How The Endoscopist’s Role Impact The Procedure Quality Especially Considering The Concept Of Insourcing in The United Kingdom

Aims The study aimed to provide insights into the quality and effectiveness of colonoscopies by the insourced endoscopy teams in comparison to the “standard” endoscopists in a tertiary care center in the UK

Methods The retrospective cross-sectional study focused on comparing the colonoscopy quality indicators between “standard” (in-hospital endoscopist) vs “insourced”. Procedures that were therapeutic or part of screenings such as Bowel Cancer Screening Programme were excluded. Outcome measures such as scope withdrawal times and polyp detection rates were compared in relation to the role of the endoscopist. The Ethical approval was obtained from the South Yorkshire Research Ethics Committee, and all patient data were anonymized to protect confidentiality.

Results 11126 diagnostic colonoscopies were conducted. The mean (s.d.) age of the patients had a colonoscopy with standard vs insourced groups were 63.4(11.6) vs 63.4(12.2 years respectively (p. value 0.9). The mean withdrawal time for the standard group was 11.6 minutes (SD=5.8), while the insourced group had a mean time of 9.5 minutes (SD=3.7). (p-value<0.001). Additionally, the polyp detection rate was higher in the standard group at 43.9% compared to 36.8% in the insourced group. (chi-square value of 17 and p-value<0.001). Colonoscopy completion rate was similar in both groups. Colonoscopy completion rate was similar in both groups. The use of Buscopan was substantially lower in the insourced group (0.14 vs. 1.38, p<0.001), while the Boston score was higher for insourced (7.38 vs. 6.59, p<0.001). However, no significant differences were observed in the total use of Midazolam (p=0.7) or Fentanyl (p=0.2) between the two groups. Positive FOB/FIT test (B=-0.36), which reduces the odds of the outcome by 30% (Exp(B)=0.70, p=0.01). Other factors, including family history of colorectal cancer, cancer-related surveillance, colonoscopy completion rate, and bowel preparation score, show no statistically significant effect.

Conclusions Polyp detection rates and scope withdrawal times were significantly lower on endoscopies done by in-sourced endoscopists. This study further helps to cement the fact raised by recent very few studies that there may be a compromise to the quality of the endoscopy while trying to match the service demands. Therefore, we believe NHS has a new challenge to increase the service provision while maintaining the quality of its services.

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Artikel online veröffentlicht:
27. März 2025