Why is the quality of colonoscopy important?

High quality colonoscopy is critical to the early detection and treatment of bowel cancer.

Removal of polyps and adenomas may prevent bowel cancer developing, while early diagnosis of bowel cancer can improve treatment outcomes and survival.

Colonoscopy can also identify those who require regular colonoscopy surveillance due to having an increased risk of bowel cancer.

The quality of colonoscopy is therefore important for minimising the risk of complications from the procedure.

Complications associated with colonoscopy include:

  • risks of the procedure itself such as perforation and bleeding
  • risks associated with bowel preparation including dehydration and electrolyte imbalances which can be serious
  • complications arising from sedation or anaesthesia

The risk of serious complications is approximately 4 perforations and 8 major bleeding events per 10,000 screening colonoscopies with an estimated mortality rate of 0.007%.

Risk increases with age, with the number of colonoscopies and when polyps are removed.

While the risk of complication is relatively small, a large number of people undergo colonoscopy, many of whom are not diagnosed with any disease.

Who will perform the colonoscopy?

Once you’ve been referred by your GP for a colonoscopy, find out who will be performing the procedure.

Make sure your colonoscopy will be done by an experienced colonoscopist who is interested in constant improvement in the quality of colonoscopy that he or she provides.

Questions to ask

Below is a list of questions to ask your colonoscopist to help ensure a high-quality colonoscopy.

This percentage is referred to as a Colonoscopist’s Adenoma Detection Rate (ADR) and is considered the measurement that best reflects how carefully colonoscopy is performed.

This percentage is referred to as a Colonoscopist’s caecal intubation rate and is considered an important indicator of colonoscopy quality.

This will illustrate if the full extent of the bowel was examined.

Effective bowel preparation requires that at least half the preparation is ingested on the day of colonoscopy.

To ensure effective examination of the bowel it must be prepared according to the instructions accompanying the bowel preparation, otherwise polyps and cancers can be missed, and the colonoscopy may need to be repeated.

Longer colonoscopy withdrawal times have been shown to improve polyp detection rates, whereas rapid withdrawal of the colonoscopy may miss polyps and reduce the effectiveness of bowel cancer prevention.

What you can expect from your colonoscopist

  • They are well trained in the procedure and meets agreed standards for competence.
  • There will be skilful and thorough examination of all parts of the large bowel.
  • Risk factors (e.g. anticoagulant therapy, presence of severe co-morbidities) will be identified well before colonoscopy and action taken to minimise risk.
  • You will be given a clear explanation of what is involved in the procedure and have an opportunity to ask for more information and that this information will be provided before starting your bowel preparation.
  • You will be given clear information about the details of the bowel preparation, including the importance of maintaining hydration.
  • The type of bowel preparation selected for you was based on your personal risk factors (e.g. age, renal impairment) and your personal preference.
  • The procedure will be performed safely and with minimal discomfort.
  • Verbal and written information about the results of the procedure are given to you.
  • Verbal and written instructions about what to do if problems occur after discharge are provided.
  • Information about follow-up review is given.

My Colonoscopy Experience

Every person’s feedback about their colonoscopy experience is unique and valuable. Help us ensure the patient voice is heard, so that future colonoscopy care reflects what patients want and need.