Cecum intubation rate as quality indicator in clinical versus screening colonoscopy

Abstract

Background and study aims Some guidelines recommend a minimum standard of 90 % cecal intubation rate (CIR) in routine clinics and 95 % in screening colonoscopy, while others have not made this distinction – both with limited evidence to support either view. This study questions the rationale for making such differentiation.

Patients and methods We assessed cecum intubation rates amongst colonoscopies recorded in the Norwegian national quality register Gastronet by 35 endoscopists performing both clinical and screening colonoscopies. Colonoscopies were categorized into primary screening colonoscopy, work-up colonoscopy of screen-positives and clinical colonoscopy or surveillance. Cases with insufficient bowel preparation or mechanical obstruction were excluded. Endoscopists were categorized into “junior” and “senior” endoscopists depending on training and experience. Univariable and multivariable logistic regression analyses were applied.

Results During a 2-year period, 10,267 colonoscopies were included (primary screening colonoscopy: 746; work-up colonoscopy of screen-positives: 2,604; clinical colonoscopy or surveillance: 6917). The crude CIR in clinical routine colonoscopy, primary screening colonoscopy and work-up colonoscopy was 97.1 %, 97.1 % and 98.6 %, respectively. In a multiple logistic regression analysis, there were no differences in CIR between the 3 groups. Poor bowel cleansing and female sex were independent predictors for intubation failure.

Conclusion Cecal intubation rate in clinical colonoscopies and colonoscopy screening are similar. There is no reason to differentiate between screening and clinical colonoscopy with regard to CIR.

• References

• 1 Baxter NN, Sutradhar R, Forbes SS. et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 1 (Suppl. 40) 65-72
• 2 Rex DK, Bond JH, Winawer S. et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2002; 97: 1296-1308
• 3 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
• 4 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
• 5 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
• 6 European Colorectal Cancer Screening Guidelines Working G, von Karsa L, Patnick J et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45: 51-59
• 7 Gupta M, Holub JL, Eisen G. Do indication and demographics for colonoscopy affect completion? A large national database evaluation. Eur J Gastroenterol Hepatol 2010; 22: 620-627
• 8 Nagrath N, Phull PS. Variation in cecal intubation rates between screening and symptomatic patients. United European Gastroenterol J 2014; 2: 295-300
• 9 Kaminski MF, Bretthauer M, Zauber AG. et al. The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy 2012; 44: 695-702
• 10 Bhangu A, Bowley DM, Horner R. et al. Volume and accreditation, but not specialty, affect quality standards in colonoscopy. Br J Surg 2012; 99: 1436-1444
• 11 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
• 12 Pox CP, Altenhofen L, Brenner H. et al. Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 2012; 142: 1460-1467e2
• 13 Valori R, Sint Nicolaas J, de Jonge V. Quality assurance of endoscopy in colorectal cancer screening. Best Pract Res Clin Gastroenterol 2010; 24: 451-464
• 14 Pace D, Borgaonkar M, Hickey N. et al. Does the hands-on, technical training of residents in colonoscopy affect quality outcomes?. Surg Endosc 2015; 30: 1352-1355