth-grade reading level, and offer additional preprocedural education and support as needed.

4. High-definition colonoscopes should be used for both screening and surveillance colonoscopy.

5. Cecal landmarks should be photo-documented in colonoscopy reports, and cecal intubation rates should be measured on an endoscopist level.

6. Colonoscope withdrawal times should be measured on an endoscopist level.

7. To improve polyp detection, endoscopists should perform a second look at the right colon.

8. Adenoma detection rates should be measured at both the endoscopist and facility levels.

9. The goal adenoma detection rate should be greater than or equal to 30%.

10. Serrated lesion detection rates should be measured at both the endoscopist and facility levels.

11. Cold snare polypectomy should be used for polyps measuring between 3 and 9 mm. Forceps should be avoided for polyps greater than 2 mm.

12. Removal of complex polyps where cancer is not suspected should be attempted by an expert in polypectomy.

13. Colonoscopy should be documented thoroughly. Items that should be included are: indication, extent of examination, bowel preparation quality, findings and interventions, and follow-up plan with rationale.

14. Patients should be educated on the potential for adverse events, warning symptoms, and emergency contact information.

15. Current guidelines should be followed. This includes having all patients with advanced adenomas get a repeat colonoscopy in 3 years. Other patients should not undergo repeat examinations before 10 years.

References:

Keswani, Rajesh N.; Crockett, Seth D.; Calderwood, Audrey H. “AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review,” Gastroenterology, August 1, 2021. Retrieved from: https://www.gastrojournal.org/article/S0016-5085(21)03031-6/fulltext