title: Predictive factors affecting cecal intubation failure in colonoscopy trainees.
abstract: BACKGROUND
  Successful cecal intubation (SCI) is not only a quality indicator but also an important marker in a colonoscopy trainee's progress. We conducted this study to determine factors predicting SCI in colonoscopy trainees, and to compare these factors before and after trainees achieve technical competence.
  
  
  METHODS
  Design of this study was a cross-sectional studies of two time series design for one year at a single center. From March 2011 to February 2012, a total 2,050 subjects who underwent colonoscopy by four first-year gastrointestinal fellows were enrolled at Christian hospital, Wonju, Republic of Korea. Four gastrointestinal fellows have filled out the colonoscopic documentation. Main outcome measurement was predictive factors affecting cecal intubation failure and learning curves.
  
  
  RESULTS
  Colonoscopy was successfully completed to the cecum in 1,720 patients (83.9%). Success rates gradually increased as trainees performed more colonoscopies: the rate of SCI was 62% in the first 50 cases, and grew to 93% by the 250th case. Logistic regression analysis of factors affecting cecal intubation failure showed that female gender, low BMI (BMI < 18.5 kg/m²), poor bowel preparation, and past history of stomach surgery were more often associated with cecal intubation failure, particularly before the trainees achieved technical competence.
  
  
  CONCLUSIONS
  Several patient characteristics were identified that may predict difficulty of cecal intubation in colonoscopy trainees. Particularly, low BMI, inadequate bowel cleansing, and previous stomach operation were predictors of cecal intubation failure before the trainees have reached technical competency. The results could be informative so that trainees enhance the success rate regarding better colonoscopy training programs.
authors: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors: Hong-Jun
authors: HJ
authors: Park
authors: Jin-Heon
authors: JH
authors: Hong
authors: Hyun-Soo
authors: HS
authors: Kim
authors: Bo-Ra
authors: BR
authors: Kim
authors: So-Yeon
authors: SY
authors: Park
authors: Ki-Won
authors: KW
authors: Jo
authors: Jae-Woo
authors: JW
authors: Kim
mesh_terms: D002432:Cecum; D002983:Clinical Competence / Q000592:standards; D003113:Colonoscopy / Q000193:education*; D003430:Cross-Sectional Studies; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D017211:Treatment Failure