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Abstract

Taylor 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,1Shah 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 (294) Google Scholar 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. It would be ideal to have independent verification as part of a quality assurance program. Although it will be a challenge to implement independent verification in usual clinical practice across wide geographic areas, we should strive to do this for the colonoscopies performed to support our recently announced province-wide fecal occult blood testing screening program.2Ontario Ministry of Health and Long-Term Care. News Media. Available at: www.health.gov.on.ca. Accessed August 30, 2007.Google Scholar Radaelli and Minoli point to the need to evaluate clinical factors, such as quality of bowel preparation and sedation. As we note in our Discussion section, this was not possible given the design of our study. It is interesting that their study determined that the use of sedation was less common in “outpatient units.” We look forward to the full publication of their work. Rubin and Galambos misinterpret our findings, raising the issue of our “low complete screening colonoscopy rates.” As we note in our Discussion section, “although we constructed inclusion and exclusion criteria to approximate an average risk screening population, we could not distinguish screening from diagnostic colonoscopy.” Furthermore, Rubin and Galambos misinterpret our quintile variable. As we note in the Methods section, “endoscopist volume was defined using the total number of colonoscopies performed during the study period and calculating the average annual volume for each endoscopist.” Finally, we point out the differences in the types of sedation used may be less important than whether the patient actually receives any sedation. In other words, the differences in colonoscopy completion rates between groups of patients, all of whom receive some type of sedation, may be small compared with differences in completion rates between patients who do and do not receive sedation. We are pleased with the interest generated by our work, and as we have pointed out, further study is clearly needed. Assessing the Extent of ColonoscopyGastroenterologyVol. 133Issue 4PreviewWe read with interest the study by Shah et al1 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. Full-Text PDF