GMKA Publishes Results of the First National Study on Quality of Colonoscopy in Ukraine
Colonoscopy is a proven screening method for reducing mortality from colorectal cancer (CRC), the most frequently diagnosed cancer in Ukraine. To assess adherence to globally recognized colonoscopy performance measures (PMs) and identify factors affecting screening quality, the Global Medical Knowledge Alliance (GMKA), in collaboration with EndoAcademy, one of Ukraine's largest professional endoscopy societies, conducted the first national survey among Ukrainian endoscopists. Study findings were published in JCO Global Oncology.
In 2022, Ukraine recorded 20,877 new cases of colorectal cancer and 11,263 related deaths. Screening colonoscopy enables early detection of neoplasia and removal of precancerous lesions, effectively lowering both incidence and mortality. However, despite advances in endoscopic technology, the rate of missed lesions and interval cancers—those developing between screening exams—remains substantial.
To improve colonoscopy effectiveness, the European Society of Gastrointestinal Endoscopy (ESGE) and the American Society for Gastrointestinal Endoscopy (ASGE) have defined key performance measures (PMs). Adherence to these indicators increases adenoma detection rates, enhances patient safety and experience, and reduces the need for repeat procedures.
“Colorectal cancer screening is effective only when viewed as an integrated system, not as isolated exams. Adherence to quality indicators determines the true impact of screening colonoscopy on long-term outcomes. We evaluated the current level of compliance in Ukraine and identified factors influencing quality. Understanding these factors is crucial for developing a systematic, nationwide approach to colorectal cancer screening,” said Ivan Hornik, MD, endoscopist, research analyst at GMKA, and the study’s first author.
Study Overview
The research team conducted a web-based survey that included 122 endoscopists, members of EndoAcademy. Most participants worked in public healthcare facilities across different regions of Ukraine and performed more than 300 colonoscopies annually.
The questionnaire, developed based on ESGE and ASGE guidelines, included 12 performance measures:
Noncalculated PMs (performed/not performed):
- Postpolypectomy surveillance recommendations
- Retrieval of removed polyps
- Photo/video recording of the procedure
- Allocation of adequate time for the procedure
- Withdrawal time
- Endoscopic tattooing
Calculated PMs (requiring continuous data tracking):
- Rate of adequate bowel preparation
- Cecal intubation rate
- Adenoma detection rate (ADR)
- Polyp detection rate
- Sessile serrated lesion detection rate
- Complication rate
Key Findings
- High adherence was observed for noncalculated PMs, such as surveillance interval recommendations and polyp retrieval.
- Calculated PMs, such as adenoma detection rate or complication rate, were less consistently tracked.
The median number of PMs adhered to was 6 (IQR, 5–8). - About 31.1% of respondents reported suboptimal polyp management during colonoscopy.
Adherence to each additional PM was associated with a significant improvement in optimal polyp management, highlighting the importance of comprehensive quality monitoring. The most frequently reported barriers included limited access to equipment, unreliable access to essential consumables, and low reimbursement rates from the National Health Service of Ukraine.
Implications
The GMKA study reveals gaps in adherence to colonoscopy quality indicators and in the management of detected lesions. These findings underscore the need for structured quality improvement initiatives, particularly as Ukraine moves toward implementing a national colorectal cancer screening program.
Integrating international quality standards into professional education and clinical practice could substantially improve patient outcomes and the overall effectiveness of CRC screening nationwide.
This study also reflects GMKA’s broader mission as a nonprofit advancing evidence-based medicine in Ukraine through education, research, and implementation of global healthcare standards. By empowering healthcare professionals with access to global best practices and fostering continuous professional and personal growth, GMKA aims to strengthen the quality of medical care and advance a more effective, patient-centered healthcare system nationwide.
