Factors that influence cecal intubation rate during colonoscopy in deeply sedated patients

Hsu, Cheng–Lung; Lin, Wei; Su, Ming‐Yao; Chiu, Cheng-Tang; Ho, Yu‐Pin; Chen, Pang‐Chi

doi:10.1111/j.1440-1746.2011.06795.x

Cited by 76 publications

(60 citation statements)

References 35 publications

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“…The predictive factors of CIR failure we studied are in line with the published literature, namely sedation, age and bowel preparation; we identified female sex as a risk factor for colonoscopy incompleteness; however, some inconsistencies in the literature seem to exist [20,21] . Note that for a proper CIR we need to have iconographic documentation of the caecum and associated landmarks to guarantee the quality of our performance [5] .…”

Section: Discussionsupporting

confidence: 68%

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Taveira

Areia

Elvas

et al. 2017

GE Port J Gastroenterol

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Background: Colonoscopy quality is a hot topic in gastroenterological communities, with several actual guidelines focusing on this aspect. Although the adenoma detection rate (ADR) is the single most important indicator, several other metrics are described and need reporting. Electronic medical reports are essential for the audit of quality indicators; nevertheless, they have proved not to be faultless. Aim: The aim of this study was to analyse and audit quality indicators (apart from ADR) using only our internal electronic endoscopy records as a starting point for improvement. Methods: An analysis of electronically recorded information of 8,851 total colonoscopies from a single tertiary centre from 2010 to 2015 was performed. Results: The mean patient age was 63.4 ± 8.5 years; 45.5% of them were female, and in 14.6% sedation was used. Photographic documentation was done in 98.4% with 10.7 photographs on average, and 37.4% reports had <8 pictures per exam. Bowel preparation was rated as adequate in 67%, fair in 27% and inadequate in 4.9% of cases. The adjusted caecal intubation rate (CIR) was 92%, while negative predictors were inadequate preparation (OR 119, 95% CI 84-170), no sedation (OR 2.39, 95% CI 1.81-3.15), female gender (OR 1.61, 95% CI 1.38-1.88) and age ≥65 years (OR 1.56, 95% CI 1.34-1.82). In 28% of patients, a snare polypectomy was performed, correlating with adequate preparation (OR 5.75, 95% CI 3.90-8.48), male gender (OR 1.82, 95% CI 1.64-2.01) and age ≥65 years (OR 1.25, 95% CI 1.13-1.37; p < 0.01) as positive predictors. An annual evolution was observed with improvements in photographic documentation (10.7 vs. 12.9; p < 0.001), CIR (91 vs. 94%; p = 0.002) and “adequate” bowel preparation (p = 0.004). Conclusions: There is much more to report than the ADR to ensure quality in colonoscopy practice. Better registry systematization and integrated software should be goals to achieve in the short term.

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Section: Discussionsupporting

confidence: 68%

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Taveira

Areia

Elvas

et al. 2017

GE Port J Gastroenterol

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“…Various factors have been implicated in influencing CIT. These factors included age, gender, quality of bowel preparation, history of prior abdominal surgery, experience of the colonoscopist, diverticulosis and constipation[4,10-14]. In addition, research on the relationship between CIT and obesity indices, such as body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area, has been reported[9,13,15-17].…”

Section: Introductionmentioning

confidence: 99%

Predictors for difficult cecal insertion in colonoscopy: The impact of obesity indices

Moon

Kim

Sohn

et al. 2017

WJG

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AIMTo identify the factors influencing cecal insertion time (CIT) and to evaluate the effect of obesity indices on CIT.METHODSWe retrospectively reviewed the data for participants who received both colonoscopy and abdominal computed tomography (CT) from February 2008 to May 2008 as part of a comprehensive health screening program. Age, gender, obesity indices [body mass index (BMI), waist-to-hip circumference ratio (WHR), waist circumference (WC), visceral adipose tissue (VAT) volume and subcutaneous adipose tissue (SAT) volume on abdominal CT], history of prior abdominal surgery, constipation, experience of the colonoscopist, quality of bowel preparation, diverticulosis and time required to reach the cecum were analyzed. CIT was categorized as longer than 10 min (prolonged CIT) and shorter than or equal to 10 min, and then the factors that required a CIT longer than 10 min were examined.RESULTSA total of 1678 participants were enrolled. The mean age was 50.42 ± 9.931 years and 60.3% were men. The mean BMI, WHR, WC, VAT volume and SAT volume were 23.92 ± 2.964 kg/m2, 0.90 ± 0.076, 86.95 ± 8.030 cm, 905.29 ± 475.220 cm3 and 1707.72 ± 576.550 cm3, respectively. The number of patients who underwent abdominal surgery was 268 (16.0%). Colonoscopy was performed by an attending physician alone in 61.9% of cases and with the involvement of a fellow in 38.1% of cases. The median CIT was 7 min (range 2-56 min, IQR 5-10 min), and mean CIT was 8.58 ± 5.291 min. Being female, BMI, VAT volume and involvement of fellow were significantly associated with a prolonged CIT in univariable analysis. In multivariable analysis, being female (OR = 1.29, P = 0.047), lower BMI (< 23 kg/m2) (OR = 1.62, P = 0.004) or higher BMI (≥ 25 kg/m2) (OR = 1.80, P < 0.001), low VAT volume (< 500 cm3) (OR = 1.50, P = 0.013) and fellow involvement (OR = 1.73, P < 0.001) were significant predictors of prolonged CIT. In subgroup analyses for gender, lower BMI or higher BMI and fellow involvement were predictors for prolonged CIT in both genders. However, low VAT volume was associated with prolonged CIT in only women (OR = 1.54, P = 0.034).CONCLUSIONBeing female, having a lower or higher BMI than the normal range, a low VAT volume, and fellow involvement were predictors of a longer CIT.

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“…As more screening programs are implemented worldwide, it becomes important to estimate the number of colonoscopies needed for CRC screening. To our knowledge, this is the fi rst study to evaluate the need for second-look colonoscopies, as previous literature has mainly focused on failed cecal intubation as a cause for a second colonoscopy ( 19,21,22 ). In our cohort, cecal intubation failed in 3% of the colonoscopies.…”

Section: Discussionmentioning

confidence: 67%