Quality metrics reflecting patient experience of gastrointestinal endoscopy in inflammatory bowel disease: results of national endoscopy dataset analysis

Introduction: The European Society of Gastrointestinal Endoscopy has recently defined important performance measures for endoscopy in inflammatory bowel disease (IBD). The role of patient experience in quality assessment of endoscopy in IBD has yet to be defined. We undertook an observational study based on analysis of a large multi-center dataset with national coverage in Ireland. The aim was to analyze individual and composite metrics that reflect patients’ experience with endoscopic procedures for IBD. Methods: Anonymized data were extracted from electronic procedure records of patients who underwent colonoscopy in 24 Irish hospitals. The performance indicator of colonic intubation (PICI), a novel composite score reflecting sedation rates and patient comfort, and IBD-specific endoscopic domains were evaluated. Results: Data from 261 524 colonoscopies were analysed from 2014 to 2020. Crohn’s disease (CD) patients had a significantly lower odds ratio (OR) of achieving PICI compared to non-IBD patients (0.69, 0.65-0.74, P < .001). Severe colitis was also associated with a significantly lower OR of achieving PICI (OR 0.53, 0.38-0.74, P < .001). In total, 80.2% of CD patients had a comfort score ≤2 compared to 87.8% of those with ulcerative colitis (UC) and 84.2% without IBD. Additionally, 60.7% of patients with CD required a midazolam dose of 3 mg or more compared to 50.4% of those with UC and 76.7% of those without IBD. In total, 50% of CD patients required fentanyl doses >50 µg compared to 34% of UC patients and 30.3% of patients without IBD. Conclusion: This analysis of a large national endoscopy dataset highlights variability in quality metrics for IBD endoscopy and underscores the need for a metric such as PICI to more accurately capture and reflect patient endoscopic experience with IBD.