Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital.
BACKGROUND
Despite increased emphasis on endoscopic performance indicators, e.g., cecal intubation rates, limited data from actual clinical practice have been published.


OBJECTIVE
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 21201, USA.
Florence
F
Aslinia
Lance
L
Uradomo
Allison
A
Steele
Bruce D
BD
Greenwald
Jean-Pierre
JP
Raufman
D000368:Aged; D002432:Cecum; D002983:Clinical Competence; D020685:Colonoscopes; D003113:Colonoscopy / Q000592:standards / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007440:Intubation; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care