The Performance of Colonoscopy in a Group Gastroenterology Practice

Abstract

Purpose: Little information exists regarding the use and usefulness of ancillary maneuvers such as the application of abdominal pressure and changing the patient's position to successfully complete colonoscopy. Our aim was to determine the frequency, type and success of ancillary maneuvers used by a diverse group of colonoscopists when performing colonoscopy. Methods: In an ongoing IRB-approved study, data has been collected during all colonoscopies performed since 4/3/06. Data collection sheets, completed at the time of the colonoscopy, included: gender, age, BMI, previous abdominal surgery, previous failed colonoscopy, endoscopist years of experience, procedure information (type of scope used, time to reach cecum, quality of bowel prep, patient tolerance), maneuvers needed to reach the cecum (abdominal pressure, change patient position, stiffen scope, change scope), and success in reaching the cecum. When a maneuver was performed, additional information obtained included the location of tip of colonoscope, type of maneuver and whether the maneuver was successful in producing forward movement of the colonoscope. Descriptive statistics and parametric and nonparametric analyses were completed. Logistic regression analysis was used to determine factors predictive of successfully completing colonoscopy. Results: From 4/3/06 to 5/15/06, data from 820 patients was collected (419 women; mean age 62.8 ± 12.3). The most common indications for colonoscopy were colon cancer screening and polyp surveillance. Twenty-six endoscopists participated. The cecum was reached in 770 cases (94%). The mean time to reach the cecum was 10:09 ± 00:14 min. Additional maneuvers to reach the cecum were required in 76% of the colonoscopies and a majority required multiple maneuvers (e.g., stiffen scope and apply abdominal pressure). While a number of factors were predictive of inability to reach the cecum in univariate analysis, only the quality of the bowel preparation and patient tolerance of the procedure remained as predictive factors using the multivariate approach. Patient accrual continues and will be reported at the meeting as will a detailed analysis of the data. Conclusions: These data from a large group of gastroenterologists at a single institution suggest that ancillary maneuvers are frequently utilized by colonoscopists to aid in the completion of colonoscopy. Patient tolerance during colonoscopy and the quality of the bowel preparation appear to be the main factors predicting a successful outcome.