title: Variation in caecal intubation rates between screening and symptomatic patients.
abstract: BACKGROUND
  The caecal intubation rate (CIR) is an important quality standard for endoscopists, as well as for national bowel cancer screening programmes; however, individuals undergoing colonoscopy for bowel screening and symptomatic patients represent different groups, and their characteristics may affect colonoscopy performance.
  
  
  OBJECTIVE
  To compare colonoscopists' performance, as assessed by the CIR, in symptomatic patients compared to individuals undergoing colonoscopy for bowel cancer screening.
  
  
  METHODS
  Retrospective audit of CIRs for all patients undergoing colonoscopy at our institution during the year 2008. We retrieved the data from an endoscopy reporting software database and from the local bowel cancer screening programme database. Demographic data was extracted, as well as details of known factors that may affect completion of colonoscopy, such as poor bowel preparation, presence of diverticular disease, polyps, tumour and strictures. The unadjusted CIRs for colonoscopists participating in the screening programme were compared between the bowel screening and the symptomatic patient groups.
  
  
  RESULTS
  Five screening colonoscopists performed 1056 colonoscopies, of which 488 were bowel screening procedures. The overall CIR was significantly lower in the symptomatic, compared to the screening, individuals (88.5% versus 93%, P < 0.02). No significant differences were observed between the two groups for risk factors that could impair the CIR. The CIR was <90% for two of the five colonoscopists in symptomatic patients, and just under 90% for one colonoscopist in screening individuals. Multivariate analysis revealed that non-screening colonoscopy was an independent predictor for an incomplete procedure (OR 1.8; 95% CI 1.2-2.8).
  
  
  CONCLUSIONS
  The CIR, a key quality performance indicator for colonoscopy, is lower in symptomatic patients compared to individuals undergoing colorectal cancer screening. These results suggested that CIR should be monitored independently in screening and non-screening colonoscopies.
authors.affiliation: University of Aberdeen Medical School, University of Aberdeen, Aberdeen, UK.
authors.forename: Nalin
authors.initials: N
authors.lastname: Nagrath
authors.affiliation: Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Perminder S
authors.initials: PS
authors.lastname: Phull
keywords: Caecal intubation rate; colonoscopists; colonoscopy; colorectal cancer; patient type; performance assessment; quality; screening; symptomatic patients
references.citation: Gastroenterology. 2007 Jun;132(7):2297-303
references.pmid: 17570204
references.citation: Colorectal Dis. 2007 Oct;9(8):745-8
references.pmid: 17477852
references.citation: World J Gastroenterol. 2013 Apr 21;19(15):2355-61
references.pmid: 23613629
references.citation: Eur J Gastroenterol Hepatol. 2010 May;22(5):620-7
references.pmid: 20032782
references.citation: Am J Gastroenterol. 2002 Jun;97(6):1296-308
references.pmid: 12094842
references.citation: Ann Intern Med. 2009 Jun 16;150(12):849-57, W152
references.pmid: 19528563
references.citation: Dig Liver Dis. 2005 Feb;37(2):113-8
references.pmid: 15733524
references.citation: Gastroenterology. 2008 May;134(5):1570-95
references.pmid: 18384785
references.citation: Am J Gastroenterol. 2000 Oct;95(10):2784-7
references.pmid: 11051348
references.citation: BMC Gastroenterol. 2007 Jun 08;7:19
references.pmid: 17559669
references.citation: World J Gastroenterol. 2008 Apr 7;14(13):1981-3
references.pmid: 18395895
references.citation: Dig Dis Sci. 2009 Aug;54(8):1656-61
references.pmid: 19034661
references.citation: Am J Gastroenterol. 2006 Dec;101(12):2726-30
references.pmid: 17227519
references.citation: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001216
references.pmid: 17253456
references.citation: Digestion. 2009;80(4):267-70
references.pmid: 19923819
references.citation: Dis Colon Rectum. 2010 Jul;53(7):1055-60
references.pmid: 20551759
references.citation: Frontline Gastroenterol. 2012 Jul;3(3):124-129
references.pmid: 28839652
references.citation: BMJ. 2004 Jul 17;329(7458):133
references.pmid: 15237087