Introduction Establishing intubation of caecum is an important aspect of quality indicator1 of colonoscopy, BSG recommendation is that photographic and written confirmation of caecal intubation is kept.
Establishing reliability of photodocumentation of caecum as evidence of caecal intubation in a DGH setting.
Reproducibility of findings.
Methods A retrospective study of 100 consecutive endoscopic (single) caecal photographs documented by eight endoscopists (7 consultants, 1 SPR) were collected onto a spreadsheet. Nine endoscopists then independently scored the photographs anonymously using a range from 1 to 6 as tabulated to determine the strength of the photograph as displaying caecal intubation. Seven photographs were duplicated in sheet 1 and sheet 5 to assess intra-observer reproducibility.
Results The results were as follows for the first part of the study:
Intra observer variablity (numer of sets of pictures with difference in score of more than 1 point) was 5 out of 63 (7.93%) was good, but there was poor agreement between observers.
Conclusion In 48% of assessments the photograph was assessed as either definitely caecum or likely caecum. These results are higher than found in some previous studies.2–5 Factors including poor bowel preparation, caecal anatomy, patient tolerance of the procedure can influence the quality of photographs. It would be interesting to know if multiple photographs gave better results. Other methods including video (as opposed to still) photography 6, barium x-rays have also been recommended.
Competing interests None declared.
References 1. Systematic quality control programme for colonoscopy in an endoscopy centre in Norway. Tidsskr Nor Laegeforen 2004;124:1402–5.
2. Cirocco WC, Rusin LC. Confirmation of cecal intubation during colonoscopy. Brooklyn, USA: Department of Surgery, S.U.N.Y.-H.S.C.B.
3. The caecum or not the caecum. Eur J Gastroenterol Hepatol 20;20(6):500-2.
4. Thuraisingham AI, Brown JL Anderson JT. What are the sensitivity and specificity of endoscopic photographs in determining completion of colonoscopy? Result from a questionnaire. Eur J Gastroenterol Hepatol 2008;20:567–71.
5. Rex DK. Still photography versus videotaping for documentation of cecal intubation: a prospective study. Gastrointest Endosco 2000;51:451–9.
6. Rex DK. Indiana USA: Division of Gastroenterology/Hepatology. Indiana University School of Medicine.
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