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Well structured survey.
Dear CPSO and CCO Quality Conmittee for Colonoscopy
I am a radiologist and Head of CT Colonography (CTC) service provision. As you may know, CTC is the preferred structural colonic imaging test after incomplete, inadvisable or declined colonoscopy, and plays an important role in screening completion after incomplete exams in as many as 5% of people undergoing colonoscopy. It is my hope that the CPSO and CCO would recognize the need for better follow up and reporting of CTC results to improve standards across the province, ensure appropriate access and that CTC exams are performed and interpreted by accredited providers with feedback on results. Thank you.
I think doing routine colonoscopies in the general population is neither useful nor practical. But high risk individuals should get a colonoscopy done after a certain age and then their future colonoscopy intervals should be determined.
In response to a previous comment, as a gastroenterologist, I believe that “routine screening colonoscopy” is both useful and practical, but Ontario should be moving quickly towards fecal immunochemical testing, which would be both useful and practical, and patients should have the choice.
“High risk” individuals are those over 50 years old, and surveillance intervals have been published. Compared to screening for prostate cancer, lung cancer, and even breast cancer, the evidence for colon cancer screening remains robust.
I think that the survey indicated a small number of quality indicators, but has, as far as I can see, completely ignored a significant number of quality indicators that also exist in the quality literature (adenoma detection rate, post-colonoscopy colorectal cancer rate, adenoma per patient rate, colonoscopy preparation quality). Rather than setting a bar low, and documenting that most practitioners exceed a certain minimal quality standard, there should be a process to identify excellent endoscopists, and stratify all practitioners, to encourage improvement, rather than “rubber stamp” a large number of practitioners practicing at different levels of competence.