Abstract
Background and study aim Cecal intubation rate (CIR) is an established performance indicator of colonoscopy.
In some patients, cecal intubation with acceptable tolerance is only achieved with
additional sedation. This study proposes a composite Performance Indicator of Colonic
Intubation (PICI), which combines CIR, comfort, and sedation.
Methods Data from 20 085 colonoscopies reported in the 2011 UK national audit were analyzed.
PICI was defined as the percentage of procedures achieving cecal intubation with median
dose (2 mg) of midazolam or less, and nurse-assessed comfort score of 1 – 3/5. Multivariate
logistic regression analysis evaluated possible associations between PICI and patient,
unit, colonoscopist, and diagnostic factors.
Results PICI was achieved in 54.1 % of procedures. PICI identified factors affecting performance
more frequently than single measures such as CIR and polyp detection, or CIR + comfort
alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult
blood test as indication were associated with a higher PICI. Unit accreditation, the
presence of magnetic imagers in the unit, greater annual volume, fewer years’ experience,
and higher training/trainer status were associated with higher PICI rates. Procedures
in which PICI was achieved were associated with significantly higher polyp detection
rates than when PICI was not achieved.
Conclusions PICI provides a simpler picture of performance of colonoscopic intubation than separate
measures of CIR, comfort, and sedation. It is associated with more factors that are
amenable to change that might improve performance and with higher likelihood of polyp
detection. It is proposed that PICI becomes the key performance indicator for intubation
of the colon in colonoscopy quality improvement initiatives.
