Meticulous cecal image documentation at colonoscopy is associated with improved polyp detection

Background and study aims: No studies have looked at the quality of cecal images versus the outcomes of colonoscopic procedures. Here, we tested our hypothesis that endoscopists who provide better image documentation of the cecum during their procedures have a higher polyp detection rate (PDR).

Patients and methods: In this retrospective study, planned colonoscopies performed by 16 experienced colonoscopists were included. We formulated a new scoring system, the cecal image documentation score (CIDS), for quantifying the quality of the cecal images obtained at colonoscopy. Cecal image documentation was graded as follows: no image, 0; unclear image, 1; clear image, 2; clear image with a label, 3. We assessed the correlation between image quality and the PDR.

Results: A total of 651 procedures performed by 16 colonoscopists were analyzed retrospectively. The mean CIDS for the 16 endoscopists was 2.13. The mean PDR was 23.5 %, and the mean polyps per procedure value (PPP) was 0.42. The 10 colonoscopists with a mean CIDS > 2.0 (n = 429 procedures) had a PDR of 27.8 % and a PPP of 0.51. On the other hand, the 6 colonoscopists (n = 222 procedures) with a mean CIDS < 2.0 had a PDR of 15.2 % and a PPP of 0.23. A mean CIDS > 2.0 was associated with a higher PDR (odds ratio [OR] 2.1, 95 % confidence interval [CI] 1.4 – 3.2, P = 0.001). A mean CIDS > 2.0 was found to be an independent predictor of a higher PDR (OR 2.53, 95 %CI 1.45 – 3.59, P = 0.001). A mean CIDS > 2.0 was also associated with a higher right-sided PDR (OR 3.67, 95 %CI 1.91 – 7.02, P < 0.001).

Conclusions: Colonoscopists who are more meticulous in cecal image documentation detect more polyps per procedure and have higher PDRs. Better cecal image documentation is also associated with better right-sided colonic polyp detection.

• References

• 1 Fracchia M, Senore C, Armaroli P et al. Assessment of the multiple components of the variability in the adenoma detection rate in sigmoidoscopy screening, and lessons for training. Endoscopy 2010; 42: 448-455
• 2 Thomas-Gibson S, Rogers PA, Suzuki N et al. Development of a video assessment scoring method to determine the accuracy of endoscopist performance at screening flexible sigmoidoscopy. Endoscopy 2006; 38: 218-225
• 3 Goncalves AR, Ferreira C, Marques A et al. Assessment of quality in screening colonoscopy for colorectal cancer. Clin Exp Gastroenterol 2011; 4: 277-281
• 4 Crispin A, Birkner B, Munte A et al. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy 2009; 41: 1018-1025
• 5 Rey JF, Lambert R. ESGE recommendations for quality control in gastrointestinal endoscopy: guidelines for image documentation in upper and lower GI endoscopy. Endoscopy 2001; 33: 901-903
• 6 Cirocco WC, Rusin LC. Confirmation of cecal intubation during colonoscopy. Dis Colon Rectum 1995; 38: 402-406
• 7 Rex DK. Still photography versus videotaping for documentation of cecal intubation: a prospective study. Gastrointest Endosc 2000; 51: 451-459
• 8 Baraza W, Brown S, Shorthouse AJ et al. Direct photographic documentation of ileal mucosa in routine colonoscopy is not an independent valid or reliable proof of completion: quality assurance issues for the national colorectal cancer-screening programme. Colorectal Dis 2009; 11: 89-93
• 9 Iacopini G, Frontespezi S, Vitale MA et al. Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line. Gastrointest Endosc 2006; 63: 250-256
• 10 Aabakken 1 L, Rembacken B, LeMoine O et al. Minimal standard terminology for gastrointestinal endoscopy - MST 3.0. Endoscopy 2009; 41: 727-728
• 11 Rex DK, Schoenfeld PS, Cohen J et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
• 12 Rembacken B, Hassan C, Riemann JF et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2012; 44: 957-968
• 13 Bressler B, Paszat LF, Vinden C et al. Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 2004; 127: 452-456
• 14 Rex DK, Bond JH, Feld AD. Medical-legal risks of incident cancers after clearing colonoscopy. Am J Gastroenterol 2001; 96: 952-957