Activity Review: Press Conference on Clinical Performance of Day Colonoscopy
On 13 June 2017, The Specialists has organized a Press Conference on Clinical Performance of Day Colonoscopy, focusing on releasing and analyzing the clinical performance statistics of the past 10 years (2006 – 2015). Speakers are Dr. Percy Lam (Medical Director of The Specialists), Professor Chung Kim-Wah (Director of Centre for Social Policy Studies, The Hong Kong Polytechnic University) and Miss Emily Lui (Research Assistant).


((From left: Miss Emily Lui (Research Assistant of Centre for Social Policy Studies, The Hong Kong Polytechnic University); Professor Chung Kim-Wah (Director); Dr. Percy Lam (Medical Director of The Specialists); Dr. Michelle Lam (Specialist in General Surgery); Dr. Sze Yuen Chun (Specialist in Gastroenterology and Hepatology) and Miss Ng Nga Sze (General Manager).

Colorectal Cancer has become the 1st among top ten cancer (incidience). The urge for colonoscopy examination is increasing. In fact, only some well-established medical facilities have released relevant statistics for public information. In a view to increase the transparency of clinical performance of day surgery in Hong Kong, The Specialists has then commissioned Centre for Social Policy Studies, The Hong Kong Polytechnic University, to conduct the statistical analysis on colonoscopy results in the period of 2006 and 2015.

In the past ten years, The Specialists had conducted 21,004 colonoscopy examinations. We have detected 689 cancer cases, and have removed over 30,867 adenomas. According to the survey, the youngest cancer patient aged only 23, and the youngest patient found with adenomas was only 16.

Adenomas carry the potential to become adenocarcinoma (cancerous) Most colorectal cancers are developed from adenomas. Among all types of benign polyps, adenomatous and sessile serrated adenomas have higher chances to become cancerous. It takes 5 – 10 years for normal mucosal cells to develop into adenomas, then to colorectal cancers. Therefore, it is suggested that people should undergo colonoscopy examinations without delay, so as to remove adenomas to prevent colorectal cancer.



Adenoma Detection Rate keeps on increasing Our survey showed that the overall adenoma detection rate is 54.8%, after 2014, it reaches over 60%. The adenoma detection rate has been continuously climbing for around 30%. As most colorectal cancers are developed from adenomas, the rise in adenoma detection rate predicted that there is a chance of increase in cancer detection rate.



An emerging trend - Day Procedure Centre A Day Procedure Centre is a place combining several functional units of a hospital. With the help of technology, some minor operations which could only be performed in hospitals in the past can be performed in Day Procedure Centre now. Starting from last year, the government has launched Colorectal Cancer Screening Pilot Programme, in which the faecal occult blood tests for patients are funded by the government. For any positive results detected, patients could be fully subsidized for a colonoscopy examination.

Private Day Procedure Centre provides a fast appointment time at a reasonable price i.e. patients could enjoy private hospital-grade services with a relatively fair price. Recently, The Hong Kong Federation of Insurers (HKFI) has suggested that most insurance companies have expanded their coverage to minor operations in private Day Procedure Centre. This suggestion has reversed the perception, which is “only hospitalization could be covered in insurance”, of the public. Therefore, private day procedure centre became an alternative in between public and private hospitals.



Day Colonoscopy Quality exceeded international standards There are 3 criteria in accessing a day procedure centre’s quality, namely, Patient Experience, Facility and Clinic Performance. From our survey, every quality indicator (e.g. Perforation rate) exceeded the international standards (Refer to the appendix for details). it reflects that Hong Kong day colonoscopy procedure could reach and even exceed international standards. All in all, day surgery is a feasible choice in Hong Kong.



The Specialists Clinical Performance Statistics (2006-2015), calculated by Hong Kong Polytechnic University Centre for Social Policy Studies:


In this survey, the analytic instructions were provided by The Specialists, based on doctors’ medical knowledge and professional judgements. Centre for Social Policy Studies, The Hong Kong Polytechnic University was responsible for data cleansing, integration and calculation. The statistics report was then sent back to The Specialists for further and were analyzed according to the professional judgment from our doctors.


References

[1] Kaminski, M., Thomas-Gibson, S., Bugajski, M., Bretthauer, M., Rees, C., & Dekker, E. et al. (2017). Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy, 49(04), 378-397. http://dx.doi.org/10.1055/s-0043-103411

[2] Douglas K. Rex