Connect
MJA
MJA

All colonoscopies are not created equal: why Australia now has a clinical care standard for colonoscopy

Anne Duggan, Iain J Skinner and Alice L Bhasale
Med J Aust 2018; 209 (10): 427-430. || doi: 10.5694/mja18.00556
Published online: 10 September 2018

Maintaining the quality of colonoscopies is vital if promised reductions in colorectal cancer are to be achieved

In many ways, colonoscopy has been a transformative health technology. By allowing the early identification and removal of polyps, it reduces colorectal cancer incidence and mortality. Evidence for population screening using a faecal occult blood test and follow-up colonoscopy was based on randomised controlled studies that found a reduction in colorectal cancer mortality of 28–32% with flexible sigmoidoscopy.1 It is estimated that by 2040, the National Bowel Cancer Screening Program will prevent 92 200 cases of colorectal cancer and 59 000 deaths, using conservative modelling based on current participation of just 40%.2 These benefits are substantial, given that bowel cancer is the second highest cause of cancer death in Australia and participation in the National Bowel Cancer Screening Program is increasing.3 However, without high quality and appropriate use of colonoscopy, patients may be exposed to avoidable adverse outcomes without significant benefit. These include procedural and sedation-related complications, missed cancers, missed adenomas (hence increased risk of bowel cancer), and adverse patient experience. Further, overuse of the procedure in patients who are unlikely to benefit from it results in low value care and reduces access for patients in greater need. In order to ensure the maximum benefit to the Australian population, the Australian Commission on Safety and Quality in Health Care has developed a Colonoscopy Clinical Care Standard (www.safetyandquality.gov.au/our-work/clinical-care-standards/colonoscopy-clinical-care-standard).

  • Anne Duggan1
  • Iain J Skinner2
  • Alice L Bhasale1

  • 1 Australian Commission on Safety and Quality in Health Care, Sydney, NSW
  • 2 St Vincent's Private Hospital, Melbourne, VIC


Acknowledgements: 

We thank Brett Abbenbroek for his contribution to the development of the Clinical Care Standard, and the Colonoscopy Clinical Care Standard Topic Working Group for their expert advice. Funding for the development of the Colonoscopy Clinical Care Standard was provided by the Australian Government Department of Health.

Competing interests:

No relevant disclosures.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

You do not have permission to add a response to this article.