Performance measures and quality standards in lower gastrointestinal endoscopy in Sri Lanka: A Prospective Observational Study

Introduction: Lower gastrointestinal endoscopy(LGIE) is the gold standard diagnostic tool in evaluating large bowel mucosal pathology. Guidelines have been developed to ensure the quality of the procedure with regard to patient safety and diagnostic accuracy. There is lack of data regarding quality of LGIE in Sri Lanka. Objective: Aim of this study is to assess the quality of LIGE performed in a tertiary care center in Sri Lanka by comparison with the standard quality indicators. Material and Methods: An prospective observational study was carried out in a tertiary care centre in Sri Lanka. Data of 210 patients who underwent LGIE (Both Colonoscopy and Flexible sigmoidoscopy) were recorded. Variables assessed were selected from quality indicators given in the guidelines of American Society of Gastroeterologists and European Society of Gastrointestinal Endoscopy. Data was compared with pre,intra and post procedure standard quality targets and degree of achievement evaluated with measuring Kappa values, categorized as, no, minimal, weak, moderate, substantial and almost perfect level of agreement. Results: All pre-procedure measures and 6 out of 7 intra procedure measures did not reach the target goals. Only 1 out of 14 indicators had almost perfect level of agreement. Majority, (i.e. 6 out of 14) had no agreement with the standard values. Conclusion: The quality of LGIE with-regard to all the aspects falls below the expected standards indicating poor quality of LGIE performed in a Sri Lankan tertiary care setting . Using a standard protocol based pro-forma and maintaining an electronic database will increase the quality of LGIE.