Improving quality of care in endoscopy of inflammatory bowel disease: can we do better?

ABSTRACT

Introduction

Endoscopy plays a key role in the management of inflammatory bowel disease (IBD). There is an increased need for quality assurance programs that evaluate the quality, safety and patient experiences of endoscopy, by assessing procedural and clinical outcomes.

Areas covered

This review aims to summarize the most important quality indicators of endoscopy in IBD patients and could serve as the basis to improve quality endoscopic procedures and patients’ perception of endoscopy in the future. However, further studies and consensus reports are necessary to standardize the quality of care in the endoscopy unit of all IBD centers.

Expert commentary

Developing an understanding of the patient-reported perception is important for both clinicians and patients, as it facilitates patient engagement with their care. Moreover, implementing education in reporting is crucial f and the use of verifiable databases, generated from electronic reporting systems, should be encouraged rather than unverified self-reporting, to have greater validity for documenting and to formally evaluate endoscopic practice data with audits. The use of artificial intelligence may improve the quality of endoscopy, by increasing the adenoma detection rate and helping endoscopists in the challenging differentiation between inflammatory and neoplastic lesions.

KEYWORDS:

• IBD
• endoscopy
• standard of care
• patients’ perception
• quality assurance program

Article highlights

• There is a growing need for quality assurance programs that assess the quality, safety and patient experiences of endoscopy and continuous quality assurance is impossible without a complete standardized endoscopic reporting system which is cost-effective and allow the development of verifiable databases. In IBD patients, low volume PEG formulations especially in split dose, appear efficacious and well tolerated for bowel cleansing.

• Several enhanced endoscopic imaging techniques have been developed to improve dysplasia detection. Recently, virtual chromoendoscopy has been recommended by the European Society for Gastrointestinal Endoscopy guidelines for the surveillance of patients with long standing colitis.

• The use of artificial intelligence in endoscopy will probably improve the quality of endoscopy, by increasing the adenoma detection rate, ensuring adequate withdrawal time and improving bowel preparation rate.

• The development of computer-aided diagnosis systems may help in the detection of histologic activity and in the challenging differentiation between inflammatory and neoplastic lesions.

Declaration of interest

M Allocca received consulting fees from Nikkiso Europe and lecture fees from Janssen and Pfizer. F Furfaro received consulting fees form MSD and Abbvie and lecture fees from Janssen and Pfizer. G Fiorina received consultancy fees from Ferring, MSD, AbbVie, Takeda, Janssen, Amgen, Sandoz, Samsung Bioepis, Celltrion. S Danese has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor. The other authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.