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Quality Assessment of Colonoscopic Cecal Intubation

An Analysis of 6 Years of Continuous Practice at a University Hospital

Aslinia, Florence, M.D.; Uradomo, Lance, M.D., M.P.H.; Steele, Allison, M.S.N., C.R.N.P.; Greenwald, Bruce D., M.D.; Raufman, Jean-Pierre, M.D., F.A.C.G.

American Journal of Gastroenterology: April 2006 - Volume 101 - Issue 4 - p 721–731
ORIGINAL CONTRIBUTION: ENDOSCOPY
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BACKGROUND Despite increased emphasis on endoscopic performance indicators, e.g., cecal intubation rates, limited data from actual clinical practice have been published.

OBJECTIVES Retrospective database review to determine the rate and documentation of cecal intubation during colonoscopy at the University of Maryland Medical Center.

METHODS We reviewed 5,477 consecutive colonoscopies performed by 10 faculty gastroenterologists at a University hospital over a 6-yr period (March 1, 1999 to February 28, 2005). Unadjusted cecal intubation rates were analyzed as were rates that were adjusted based on the U.S. Multi-Society Task Force on Colorectal Cancer recommendations. We analyzed trends in overall and individual cecal intubation rates, circumstances that impact these rates, and the quality of documentation of cecal intubation.

RESULTS The overall adjusted cecal intubation rate for the entire 6 yr was 90.3%, and increased over the study period with the highest adjusted rate (93.7%) in the most recent year studied. There was no correlation between cecal intubation rate and patient age, gastroenterology fellow involvement, or endoscopist experience and number of procedures/year. In contrast, colon cancer screening, male gender, outpatient colonoscopy, and adequate bowel preparation predicted a higher cecal intubation rate. Written and photographic documentation of cecal intubation improved significantly after 2002.

CONCLUSIONS Our analysis revealed cecal intubation and documentation rates that meet current guidelines, and identified factors that may cause substantial variance in these rates depending on the nature of the practice. The present analysis confirms that computerized databases can be used to assess individual and group cecal intubation and documentation rates on an annual basis, and to make these data available to the public.

Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland

Reprint requests and correspondence: Jean-Pierre Raufman, M.D., F.A.C.G., Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 22 S. Greene Street, N3W62, Baltimore, MD 21201.

Received June 30, 2005; accepted August 28, 2005.

© The American College of Gastroenterology 2006. All Rights Reserved.
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