# Flying endoscopists in the Arctic: initiatives for quality assurance of endoscopies in Greenland

## TL;DR

This study evaluates the quality of endoscopies performed in remote Greenland hospitals and suggests improvements to ensure high standards while reducing environmental impact.

## Contribution

The paper introduces a quality assurance framework for endoscopies in remote Arctic hospitals, tailored to local conditions.

## Key findings

- The cecal intubation rate and adenoma detection rates were satisfactory, but bowel preparation quality needs improvement.
- A new procedure for bowel preparation is needed to address local dietary habits and improve patient outcomes.
- Surgical coastal expeditions significantly reduce the environmental impact of patient transport for endoscopies.

## Abstract

Surgical coastal expeditions (SCEs) have been organized in Greenland for many years. They aim to provide small coastal hospitals with specialist services, such as endoscopies (SCEEs), by deploying specialist personnel, surgeons, and the necessary equipment to the hospital temporarily. The purpose of this program is to increase accessibility for patients, while simultaneously reducing the costs associated with patient transport to the central hospital.

This retrospective pilot review of medical records identified quality indicators, such as bowel cleansing (BP), cecal intubation rate (CIR), and adenoma and advanced adenoma detection rates (ADR, AADR), to investigate the status and establish a system for quality monitoring of SCEsE in Greenland.

During two SCEs (8 working days), 89 SCEE were performed at Qaqortoq and Sisimiut Hospitals. The 60 patients who underwent colonoscopy included 32 men and 28 women with a mean age of 61 years (range 24–80 years). The unadjusted CIR was 91.7%. In eight (13.3%) examinations, bowel preparation was rated as unsatisfactory, resulting in two incomplete procedures. The ADR and AADR were 35% and 11.7%, respectively, and one cancer was detected (1.7%).

The results showed satisfactory ADR, AADR, and CIR levels. However, the review also highlighted the need for increased attention to BP by developing a new procedure that considers differences due to specific eating habits in Greenland and provides much better information for patients. The review provided a snapshot of the quality of colonoscopies in Greenland, highlighting the necessity to continue this process to ensure that the quality is up to standard. Furthermore, SCE helps reduce the environmental footprint of gastrointestinal endoscopy by avoiding the need for patient air transport; instead of 77 round trips (61,830 km), only 8 (6440 km) were required.

The online version contains supplementary material available at 10.1007/s00464-023-10465-4.