Terminal ileum intubation is not associated with colonoscopy quality measures

Abstract

Background and Aim: Intubation of the terminal ileum (TI) demonstrates a complete colonoscopy, but its clinical value during screening exams is unknown. We aimed to determine whether TI intubation during screening colonoscopy is associated with colonoscopy quality measures or identifies subclinical pathology. Methods: We performed a retrospective cohort study examining average-risk screening colonoscopies performed at an academic health system between July 2016 and October 2017. Data were extracted from an internal colonoscopy quality registry and the electronic health record. Appropriate statistical tests were used for group comparisons, to correlate TI intubation rate (TIIR) with measures of colonoscopy quality and to examine factors associated with the likelihood of TI intubation. Results: There were 7799 colonoscopies performed with adequate prep quality by 28 gastroenterologists. Most patients were female (56.4%) with a median age of 58. The median TIIR was 37.0%, with significant variability among physicians (2-93%). The detection rates for all polyps, adenomas, and sessile serrated polyps were 62.1%, 45.5%, and 7.2%, respectively, and none correlated with TIIR. Intubation of the TI was associated with significantly longer withdrawal times. In a random 10% sample of cases with TI intubation, no clinically significant pathology was found. Conclusions: There is wide variability in TIIR among endoscopists. Except to provide photodocumentation of exam extent when other images may be difficult to obtain, the lack of correlation between TI intubation and meaningful clinical outcomes together with the associated time costs suggest routine TI intubation during screening colonoscopy may not be warranted.

Clinical Yield of Ileal Intubation During Screening Colonoscopy

“…Also, interestingly, short cecal insertion time was predictive of ileal intubation in our cohort. Lieman et al reached a similar conclusion in their retrospective study that showed prolonged cecal insertion time was associated with a lower likelihood of ileal intubation (median and interquartile range: 6 [ 4 , 10 ] vs. 5 [ 4 , 8 ]; p<0.0001) [ 21 ].…”

“…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.…”

“…Cherian et al reported an increase in the total colonoscopy procedure time of 3 minutes due to ileoscopic examination [ 9 ]. In contrast, Leiman et al reported no impact of attempting ileal intubation on the total procedure time [ 21 ].…”

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

“…There are conflicting data regarding the association between age and likelihood of successful TII [ 2 , 19 , 25 ]. 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 ].…”

“…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.…”