Colonoscopy plays a crucial role in preventing colorectal cancer. But how can we make the procedure safer, more accurate and more comfortable for patients? We asked CCA researcher Querijn van Bokhorst, who defended his PhD thesis last week, three questions about his research and its most important findings.
1. Why is it important to improve how we measure colonoscopy quality?
“Colonoscopy is the key procedure for detecting colorectal disease and preventing colorectal cancer, but its effectiveness depends heavily on the quality of the procedure. Our research focused on how colonoscopy can be made more measurable, safer, more patient-centered and effective through better quality monitoring, optimizing standard practices and implementing technical innovations.
For example, we established an infrastructure for automated linkage of the data from the Dutch national endoscopy and pathology databases.This could make nationwide monitoring of important quality indicators, such as the detection of precancerous polyps, easier. We also established an international consensus on how to assess whether colorectal polyps smaller than 20 mm have been completely removed.”
2. What did your research reveal about patient safety and experience?
“One important finding was that clinicians accurately estimated the extent of the patients’ pain and discomfort during colonoscopy in only about half of cases. This shows why it is so important to ask patients themselves about their experience, and not only rely on observations by clinicians. In terms of colonoscopy sedation, national data showed an overall increase in the use of propofol-based sedation. Meanwhile, sedation practices we found to vary considerably between Dutch endoscopy centres. These insights may be useful to shape future (colonoscopy) sedation guidelines.
We also looked at safety. Our research helped further standardize the reporting of endoscopy-related complications and showed that cold snare removal of small polyps appears safe even when high-risk antithrombotic therapy is continued, with delayed bleeding occurring in only ~0.6% of patients. This finding eases management of antithrombotic therapy around colonoscopy.”
3. Can new technologies help make colonoscopies more accurate?
“New technologies offer opportunities, but it remains important to test whether they actually improve patient care. In a large randomized trial, we evaluated the effect real-time assistance of a computer-aided polyp detection (CADe) system during colonoscopy in patients with Lynch syndrome, a population at increased hereditary risk of colorectal cancer. In expert settings, the CADe systems did not result in a significant increase in the detection of precancerous polyps. Meanwhile, a virtual measurement tool was shown to significantly reduce variation in polyp size measurement, potentially improving the consistency of clinical decision-making involving polyp size.
Overall, the studies performed provide practical ways to better measure and advance colonoscopy quality, thereby hopefully improving clinical outcomes for patients.”