Impact of photodocumentation of caecal intubation on colonoscopy outcomes

Abstract

Objectives

The European and American colonoscopy guidelines recommend mandatory photodocumentation of caecal intubation to allow retrospective analysis and improve outcomes. We aim to demonstrate whether photodocumentation of caecal intubation improves colonoscopy outcomes.

Methods

We extracted images and procedural data from 317 consecutive colonoscopies. Images were anonymised and reviewed by four expert reviewers who scored their certainty that caecal intubation was achieved. Statistical analysis correlated adequately and inadequately photodocumented cases with polyp detection rate (PDR) and adenoma detection rate (ADR).

Results

The patients’ mean age was 59.4 years and 52% were male. Eighty-one percent were performed by consultant endoscopists and 19% by specialist registrar. Sixty-five percent of these procedures were performed by gastroenterologists and 35% by surgical endoscopists. Fifty-three percent were deemed to have adequately demonstrated photographic evidence of caecal intubation. Statistical analysis comparing adequately and inadequately photodocumented cases: the PDR of procedures with confirmed caecal intubation was greater than procedures without photographic evidence (40% vs 34%). Similarly, the ADR of photographically confirmed cases was greater than that of inadequately photodocumented cases (25% vs 18%). The number of images taken per procedure positively correlated with photographic documentation of caecal intubation.

Conclusion

While failing to reach statistical significance, there was a nominal difference in ADR and PDR demonstrated between the two groups, and with predominantly positive confidence intervals, this might suggest that a larger sample size could result in significance in favour of photodocumentation of caecal intubation. Future studies would be warranted. However, endoscopists that take more images were more likely to have proven caecal intubation.

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Data availability

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References

  1. 1.

    Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E (2010) Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 362(19):1795–1803. https://doi.org/10.1056/NEJMoa0907667

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Lee TJW, Rees CJ, Blanks RG, Moss SM, Nickerson C, Wright KC, James PW, McNally RJQ, Patnick J, Rutter MD (2014) Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program. Endoscopy 46(03):203–211. https://doi.org/10.1055/s-0033-1358831

    Article  PubMed  Google Scholar 

  3. 3.

    Kaminski MF, Thomas-Gibson S, Bugajski M, Bretthauer M, Rees CJ, Dekker E, Hoff G, Jover R, Suchanek S, Ferlitsch M, Anderson J, Roesch T, Hultcranz R, Racz I, Kuipers EJ, Garborg K, East JE, Rupinski M, Seip B, Bennett C, Senore C, Minozzi S, Bisschops R, Domagk D, Valori R, Spada C, Hassan C, Dinis-Ribeiro M, Rutter MD (2017) Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 5(3):309–334. https://doi.org/10.1177/2050640617700014

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ (2017) Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 112(7):1016–1030. https://doi.org/10.1038/ajg.2017.174

    Article  PubMed  Google Scholar 

  5. 5.

    Rizk MK, Sawhney MS, Cohen J, Pike IM, Adler DG, Dominitz JA, Lieb JG II, Lieberman DA, Park WG, Shaheen NJ, Wani S (2015) Quality indicators common to all GI endoscopic procedures. Gastrointest Endosc 81(1):3–16. https://doi.org/10.1016/j.gie.2014.07.055

    Article  PubMed  Google Scholar 

  6. 6.

    Bressler B, Paszat LF, Vinden C, Li C, He J, Rabeneck L (2004) Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 127(2):452–456. https://doi.org/10.1053/j.gastro.2004.05.032

    Article  PubMed  Google Scholar 

  7. 7.

    Moug SJ, Fountas S, Johnstone MS, Bryce AS, Renwick A, Chisholm LJ, McCarthy K, Hung A, Diament RH, McGregor JR, Khine M, Saldanha JD, Khan K, Mackay G, Leitch EF, McKee RF, Anderson JH, Griffiths B, Horgan A, Lockwood S, Bisset C, Molloy R, Vella M (2017) Analysis of lesion localisation at colonoscopy: outcomes from a multi-centre U.K. study. Surg Endosc 31(7):2959–2967. https://doi.org/10.1007/s00464-016-5313-z

    Article  PubMed  Google Scholar 

  8. 8.

    Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150(1):1–8. https://doi.org/10.7326/0003-4819-150-1-200901060-00306

    Article  PubMed  Google Scholar 

  9. 9.

    Brenner H, Chang-Claude J, Seiler CM, Hoffmeister M (2012) Interval cancers after negative colonoscopy: population-based case-control study. Gut 61(11):1576–1582. https://doi.org/10.1136/gutjnl-2011-301531

    Article  PubMed  Google Scholar 

  10. 10.

    Lee TJ, Rutter MD, Blanks RG, Moss SM, Goddard AF, Chilton A, Nickerson C, McNally RJ, Patnick J, Rees CJ (2012) Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut 61(7):1050–1057. https://doi.org/10.1136/gutjnl-2011-300651

    Article  PubMed  Google Scholar 

  11. 11.

    Maida M, Morreale G, Sinagra E, Ianiro G, Margherita V, Cirrone Cipolla A, Camilleri S (2019) Quality measures improving endoscopic screening of colorectal cancer: a review of the literature. Expert Rev Anticancer Ther 19(3):223–235. https://doi.org/10.1080/14737140.2019.1565999

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Nakada A, Niikura R, Yamada A, Yoshida S, Hirata Y, Koike K (2017) The incidence of post-colonoscopy colorectal cancer: a retrospective long-term cohort study using a colonoscopy database. Int J Color Dis 32(6):839–845. https://doi.org/10.1007/s00384-017-2757-0

    Article  Google Scholar 

  13. 13.

    Thoufeeq MH, Rembacken BJ (2015) Meticulous cecal image documentation at colonoscopy is associated with improved polyp detection. Endosc Int Open 3(6):E629–E633. https://doi.org/10.1055/s-0034-1392783

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Somasundaram CS, Ramanaden D, Baghomian A, Finnie I (2012) PMO-205 Photographic confirmation of complete colonoscopy. Gut 61(Suppl 2):A157–A157. https://doi.org/10.1136/gutjnl-2012-302514b.205

    Article  Google Scholar 

  15. 15.

    Wanders LK, van Doorn SC, Fockens P, Dekker E (2015) Quality of colonoscopy and advances in detection of colorectal lesions: a current overview. Expert Rev Gastroenterol Hepatol 9(4):417–430. https://doi.org/10.1586/17474124.2015.972940

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG II, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS (2015) Quality indicators for colonoscopy. Gastrointest Endosc 81(1):31–53. https://doi.org/10.1016/j.gie.2014.07.058

    Article  PubMed  Google Scholar 

  17. 17.

    Gomez D, Dalal Z, Raw E, Roberts C, Lyndon PJ (2004) Anatomical distribution of colorectal cancer over a 10 year period in a district general hospital: is there a true “rightward shift”? Postgrad Med J 80(949):667–669. https://doi.org/10.1136/pgmj.2004.020198

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Rex DK (2000) Still photography versus videotaping for documentation of cecal intubation: a prospective study. Gastrointest Endosc 51(4 Pt 1):451–459. https://doi.org/10.1016/s0016-5107(00)70447-0

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Brendan Moran.

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The authors declare no conflict of interests for this article.

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Ethical approval was granted by the Clinical Research Ethics Committee, Galway University Hospitals Group, Ireland—Ref: C.A. 2226.

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Moran, B., Sehgal, R., O’Morain, N. et al. Impact of photodocumentation of caecal intubation on colonoscopy outcomes. Ir J Med Sci (2021). https://doi.org/10.1007/s11845-020-02469-z

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Keywords

  • Caecal imaging
  • Caecal intubation
  • Caecal intubation rate (CIR)
  • Colonoscopy
  • Outcomes
  • Photodocumentation