Evaluation of quality measures for Colonoscopy in Colorectal cancer screening among patients in Mahosot hospital, Vientiane capital, Lao PDR: A cross-sectional, prospective study

Background: In Lao PDR, colorectal cancer (CRC) is a significant public health concern, accounting for 8.5% of all cancer cases and ranking as the fourth most common cancer in the country. Colonoscopy emerges as the gold standard for CRC screening. The quality of a colonoscopy is critical to achieving positive patient outcome. Key quality indicators mainly include adenoma detection rate, bowel preparation adequacy, average withdrawal time, cecal intubation rate and complication post colonoscopy procedure. Objectives: This study aimed to evaluate the prevalence of colorectal polyps and cancer detected, determine adenoma detection rate, and assess the quality of colonoscopy procedure during colorectal cancer screening of our centre and another representative of referral centre in Laos. Methods: We conducted a cross-sectional descriptive study from July 2023 to February 2024, involving 288 individuals for collecting demographic data, procedure indications, and various colonoscopies. Results: A total of 288 patients were enrolled in the study. The mean age was 45.57 ± 14.67 years (SD) with approximately equal gender distribution (Female 50.67%). The majority of colorectal cancer screenings were conducted in individuals under 50 years old. Most patients achieved optimal bowel preparation, and underwent complete colonoscopy procedures. Approximately 95.5% underwent a complete colonoscopy with an average withdrawal time of 8.16 ± 4.37 minutes. Pathological analysis revealed non-neoplastic, benign neoplastic, and malignant polyps. The overall adenoma detection rate was 27.63%, with advanced adenoma detection in 5.81% and colon cancer detection in 5.9%. Patients over 50 years exhibited a higher risk of adenoma detection rate while good bowel preparation did not significantly affect detection rates. However, longer withdrawal times during colonoscopy correlated with increased adenoma detection rate. Conclusion: Our study showed that the quality indicators of colonoscopy were acceptable with results indicating an average risk of colorectal cancer screening with overall adenoma detection rate, achieved adequate bowel cleansing, with high rate of cecal intubation rate, and appropriated withdrawal time examination as per protocol associated with increased adenoma detection.