Introduction The Composite Caecal Intubation Rate (CIRc) has been proposed as a more pragmatic colonoscopy performance index, encompassing three key components; caecal intubation rate (CIR), patient comfort and sedation dose.1 We calculated CIRcs within a Tertiary Unit (St Mark’s Hospital,UK), aiming to assess performance and look for possible correlation between CIRc and adenoma detection rate (ADR).2
Methods We analysed all colonoscopies performed by 32 Endoscopists in 12 months. CIRc was the proportion of procedures fulfilling the following criteria; procedure completion, comfort score ≤3 (Gloucester scale)3 and midazolam dose 0–2 mg. We examined the association between CIRc and annual colonoscopy volume, completion rate, midazolam dose and polyp detection rate (PDR). Finally, we sought for a correlation between CIRc and ADR for 7 Bowel Cancer Screening Programme (BCSP) Endoscopists.
Results Analysis included 5416 colonoscopies. Overall CIRc was 85.6%. There was significant correlation between CIRc and annual colonoscopy volume; all colonoscopists with >250 procedures had CIRcs >85%. The majority of operators with <200 procedures had the lower scores, but still more than 70%. There were Endoscopists with low annual volumes and high CIRc meaning that expert endoscopists with high lifetime (but low annual) volumes can nonetheless deliver high quality colonoscopy. There was also evidence of a negative correlation between midazolam and CIRc, but of no statistical significance. No significant association was observed with CIR or PDR. There was a reasonable positive correlation, albeit non significant, between ADR and CIRc in the BCSP Endoscopists’ subgroup.
Conclusion CIRc is a more informative performance index, reflecting key aspects of colonoscopy. Reassuringly, overall CIRc achievement in the Unit was above National Audit data (54.1%).1 Endoscopists with larger procedure volumes performed better. No significant correlation with ADR was seen, although a positive trend was noted. The small amount of patients included in the ADR analysis group is insufficient to draw definite conclusions. Applying CIRc at a local level may aid in identification of under-performers, although case-mix factors may affect results.
References 1 Valori R, Damery S, Swarbrick E, et al. PWE-057 A composite measure of colonic intubation is better able to distinguish performance of colonoscopy and is associated with higher polyp detection rates. Gut 2014;63:A148.
2 Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014;370:1298–306.
3 Ekkelenkamp VE, Dowler K, Valori RM, Dunckley P. Patient comfort and quality in colonoscopy. World J Gastroenterol 2013;19:2355–61.
Disclosure of Interest None Declared
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