M1432: Qualitative Evolution of Colonoscopy - An Analysis Over 10 Years of Continuous Practice At a Large Community, Teaching Hospital

Abstract

With the exponential growth in colonoscopy since its introduction in 1963 have come significant advances in colonoscope design as well as the development of quality metrics for this test. The latest objective quality indicators, defined by the ASGE and the US Multi-Society Task Force on Colorectal Cancer, included the intra-procedure markers of cecal intubation rates,adenoma detection and withdrawal times.Our aim was to compare quality indicators for colonoscopy, particularly,cecal intubation and polyp detection rates, over a 10-year period at a community teaching hospital.We retrospectively reviewed data from colonoscopies done in a population presenting for colorectal cancer screening/surveillance over a 10-year period (1999-2009), specifically looking at cecal intubation and polyp detection rates. Cecal intubation was defined as success at reaching the cecum, ileum, ileocecal valve or surgical stoma. Polyp detection was defined as >1 polyp detected on colonoscopy or flexible sigmoidoscopy. The data was extracted using a computerized endoscopic database (ProVation Medical,Minneapolis,USA).33,553 total colonoscopies were performed during the period Nov 1999-Nov 2009. Comparing cross-sectional data over a period of 1 year from 1999-2000 and 2008-09, there was a 27.6% increase in the number of colonoscopies performed (2658 to 3392). The cecal intubation rate for the 10-year period was 92.1% (30,900/33,553). Comparing cross-sectional data over a period of 1 year from 2008-09 and 1999-2000,the cecal intubation rates were 94.4% (3155/3342) and 82.4% (1951/2368) respectively and the polyp detection rates were 33.03% (1156/3500) and 33.65% (1082/3215) respectively.Using high definition endoscopes(Olympus 180 series) over a 2-month period, Sep-Oct 2009, the cecal intubation and polyp detection rates were 94.3% and 32.7%(190/581) respectively. In comparison, over the 2-month period Sep-Oct 2008, where standard definition endoscopes were used(Olympus 160 series),the cecal intubation and polyp detection rates were 94.8% and 38.3%(242/632) respectively.This data reveals a significant increase in colonoscopies being performed over the last 10 years, with a 12.2% increase in cecal intubation rates and no significant change in polyp detection rates. The marked increase in cecal intubation rates may reflect a qualitative evolution with improvement in operator technique, improvements in endoscope design, or increasing awareness of quality indicators. The stable rate of polyp detection suggests that improvements in imaging design, including the transition to high definition endoscopy, have not played a significant role in the efficacy of screening colonoscopy.