Impact of Cecal Intubation Rate on Adenoma Detection Rate: Analysis of Average Risk Screening Colonoscopy Examinations

Abstract

Purpose: Adenoma detection rate and cecal intubation rate are established independent quality indicators for a screening colonoscopy exam. However, data is conflicting regarding the effect of cecal intubation rate on the detection of adenomas. The aim of this study is to estimate the impact of cecal intubation rate on the detection of adenomas and polyps. Methods: Retrospective analysis of average risk screening colonoscopies performed at a university hospital using the electronic reporting system was done. All patients who underwent a colonoscopy with the indication “screening-average risk” during the study period [2006-2011] were included. Surveillance procedures and patients with high-risk family history were excluded since they are expected to have higher adenoma rate. We reviewed demographic details, procedural data and corresponding pathology reports. Polyp detection rate (PDR) is defined as the number of colonoscopies with at least one polyp removed/total number of procedures. Adenoma detection rate (ADR) is defined as the number of colonoscopies with removal of at least one pathologically confirmed adenoma/total number of procedures. Cecal intubation is defined as intubation beyond the ileo-cecal valve with complete examination of the cecum. Cecal intubation rate is defined as the proportion of exams where cecal intubation is completed. Incomplete exams due to poor or inadequate bowel preparation were excluded. Pearson Correlation coefficient was calculated to estimate the degree of correlation between the cecal intubation rate and ADR/PDR. Results: A total of 2,370 patients fulfilled the inclusion criteria. ADR, PDR and cecal intubation rates for each of the five participating endoscopists were calculated (see Table). The Pearson correlation coefficient (R) for cecal intubation rate and ADR was -0.4, but did not reach statistical significance [p= 0.50]. The R for cecal intubation rate and PDR was -0.2 and not statistically significant [p= 0.64].Table: No Caption available.Conclusion: Cecal intubation rate is not a good predictor of adenoma detection rate.