Sustained Success in Endoscopic Performance demonstrated by the Irish National Endoscopy Quality Improvement Programme

Background The National Gastrointestinal Endoscopy Quality Improvement (NEQI) Programme captures over 94% of endoscopic activity in the Republic of Ireland (ROI), accounting for >120,000 colonoscopies per annum. Aims To assess temporal changes in colonoscopy Key Quality Indicators (KQIs) at a national level over a 5-year period amongst low, intermediate and high-volume endoscopists. Methods A retrospective analysis of all NEQI colonoscopy episodes occurring between 2016-2022, collating colonoscopy KQIs (Caecal intubation rate (CIR), Comfort Scores (CS), Polyp Detection Rates (PDR) and sedation use). Endoscopists with 5 consecutive years of activity, were defined as low, intermediate or high activity according to annual procedural volumes. Results Over 658,000 colonoscopies were completed by 1240 endoscopists. Workload is disproportionate, with 36% of endoscopists completing 66% of national colonoscopy volume. Low, intermediate and high activity endoscopists all demonstrated sustained improvements in KQI targets over the study period. Comparing experts (≥300 colonoscopies/year) vs non-experts, KQI plateaus were demonstrated for PDR at <150 colonoscopies per year (34.2% vs 29.6%, p=0.002), CS at <200 procedures per year (97.5% vs 94.9%, p<0.001) and CIR at <250 colonoscopies per year (94.5% vs 93.4%, p=0.048). Conclusions This study represents the first published endoscopist-level NEQI data demonstrating ongoing KQI improvements, for endoscopists at all activity levels. Sustaining this improvement and continuing to capture national endoscopic performance will remain a core role of the Irish NEQI programme. Workforce imbalances and minimum annual volumes continue to represent challenges for national endoscopy programmes.