Caecal Intubation Rate Research Articles

PWE-027 The Reasons For Gender Differences In Caecal Intubation Rates – Analysis Of 8324 Colonoscopies Over 6 Years

IntroductionIn 2012 we presented a poster to the Digestive Disorders Foundation Meeting, we analysed 5162 colonoscopies and noted a significant difference in caecal intubation rates (CIR) of male and female...

PWE-041 Management Of Large Colonic Polyps In A Bowel Cancer Screening Programme

IntroductionBowel cancer is the third most common cancer in the United Kingdom forming up to 13.6% of all newl1y diagnosed cancers (1). Bowel cancer screening colonoscopy allows early polyp detection...

PWE-005 Management Of High Risk Colonic Polyps

IntroductionColorectal cancer is a significant health problem, the importance of which will increase substantially in the coming years. Demand for colonoscopy will increase and so will demand for complex polypectomy...

PWE-065 Colonoscopy Performance In A District General Hospital. Has The Standardisation Of Training Standardised Performance?

IntroductionSince the introduction of the JAG endoscopy training system (JETS) for trainees in 2003 there have been demonstrable improvements in the key performance indicators (KPIs) of colonoscopy performance. Caecal intubation,...

PWE-062 Terminal Ileal Intubation Over A Five Year Period; Was It Useful?

IntroductionThe value of routine ileoscopy during colonoscopy is unclear, but intubation of the terminal ileum (TI) is considered to be the main method of confirming completeness of colonoscopy. TI intubation...

PWE-061 Split-dose Moviprep (low Volume Peg) And Afternoon Colonoscopy: A Step In The Right Direction

IntroductionGood bowel preparation is essential for optimal mucosal visualisation during colonoscopy. The aim of this retrospective study was to evaluate the efficacy of three types of bowel preparation – Picolax...

An analysis of the learning curve to achieve competency at colonoscopy using the JETS database

ObjectiveThe number of colonoscopies required to reach competency is not well established. The primary aim of this study was to determine the number of colonoscopies trainees need to perform to...

Correlation of caecal intubation rate to volume: colonoscopists should undertake at least 120 procedures per year

IntroductionThe measurement of the quality of colonoscopy has been in the vanguard of quality improvement. The Joint Advisory Group on Gastrointestinal endoscopy (JAG) has issued guidance for practitioners to achieve...

Terminal Ileal Intubation during Colonoscopy over a Five-Year Period: Was It Useful?

Purpose: The value of routine ileoscopy during colonoscopy is unclear, but intubation of the terminal ileum (TI) is considered to be the main method of confirming completeness of colonoscopy. TI intubation rates are variable and intubation is often omitted due to time constraints and the perception of little added diagnostic value. Our aim was to assess the diagnostic yield of TI intubation during colonoscopies at our institution. Methods: A retrospective study was undertaken at our institution. Colonoscopy data over a 5-year period (1st October 2007 to 30th September 2012), were retrieved from the Endoscopy Reporting System database (Unisoft, Enfield, UK). Patients with ileo-caecal resection were excluded. Demographic data, TI pathology (endoscopic and histopathologic), and indications for colonoscopy were analysed. Results: 8,016 colonoscopies were performed with an overall unadjusted caecal intubation rate of 90.3%. The endoscopists were of different grades including gastroenterologists, colorectal surgeons, and a nurse endoscopist; 206 with previous ileo-caecal resection were excluded. Further analysis was performed on 7,810 colonoscopies. Mean age was 61 years with a female preponderance at 52.6%. The TI was intubated in 1,845 (23.5%). Endoscopic TI pathology was identified in 42 patients (2.3%). Histology was available for 31, of which 23 (1.3%) had confirmed histological abnormalities. Diagnoses on ileoscopy included one adenocarcinoma, one carcinoid tumour, one metastatic malignant melanoma and 20 with terminal ileitis, of which, six had histological features of Crohn's disease. The most common indications in those with TI pathology were diarrhoea (15), abdominal pain (8), and rectal bleeding (8). Conclusion: Although overall diagnostic yield was low, TI intubation identified significant pathologies requiring further action, including three malignancies. Routine ileoscopy at colonoscopy is a simple manoeuvre, which, apart from quality assurance can identify important pathology. The most common indication in those with confirmed TI pathology was diarrhoea, therefore ileoscopy may have added diagnostic value in this context.

Split-dose MoviPrep® (Low-volume PEG) and Afternoon Colonoscopy: A Step in the Right Direction

Purpose: Good bowel preparation is essential for optimal visualisation of the mucosa during colonoscopy. The aim of this retrospective study was to evaluate the efficacy of three types of bowel preparation: Picolax® (sodium picosulphate), single-dose MoviPrep®, and split-dose MoviPrep®. Methods: Two groups of patients—bowel cancer screening and symptomatic patients—who underwent colonoscopy at our institution over a 12-month period were identified. Within the two groups, 50 patients receiving each type of bowel preparation were selected providing a total of 300. Data collected included subjective rating of bowel preparation (good, satisfactory, poor), depth of insertion, timing of endoscopy, and polyp detection. Results: In symptomatic patients, 94% prescribed split-dose MoviPrep® had good or satisfactory bowel preparation with an unadjusted caecal intubation rate of 96%. Eighty percent prescribed single-dose MoviPrep® and 84% prescribed Picolax received the same rating with a caecal intubation rate of 88% and 92%, respectively. More colonoscopies done in the afternoon received a ‘good' bowel preparation rating (65.3% vs 30.8%; p<0.001) and more polyps (52.6% vs 47.4%) were detected regardless of preparation type. MoviPrep® was associated with the highest polyp detection rate (61% vs 34%; p=0.03). In screening patients, 98% prescribed split-dose MoviPrep® had good or satisfactory bowel preparation; 94% prescribed single-dose MoviPrep® and 90% prescribed Picolax® achieved the same rating. There was no significant difference in caecal intubation or polyp detection within the screening group. Conclusion: Split-dose MoviPrep® (low-volume PEG) and colonoscopy performed in the afternoon are two independent factors facilitating better bowel cleansing and higher polyp detection.Figure

Colonoscopy quality assessment in a mass population screening programme based on faecal occult blood test

the success of colorectal cancer (CRC) screening programmes largely depends on the quality of the events, processes and outcomes and therefore, quality assurance of endoscopy is an essential component. The quality indicators for colonoscopy in a screening programme setting are different from those performed in symptomatic people. The objective of this study was to report the main quality indicators of colonoscopies performed after a positive faecal occult blood test (FOBT) in a CRC screening programme in Catalonia. the period of study includes three rounds of the CRC screening programme from June 2006 to July 2013. Two types of FOBT were used: a qualitative biochemical guaiac-based test (gFOBT) and a quantitative immunochemical test (FIT). Quality indicators analysed in this study were compared to recommended colonoscopy standards from the published guidelines. during the study period, 1,806 colonoscopies were performed in 1,691 individuals with a positive FOBT. All indicators were within the standard except waiting time to colonoscopy. Caecal intubation rate was 95.6 % and adequate bowel cleansing 93.6 %. Adenoma detection rate was better using FIT than gFOBT, 30.7 and 3.8 per 1,000 screenees, respectively. Cancer detection rate was also greater using FIT. Nearly 62 % of cancers were diagnosed at an early stage. The overall complication rate was 10.7 ‰. although the majority of results reached the recommended standards, some areas have been identified for quality enhancement. Continuous monitoring of quality indicators is essential for improving the current effectiveness of CRC screening programmes.

Management of the malignant colorectal polyp: ACPGBI position statement

*Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK, †Torbay Hospital, Torquay, UK, ‡Department of General Surgery, Manchester Royal Infirmary, Manchester, UK, §Royal Infirmary, Glasgow, UK, ¶Department of Histopathology, Royal Bolton NHS Foundation Trust, Bolton, UK, **Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK, ††The Royal Marsden Hospital, London, UK, ‡‡Salisbury NHS Foundation Trust, Salisbury, UK and §§Department of Histopathology, University Hospital of South Manchester, Manchester, UK

AN AUDIT OF THE LAST 500 BOWEL CANCER SCREENING PROCEDURES WITHIN THE NORTHERN TRUST

IntroductionThe Bowel Cancer Screening Programme (BCS) in Northern Ireland offers screening every two years to all men and women aged 60 to 71. An FOB (faecal occult blood) kit is...

STREAMLINING INPATIENT COLONOSCOPY IN A TERTIARY CARE GI SERVICE

IntroductionGreater than 20% of all colonoscopies are associated with suboptimal bowel preparation,1 resulting in lower caecal intubation rates, longer procedure times, decreased adenoma detection rates and higher costs.2 Inadequate bowel...

PWE-048 An Evaluation of Screening Colonoscopists’ Performance After a Structured Accreditation Process

IntroductionColorectal cancer screening with colonoscopy has been shown to reduce mortality by removal of adenomatous polyps with potential for malignant change. Colonoscopists with higher adenoma detection rates have lower rates...

PTH-058 Trainee Colonoscopists Acquire Competency at Different Rates, as Determined by Cusum Analysis Of Colonoscopy Data From The Jets Database

IntroductionThe number of colonoscopies required to reach competency is not well established. Nevertheless, a minimal number forms part of UK certification criteria.The Cusum technique is a statistical analysis of sequential...

OC-047 Correlation of Caecal Intubation Rate to Volume – Colonoscopists should Undertake at least 120 Procedures per Year

<h3>Introduction</h3> Quality assurance of colonoscopy is a central theme in endoscopic provision. In the UK the Joint Advisory Group on Gastrointestinal endoscopy (JAG), has issued guidance for caecal intubation rates (CIR) of 90% or higher on an intention-to-colonoscope basis. They also advise that practitioners should undertake at least 100 colonoscopies per annum. We looked at the correlation between volume per annum and CIR to test JAG’s standard. <h3>Methods</h3> We analysed 129 operator records who undertook between 20–399 colonoscopies per annum. This amounted to 12 594 colonoscopies undertaken over a two year period (2008–9) across 6 hospitals in 3 regions. Each operator’s volume per annum was plotted against CIR. This was done as individual operators and also when individuals were grouped with others performing a similar volume of colonoscopy per annum (groups of 50). An additional analysis of operators undertaking 20–199 colonoscopies per annum looked at groups of 20 and groups of 10. <h3>Results</h3> Figure A shows a scatter plot of individuals’ volume (per annum) against CIR, the trend-line crosses the 90% CIR standard at 125 procedures per annum. The 3 other scatter plots of individuals grouped with others undertaking a similar volume per annum (groups of 50, 20 and 10) plotted against CIR, the trend-line crosses the 90% CIR standard at 110–120 procedures per annum. <h3>Conclusion</h3> The analysis of 12 594 colonoscopies, performed by 129 operators, carrying out between 20–399 colonoscopies per annum, suggest that to meet a minimum CIR standard of 90% at least 120 colonoscopies should be performed per annum. This is equivalent to performing 3 colonoscopies per week. We recommend advisory bodies on quality standards adopt this minimum activity threshold into their guidance. <h3>Disclosure of Interest</h3> None Declared

PTH-171 Colonoscopy Performance in Extended Three Session Working Days

IntroductionThree session working days were introduced in our endoscopy unit to accommodate the increasing demand for endoscopic procedures. There is evidence to suggest that caecal intubation rate (CIR) and polyp...

PTU-032 Would you like a Trainee to Perform your Colonoscopy?

IntroductionQuality assurance in colonoscopy is underpinned by a framework of nationally agreed quality indicators and auditable outcomes to maintain minimum standards. High quality colonoscopy training is a vital part of...

OC-048 Colonoscopy: What is the Number Required to Maintain Competency? – a Retrospective Audit

<h3>Introduction</h3> There has been increasing demand for gastroenterologist to maintain JAG competencies year on year.¹ However there are few studies into the adequate number required despite the bowel cancer screening programme suggesting &gt; 100 per annum. The study aims to compare competencies standards in relation to the number of colonoscopies performed in a year. <h3>Methods</h3> Data was collected retrospectively within the trust between 1/12/2010 and 30/11/2011. These include colonoscopies performed in the 3 main hospitals within the UHMBT – Royal Lancaster Infirmary, Furness General Hospital and Westmoreland General Hospital. A total of 2502 colonoscopies performed were retrieved. The endoscopy reporting system ‘Endobase’ and ‘Indigo 4 Review’ were used to retrieve endoscopy report and pathology report respectively. The caecal intubation rate (completion rate), polyp detection rate, adenoma detection rate, adequacy of bowel prep and sedation rate were set standards. Chi squared test for correlation was used to compare all standards. Two groups were formed to compare the set standards as colonoscopist who performed &gt; 100 colonoscopies per annum (pa) and those who performed &lt; 100 colonoscopies pa. Withdrawal time, polyp recovery and complication rates were not included in this audit. <h3>Results</h3> Of the 2502 colonoscopies performed, 633 were performed by colonoscopist who performed &lt; 100, 1869 colonoscopies were performed by colonoscopist who performed &gt; 100 colonoscopies. Completion rate for &lt; 100 colonscopies was 85.62% and &gt; 100 colonoscopies was 92.24% (p &lt; 0.0001). Polyp detection rate (PDR) for &lt;100 colonscopies was 17.85% and &gt; 100 colonoscopies was 30.34% (p &lt; 0.0001). Adenoma detection rate for &lt; 100 colonoscopies was 25.28% and &gt; 100 colonoscopies was 32.98% (p = 0.0003). Comparison of completion rates between both good and satisfactory bowel prep was 91.27% against poor prep 81.25% (p &lt; 0.001). Reasons for non completion in order of frequency were patient discomfort, excess looping, pathology encountered limiting progression, inadequate bowel preparation, tight stricture and instrument inadequacy. For sedation, the number of times pethidine given &gt; 50 mg was 0.15% and number of times midazolam given &gt; 5 mg was 0.05%. <h3>Conclusion</h3> Performing at least 100 colonoscopies a year statistically improves completion rate, polyp detection rate and adenoma detection rate. Good and satisfactory bowel prep statistically improves completion rate. This audit supports the JAG recommendation that a colonoscopist should perform &gt; 100 colonoscopies per annum to maintain competency. <h3>Disclosure of Interest</h3> None Declared <h3>Reference</h3> Valori R, Barton R. BSG quality and safety indicators for endoscopy. JAG: Joint Advisory Group on GI Endoscopy. 2007; 1–13.