Abstract
BACKGROUND AND STUDY AIMS: 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. The aim of this study was to assess temporal changes in colonoscopy Key Quality Indicators (KQIs) at a national level over a 5-year period among low-, intermediate-, and high-volume endoscopists. METHODS: A retrospective analysis of all NEQI colonoscopy episodes occurring between 2016 and 2022, collating colonoscopy KQIs (cecal intubation rate [CIR], comfort score [CS], polyp detection rate [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 program. Workforce imbalances and minimum annual volumes continue to represent challenges for national endoscopy programs.