Colonoscopy is used both diagnostically and therapeutically and permits examination and treatment of the rectum, colon, and a portion of the terminal ileum. Performance of a high-quality colonoscopy examination requires understanding and mastery of cognitive and technical skills.
●Preprocedure – Attention must be paid to the general issues of timely scheduling, appropriate patient preparation, targeted history and physical examination, evaluation of bleeding risk, assessment for appropriate sedation, and team pause before commencing sedation. It is also important to understand appropriate indications and recommended surveillance intervals based upon the patient’s risk factors (eg, family history of colorectal cancer, prior adenomatous polyps, hereditary colon cancer syndrome, or inflammatory bowel disease). Finally, obtaining informed consent with a detailed explanation of the risks associated with colonoscopy is essential.
●Intraprocedure – Performing a high-quality examination requires careful visualization of the entire colonic mucosa. Metrics such as cecal intubation rates, withdrawal times, and adenoma detection rates serve as surrogate, though imperfect, markers of careful visualization. In addition, a high-quality examination requires appropriate tissue acquisition (eg, surveillance biopsies in inflammatory bowel disease) and endoscopic removal of all polyps less than 2 cm. Removal of polyps larger than 2 cm may require special endoscopic skills.
●Postprocedure – There must be immediate, complete, and accurate documentation (both written and photographic) of preparation quality and findings, as well as explicit recommendations for follow-up. Tissue samples taken during colonoscopy must be documented. Pathology results should be reviewed with results and recommendations communicated to the patient and referring providers. Finally, there should be a system for tracking complications.