Impact of sedation on the Performance Indicator of Colonic Intubation

Abstract

Background: Performance Indicator of Colonic Intubation (PICI) has been introduced as new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. In a UK national audit, adequate PICI was achieved in 54.1% of colonoscopies and associated with higher polyp detection rates. In this study, achievement of PICI was assessed within the Dutch colorectal cancer (CRC) screening program and the association between PICI and the adenoma detection rate (ADR) was determined. Furthermore, we assessed the achievement of the performance indicator using the Dutch median midazolam dose. Methods: This retrospective study was conducted within the Dutch FIT-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between 01-01-2016 and 01-01-2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) between 1 - 3 and use of ≤ 2.5 mg midazolam. Results: During the study period, 107.328 colonoscopies were performed. Adequate PICI was achieved in 49.500 (46.1%) colonoscopies. In the colonoscopies with inadequate PICI, this was due to higher sedation dosages in 87.8%. Adequate PICI was associated with higher ADR (OR: 1.16; 95%CI: 1.12-1.20). When using a cut-off of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95.410 colonoscopies (88.9%). Conclusion: PICI appears to be an indicator that is heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as quality indicator is limited.

Sedation Is Associated with Higher Polyp and Adenoma Detection Rates during Colonoscopy: A Retrospective Cohort Study

“…To our knowledge, this is the largest study to date specifically evaluating the effects of sedation in ADR among outpatient colonoscopies. In previous studies, it is reported that sedation can improve patient comfort and satisfaction [12,16,[23][24][25]. However, the overall quality indicators, the findings (about impact of sedation) are controversial, both in terms of demonstrating an increase and in terms of demonstrating similarity.…”

Sedation is associated with higher polyp and adenoma detection rates during colonoscopy: a retrospective cohort study

“…To our knowledge, this is the largest study to date speci cally evaluating the effects of sedation in PDR and ADR among outpatient colonoscopies. In previous studies, its' reported that sedation can improve patient comfort and satisfaction [12][13][14][15][16] . However, the overall quality indicators, the ndings are controversial, both in terms of demonstrating an increase and in terms of demonstrating similarity.…”

Correlation between adenoma detection rate and other quality indicators, and its variability depending on factors such as sedation or indication for colonoscopy

“…Cecal intubation rate was higher when colonoscopies were performed with sedation which is in accordance with the data from the literature. There is a new measure of quality in colonoscopy that is being studied, called Performance Indicator of Colonic Intubation (PICI), which is defined as the rate of cecal intubation without significant discomfort and use of minimal sedation ( Nass et al, 2021 ). The study of this indicator shows that there is an interest in reducing the amount of sedation during colonoscopy, or in performing as many examinations as possible without sedation, while maintaining the comfort of the patient and the quality of the examination.…”