Assessing the Extent of Colonoscopy

Abstract

We read with interest the study by Shah et al1Shah H.A. Paszat L.F. Saskin R. et al.Factors associated with incomplete colonoscopy: a population-based study.Gastroenterology. 2007; 132: 2297-2303Abstract Full Text Full Text PDF PubMed Scopus (293) Google Scholar in the June 2007 issue of Gastroenterology and wish to make 3 comments. First, where a colonoscopy was planned to be limited in extent before starting the procedure, that is, to assess disease extent in ulcerative colitis or to check for polyp recurrence at a designated site, did this count as a failure to complete? Second, in this study, completion of colonoscopy was determined by the colonoscopist whose financial reimbursement was related directly to the extent of colon examined. We suggest that, under these circumstances, there is an incentive to overestimate the level of insertion of the colonoscope. Last, self-reporting of cecal or ileal intubation (similar to study by Bowles et al2Bowles C.J.A. Leicester R. Romaya C. et al.A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal screening tomorrow?.Gut. 2004; 53: 277-283Crossref PubMed Scopus (518) Google Scholar) by the colonoscopist may overestimate the level reached. To overcome this potential source of error, we carried out a 1-year prospective audit of colonoscopies performed in Kent, England,3Harris A.W. Arais K. Rouse T. Prospective audit of colonoscopy quality in Kent & Medway.Gut. 2006; 55: A8PubMed Google Scholar where cecal or terminal ileal intubation was independently verified and documented by the endoscopy unit nurses. Factors Associated With Incomplete Colonoscopy: A Population-Based StudyGastroenterologyVol. 132Issue 7PreviewBackground & Aims: The U.S. Multi-Society Task Force on Colorectal Cancer sets a target of cecal intubation in at least 90% of colonoscopies. We conducted a population-based study to determine the colonoscopy completion rate and to identify factors associated with incomplete procedures. Methods: Men and women 50 to 74 years of age who underwent a colonoscopy in Ontario between January 1, 1999, and December 31, 2003, were identified. The first (index) colonoscopy was classified as complete or incomplete. Full-Text PDF ReplyGastroenterologyVol. 133Issue 4PreviewTaylor and Harris raise the issue of including procedures in which the intent of the endoscopist was to perform a limited examination (such as to assess the extent of inflammatory bowel disease [IBD] or check a polypectomy site for recurrence). As described in our Methods section,1 we excluded patients who, in the prior 5 years, had a colonoscopy or an admission for IBD. We did this to approximate a screening population who were undergoing their first colonoscopy. We agree that the financial incentive for endoscopists, as noted in our Discussion section, combined with self-reporting of extent of colon examined may lead to an overestimation of the depth of insertion. Full-Text PDF