Les normes de pratique clinique pour une coloscopie de qualité
Mots-clés :
coloscopie, qualité, préparation colique, cancers d'intervalle, TDARésumé
La coloscopie reste de nos jours l’examen le plus performant pour la prévention, le dépistage et le diagnostic des lésions colorectales. Cette place prépondérante nécessite le respect des normes de qualité qui doivent s’imposer à tous les endoscopistes. C’est ainsi que des critères de qualité ont fait l’objet de recommandations par différentes sociétés savantes internationales couvrant toutes les étapes de la procédure et dont l’objectif ultime était de réduire le taux des cancers colorectaux d’intervalle (CCRi) en rapport avec des lésions manquées lors de la coloscopie. Ces critères ont été classés en trois catégories : pré, per et post procéduraux. Les principaux indicateurs pré-procéduraux sont le respect des indications validées par les recommandations internationales et la prescription d’une préparation colique, justifiant l’instauration d’une consultation préalable à la coloscopie. Les critères per-procéduraux concernent tout ce qui a lieu pendant l’examen, particulièrement le taux d’intubation caecale, le taux de détection des adénomes (TDA) et le temps de retrait qui sont des facteurs «endoscopiste-dépendants». En post-procédure, les principaux indicateurs sont le taux des complications, l’évaluation du ressenti des patients et le respect des intervalles de surveillance. Ces recommandations doivent être implémentées dans tous les centres d’endoscopie afin d’assurer l’amélioration progressive des pratiques individuelles. Cette mise au point, rédigée sous l’égide du club d’endoscopie digestive (CED), avait pour but de réaliser une synthèse des principaux indicateurs de qualité de la coloscopie et de proposer des recommandations qui prennent en considération les particularités de nos conditions.
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