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A Single-center Review of Pediatric Colonoscopy Quality Indicators

Pasquarella, Christine Seif*; Kaplan, Barbara*; Mahajan, Lori*; Lamparyk, Katherine; Kay, Marsha*

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 648–654
doi: 10.1097/MPG.0000000000002239
Original Articles: Gastroenterology

Objectives: Colonoscopy with terminal ileal (TI) intubation is an important diagnostic and therapeutic tool in the care of children with digestive diseases, especially in those with inflammatory bowel disease. Ileal intubation rate is a recognized quality indicator for pediatric colonoscopy. Our primary aim was to identify our single-center ileal intubation rate and to secondarily identify specific factors, including bowel preparation quality, procedure duration, and cecal intubation rates which affect successful ileal intubation and by extension, complete colonoscopy.

Methods: A retrospective chart review of all colonoscopies in 2015 was completed, identifying 458 procedures. Sixty-seven patients were excluded, resulting in 391 colonoscopies reviewed.

Results: We analyzed 391 colonoscopy procedures with a mean patient age of 14.4 ± 5.3 years. The most frequent primary indications for colonoscopy included abdominal pain with “red flag” symptoms (35.5%), known inflammatory bowel disease (25.1%), and isolated abdominal pain (11.5%). Ileal intubation was achieved in 91% of all colonoscopies, with a 94.4% cecal intubation rate. Failure of ileal and cecal intubations was classified into 4 categories: disease-related conditions, bowel preparation, technical aspects, and miscellaneous issues. Potentially modifiable factors accounted for the majority of cases of failed TI intubation. The mean colonoscopy time with and without successful TI intubation were 39 and 48.1 minutes, respectively.

Conclusions: Completion of colonoscopy to the TI is an essential part of a complete colonoscopy. TI intubation was possible in 91% of patients. This rate could potentially improve to 95% with optimization of modifiable factors such as improving bowel preparation or further refinement of endoscopic skills.

*Department of Pediatric Gastroenterology and Nutrition

Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland, OH.

Address correspondence and reprint requests to Christine Seif Pasquarella, MD, Cleveland Clinic Main Campus Mail Code A111 9500 Euclid Ave Cleveland, OH 44195 (e-mail:

Received 6 October, 2017

Accepted 16 November, 2018

This paper has not been published previously and this paper is not currently under consideration elsewhere for publication.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,