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.

Factors affecting bowel preparation adequacy and procedural time

“…This reinforces existing literature and is believed to relate to the rate of adequate bowel preparation. Poor bowel preparation has been associated with longer cecal intubation . Furthermore, the presence of adhesions from abdominal surgery can lead to constipation and difficulty maneuvering during colonoscopy.…”

“…Poor bowel preparation has been associated with longer cecal intubation. 20,[32][33][34] Furthermore, the presence of adhesions from abdominal surgery can lead to constipation and difficulty maneuvering during colonoscopy. A runway time of 6 h or less did not improve cecal intubation time in this study; however, cecal extubation was notably shorter, which suggests an overall faster procedure.…”

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

“…There is agreement that there are three main explanations for post-colonoscopy CRC: missed advanced neoplasia, new lesions and incompletely resected lesions. The most important factor related to missed advanced neoplasia is the ADR, which in turn depends on cecal intubation rate, withdrawal time, and colon cleansing 15 18 21 22 23 24 25 26 27 . All these factors are interrelated.…”

Monitoring of colonoscopy quality indicators in an academic endoscopy facility reveals adherence to international recommendations

“…intubation rate among screening and routine examinations and the target standard for both should be at least 95% (4). On top of that, a recently published study from Norway that reported CCRs above 97% in all categories, concludes that CCRs were similar among screening and routine colonoscopies and suggested the use of one target standard for better adherence to the guidelines (15). Indeed, our audit showed that apart from 2013 cohort B cases our CCR exceeded 95%, overall.…”