Improving the detection rate of microscopic colitis by introducing a colonoscopy quality-assurance programme

Background and study aimMicroscopic colitis (MC) is diagnosed when a patient with chronic watery non-bloody diarrhoea (CWND) has an endoscopically normal colon (ENC) but colonic biopsies (CBs) show unique inflammatory changes. A colonoscopy quality-assurance programme (CQAP) was instituted in 2003 in our institution. The aim of this study was to determine the effect of instituting a CQAP on the alertness of the endoscopist in detecting MC in patients with CWND and ENC.Patients and methodsInitial assessment was performed in 2003. A total of 10 patients with CWND had ENC; however, ileoscopy was not performed. CBs were obtained for further investigations in 40% of the patients. MC was diagnosed in 10% of the patients. A quality-improvement process was instituted which required both ileoscopy to be routinely performed and CB to be routinely obtained in all patients with CWND and ENC. A total of 41 patients for the period 2004–2009 were assessed retrospectively.ResultsIleoscopy was performed in 25% of patients in 2004, 57% in 2005, 67% in 2006, 67% in 2007 and 100% of patients in 2008 and 2009. Ileoscopy rates increased significantly (p < 0.001) from 53% of patients in 2004–2006 to 92% in 2007–2009. CBs were obtained in 50% of patients in 2004, 71% in 2005, 83% in 2006 and 100% of patients in 2007, 2008 and 2009. The number of patients in which CBs were obtained increased significantly (p < 0.001) from 71% of patients in 2004–2006 to 100% in 2007–2009. MC was diagnosed in 0% of patients in 2004, 14% in 2005, 33% in 2006, 50% in 2007, 50% in 2008 and 80% of patients in 2009. The frequency of diagnosing MC increased significantly (p < 0.001) from 18% of patients in 2004–2006 to 63% in 2007–2009.ConclusionThe implementation of a quality-assurance and improvement programme enhanced the quality of colonoscopy, increased the alertness of the endoscopist in detecting MC and improved the detection rate of MC.