Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate

Abstract

BackgroundHigh cecal intubation rate (CIR) is associated with significant improved adenoma detection rate (ADR), however, self-reported CIR may be overestimated and inadequate documentation of cecal intubation is associated with a lower polyp detection rate compared to clear documentation. We aimed to investigate if ileal intubation may be associated with higher detection rates (DR) for right-sided conventional adenomas (cAD) and serrated polyps (SP) compared to cecal intubation in a large screening colonoscopy cohort.Material and methodsRetrospective analysis of individuals ≥50 years with average risk for colorectal cancer (CRC) who underwent screening colonoscopy between 01/01/2012 and 14/12/2016 at a tertiary academic hospital and six community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e.g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures. Right-sided colon was defined as caecum and ascending colon.Results4.138 individuals were analysed (mean age 62 years, 52.1% female). DR for right-sided cADs and SPs were significantly higher after ileal compared to cecal intubation in univariate (12.5% vs. 6.8%, p < 0.001, and 6.3% vs. 3.3%, p < 0.001), but not in multivariate analysis (OR 1.025, 95%-CI 0.639–1.646, p = 0.918, and OR 0.937, 95%-CI 0.671–1.309, p = 0.704). DRs did not differ between ileal and cecal intubation for endoscopists with ADR ≥25 and < 25%, respectively. ADR ≥25% was significantly associated with ileal intubation (OR 21.862, 95%-CI 18.049–26.481, p < 0.001).ConclusionIleal intubation may not provide any benefit over cecal intubation concerning the detection of cADs and SPs in the right-sided colon.

Clinical Yield of Ileal Intubation During Screening Colonoscopy

“…Our study reported a higher ileal intubation rate among younger individuals undergoing screening colonoscopy. Existing studies report conflicting results regarding the association between the age of the patients and the likelihood of ileal intubation [ 2 , 14 , 21 , 22 ]. It is not clear why successful ileal intubation is more achievable in younger patients.…”

“…A prospective study conducted by Börsch et al reached a similar conclusion [ 23 ]. Nonetheless, Buerger et al suggested, in their retrospective study, that the quality of the colon preparation does not substantially impact the likelihood of ileal intubation [ 22 ].…”

Impact of pediatric versus adult colonoscope on terminal ileum intubation: a retrospective study

“…For example, lower TII rates among elderly patients have been previously observed in studies that included patients undergoing colonoscopy for non-screening indications [ 2 , 19 ]. On the other hand, 2 large retrospective studies concluded that age was not associated with a higher likelihood of TII [ 25 , 26 ]. Our study found that younger patients were more likely to have successful TII.…”

“…This has also been demonstrated in a prior prospective study [ 27 ]. However, a large retrospective cohort study reached a different conclusion, reporting no difference in TII based on the quality of the colon preparation [ 26 ].…”

“…However, several studies that reported higher TII rates were either small or represented the experience of just a few endoscopists [ 1 ]. Larger studies (i.e., >1000 patients and/or >20 endoscopists) reported lower TII rates [ 13 , 19 , 26 , 31 , 32 ], capturing the variable rate of successful TII among a heterogeneous group of endoscopists.…”