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In fact, the correct reporting of segmental bowel preparation is fundamental for detecting colonic lesions and for increasing the alertness of the endoscopist in future colonoscopies [ 17 ]. Our overall results for bowel preparation are similar to the published data on standard bowel preparation regimens, with a great improvement in these results after the introduction of the split-dose regimen for all our exams in late [ 18 ]. In fact, in recent years, bowel preparation has been a concern at our unit, and efforts have been made in Ssana of educational incentives for our patients, with good results in improving overall bowel preparation results [ 19 Sksana.

The Aronchick scale for galeries preparation was used at our unit during the study period, as at that time no ideal scale was defined, and it was the one available in the software. In addition, it was used Sussana an ongoing randomized trial about bowel preparation at our unit [ 19 ]. Later, with publications demonstrating the superiority of the Boston Bowel Preparation Scale in terms of reproducibility, we started to use that scale inand it now is galleriee scale adopted by an updated version of the software. The predictive factors of CIR failure we studied are in line with the published literature, namely sedation, age and bowel preparation; we identified female sex as nudr risk factor for colonoscopy Suxana however, some inconsistencies in the literature seem to exist [ 2021 ].

Note that for nuds proper CIR we need to have iconographic documentation of the caecum and associated landmarks to guarantee the quality of our performance [ 5 ]. We assumed that at least 8 pictures per exam are necessary galelries a proper evaluation of all findings and landmarks, following some previous European recommendations and some in-house experience [ 14 ]. Pnoto least 3 photographs for nued segmental documentation of bowel preparation, at least 2 photographs to document the caecum and ileocaecal valve, and 3 photographs for the documentation of findings and other important landmarks are needed.

This policy was first implemented ingalleries we could observe an immediate improvement in our photographic documentation results, with a statistically significant improvement in the mean number of photographs per exam Although there is no previous work to strongly justify the 8-pictures cut-off, a good documentation of caecal landmarks has nuee a positive correlation with the improvement of colonoscopy quality metrics, such as the polyp detection rate [ 22 ]. Regarding adenoma or polyp detection, as we cannot access histology reports from our endoscopy Susana alves nude photo galleries, an estimation of the polyp detection rate was only possible because all snare polypectomies were registered in that database.

In addition, the polyp and adenoma detection rates used in many studies are from screening colonoscopies only, while nuse used our entire database, not looking at the indication due to the very low prevalence of screening colonoscopies in our database. Consequently, we can answer the question if Susana alves nude photo galleries global objective for polyp detection in colonoscopy is possible, Ssuana of the indication, since every colonoscopy offers a therapeutic opportunity. Our study has several limitations, the first being its retrospective nature, based on information present only in our database, relying solely on what the endoscopist registered at the moment of the exam.

Although a limitation, we understand it as an opportunity for improvement, and a gallrries review from the ESGE makes galeries about the criteria an endoscopy unit program needs to fulfil in order to guarantee quality, such as an electronic registry with a connection with the patient record and pathology databases, restricting the areas for free text entries, greater emphasis on patients' comfort, reporting of quality indicators and follow-up instructions [ 10 ]. Due to this work, we realized that our unit software lacks several indicators, for example, valuable information for our internal quality audits is missing, such as pathologic diagnosis, validated scales, a measure of withdrawal time or polypectomy removal identification per exam.

In fact, like other national and worldwide endoscopy units, we still do not have a direct connection with pathology databases, the inability to retrieve our ADR being another important limitation. In addition, the frequency with which colonoscopies were performed following the recommended post-polypectomy and post-cancer resection surveillance intervals was not measured, since these data are also not automatically extracted from the software. Improvements of this problem should be pursued at our unit but also nationally, for example, promoted by the national Portuguese Society of Digestive Endoscopy SPEDwith proposals for the standardization of reports and available software solutions [ 2526 ].

In conclusion, quality in endoscopy is a current hot topic in gastroenterology practice and should be a concern of every endoscopy unit. The systematization of registries should be a major concern, including proper connections with pathology and internal patient programs, searching the best technological solutions, and preservation of ethical and moral concerns. In fact, we have shown that there is more beyond the ADR to worry about in colonoscopy quality metrics, and reporting our own experience is intended to be a wake-up call to improve the quality of care we are eager to provide.

Statement of Ethics The authors have no ethical conflicts to disclose. Written informed consent for the procedure was obtained from the patients. Disclosure Statement The authors declare no conflicts of interest. Author Contributions Filipe Taveira: Peery AF, et al. Burden of gastrointestinal disease in the United States: Global Burden of Disease Cancer Collaboration, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, to Rembacken B, et al. Quality in screening colonoscopy: Rutter MD, et al. United European Gastroenterol J.

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