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Technical Performance of Colonoscopy

The Key Role of Sedation/Analgesia and Other Quality Indicators

Radaelli, Franco, M.D.1; Meucci, Gianmichele, M.D.1; Sgroi, Giusy, Ph.D.2; Minoli, Giorgio, M.D.1 the Italian Association of Hospital Gastroenterologists (AIGO)

American Journal of Gastroenterology: May 2008 - Volume 103 - Issue 5 - p 1122–1130
ORIGINAL CONTRIBUTION: ENDOSCOPY
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BACKGROUND It is essential to identify the factors in clinical practice that influence the technical performance of colonoscopy as a basis for quality improvement programs.

AIMS To assess the factors linked to two key indicators of colonoscopy performance, i.e., cecal intubation and polyp diagnosis.

DESIGN AND SETTING Consecutives colonoscopies performed over a 2-wk period in 278 unselected practice sites throughout Italy were prospectively evaluated. A multivariate model was developed to identify determinants of the performance indicators of colonoscopy.

RESULTS In total, 12,835 patients (mean age 60.5 yr, standard deviation [SD] 15.1, 53% men) were studied. Sedation and/or analgesia was administered in 55.3% of procedures: 28.8% of patients received intravenous (IV) benzodiazepines, 15.4% received benzodiazepines in combination with narcotics, 3.1% received propofol, and 7.5% received other sedation regimens. Overall, cecal intubation was achieved in 80.7% of procedures, and the polyp detection rate was 27.3%. Multivariate analysis showed that the strongest predictors of cecal intubation were the quality of bowel preparation (inadequate vs excellent: odds ratio [OR] 0.013, 95% confidence interval [CI] 0.009–0.018; fair vs excellent: OR 0.246, 95% CI 0.209–0.290; and good vs excellent: OR 0.586, 95% CI 0.514–0.667) and the use of sedation (IV benzodiazepines vs no sedation: OR 1.460, 95% CI 1.282–1.663; IV benzodiazepines and narcotics vs no sedation: OR 2.128, 95% CI 1.776–2.565; and propofol vs no sedation: OR 2.355, 95% CI 1.590–3.488). The colonoscopy setting (workload and organizational complexity of the center) and the endoscopist colonoscopy volume were other factors independently correlated with completion of the procedure. Detection of polyps partially depended on the quality of bowel cleansing (inadequate vs excellent: OR 0.511, 95% CI 0.404–0.647) and use of sedation (OR 1.172, 95% CI 1.074–1.286).

CONCLUSION In usual clinical practice, the use of sedation/analgesia, the colon-cleansing quality, the endoscopist experience, and some features related to the colonscopy setting decisively influence the quality of colonoscopy. These factors indicate the targets of future corrective measures to boost the quality of this examination.

1Department of Gastroenterology, Valduce Hospital, Como, Italy; and 2Institute of Biostatistics, OPIS, Milan, Italy

Reprint requests and correspondence: Franco Radaelli, M.D., Department of Gastroenterology, Ospedale Valduce, Via Dante 11, 22100 Como, Italy.

This paper has been presented in part at the ASGE meeting, DDW, May 20–24, 2006, Los Angeles, CA.

Received August 3, 2007; accepted November 27, 2007.

© The American College of Gastroenterology 2008. All Rights Reserved.
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