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

Baraza, Wal; Brown, Steven R.; Shorthouse, A. J.; Tiffin, Nick; Hurlstone, David P.

doi:10.1111/j.1463-1318.2008.01511.x

Cited by 9 publications

(4 citation statements)

References 16 publications

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“…Furthermore, if villi are not clearly illustrated after a single water flush, additional flushes should be performed until villi are adequately demonstrated. We believe that the failure to employ these techniques was the main reason for the unfavorable opinion of terminal ileum photodocumentation recently reported by Baraza et al [14]. However, it should also be noted that their study reported a retrospective analysis of only 49 colonoscopies, performed by a single endoscopist.…”

Section: Cecal Images Statistical Differencementioning

confidence: 85%

“…Furthermore, it was not clear whether these photographs had been taken for the purpose of photodocumentation, and no standardized protocol for demonstrating villi was employed. However, in the few patients in whom water instillation was employed, increased accuracy of ileal identification was reported [14]. In summary, documentation of colonoscopy completion is an essential component of quality assurance in routine clinical practice.…”

Section: Cecal Images Statistical Differencementioning

confidence: 99%

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Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy

et al. 2011

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Section: Cecal Images Statistical Differencementioning

confidence: 85%

Section: Cecal Images Statistical Differencementioning

confidence: 99%

Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy

et al. 2011

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“…Also, some may consider “seeing the cecum at a distance” as being equivalent to “having reached the cecum”. Many efforts have been made to provide objective confirmation of complete intubation 11 . So far, the use of supportive photo documentation prevails although a photo of the cecum at distance may be erroneously accepted as a proof of reaching the cecum.…”

Section: Discussionmentioning

confidence: 99%

Cecum intubation rate as quality indicator in clinical versus screening colonoscopy

et al. 2017

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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.

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“…Images of the ileocecal valve along with the triradiate fold and appendicular orifice provide convincing evidence of a completed colonoscopy. Terminal ileal images alone without cecal images may not be reliable evidence of the completion of colonoscopy 8 . Therefore, we chose cecal image documentation over terminal ileal image documentation as a marker of completion of the procedure.…”

Section: Discussionmentioning

confidence: 99%

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

Thoufeeq

Rembacken

2015

Endosc Int Open

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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.

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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

Cited by 9 publications

References 16 publications

Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy

Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy

Cecum intubation rate as quality indicator in clinical versus screening colonoscopy

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

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