Tu1132 ASSOCIATION BETWEEN THE ADENOMA DETECTION RATE AND A COMPOSITE QUALITY INDICATOR OF CAECAL INTUBATION, PATIENT COMFORT AND SEDATION IN FIT-POSITIVE COLONOSCOPIES

Abstract

The Performance Indicator of Colonic Intubation (PICI) has been introduced as a new measure of high-quality colonic intubation, taking three key parameters into account. An adequate PICI was defined as caecal intubation without significant discomfort and use of less than the median midazolam dose in the UK. In an UK national audit, adequate PICI was achieved in 54.1% of colonoscopies. It was associated with higher polyp detection rates, but an association with the adenoma detection rate (ADR) was not assessed. In this study, we determined the association between PICI, using the UK and Dutch median sedation dose, and detection rates of (advanced) adenomas in colonoscopies for the Dutch FIT-based colorectal cancer (CRC) screening program. Furthermore, we assessed the feasibility of PICI as quality indicator in this population. This study was conducted within the Dutch FIT-based screening program. Colonoscopy and pathology data is prospectively collected in a national database, providing data on ADR. Data between 01-01-2016 and 01-01-2018 were analyzed. Achieving an adequate PICI was defined as a procedure with caecal intubation, a Gloucester Comfort Scale (GCS) between 1 and 3 (no to mild discomfort) and use of a maximum dose of 2.5 mg midazolam. Besides, we studied the PICI when using the median dose of midazolam given in this Dutch population. During the study period, 107.328 colonoscopies were performed in FIT-positive participants. The mean ADR was 64.2%. No to mild discomfort (GCS: 1-3) was recorded in 95.6% of the colonoscopies and the median midazolam dose was 5 mg (IQR: 2.5-5 mg). Adequate PICI, using the cut-off of 2.5 mg midazolam was achieved in 49.500 (46.1%) colonoscopies. In 87.8% of the colonoscopies in which PICI was inadequate, this was solely due to a higher dose of midazolam or use of propofol. Adequate PICI was associated with higher ADR (OR: 1.05; 95%CI: 1.03-1.08), but not with advanced adenoma detection rates (OR: 1.01; 95%CI: 0.99-1.04). When using the cut-off of 5 mg, the median midazolam dose in this Dutch population, adequate PICI was achieved in 95.410 colonoscopies (88.9%) and it was associated with both higher ADR (OR: 1.52; 95%CI: 1.46-1.58) and advanced adenoma detection rates (OR: 1.19; 95%CI: 1.14-1.24). Adequate PICI, using the UK and Dutch median sedation dose, was associated with higher ADRs. However, in this FIT-positive population, the UK-defined PICI was inadequate in more than half of all colonoscopies. This was mainly due to sedation practice in the Netherlands with a higher median midazolam dose of 5 mg. PICI appears to be an indicator that is heavily dependent on sedation practice, which is not the same across countries. Therefore, the PICI should be considered in the light of regional sedation practices and related to outcome parameters, like ADR.