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Relationship of Colonoscopy Completion Rates and Endoscopist Features

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The success rate for reaching the cecum has been widely discussed as an indicatorof technical expertise for colonoscopy. However, few studies have addressed the impact of endoscopist-specific parameters on cecal intubation rates. The aim of this study wasto characterize the relationship between endoscopist-specific parameters (age, gender, experience level, annual procedure volume, insertion and withdrawal times) and cecal intubation rates for colonoscopy. Procedural data from all colonoscopies performed by gastroenterologists at the outpatient endoscopy unit of Rochester Methodist Hospital, Minnesota, between January and December 2003 were reviewed. Procedural data of 45 endoscopists who performed 17,100 colonoscopies over the study period were analyzed. The average cecal intubation rate was 93.9% (SD, 2.9%). Higher experience level (> 9 years [median]) was significantly predictive of a cecal intubation rate > 94% (OR = 3.43; 95% CI, 1.03–12.29; P = 0.04). Although higher procedure volume was not predictive of higher colonoscopy completion rates overall, when analysis was confined to the junior faculty members (< 5 years’ experience), completion rates for those endoscopists doing > 200 per year (92.5%) was significantly higher than for those doing < 200 per year (88.5%; P = 0.04). Our observations suggest that cecal intubation rates increase with increasing endoscopist experience. Moreover, among junior endoscopists, an annual volume of at least 200 procedures appears to be required to maintain adequate competence. Future prospective studies should provide data to support consensus guidelines recommending minimum annual procedure numbers required for maintenance of endoscopic competence among trained endoscopists.

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References

  1. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F: Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328(19):1365–1371, 1993

    CAS  Google Scholar 

  2. Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348(9040):1472–1477, 1996

    CAS  PubMed  Google Scholar 

  3. Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O: Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348(9040):1467–1471, 1996

    PubMed  CAS  Google Scholar 

  4. Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS: A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326(10):653–657, 1992

    Article  CAS  PubMed  Google Scholar 

  5. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM: Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 84(20):1572–1575, 1992

    PubMed  CAS  Google Scholar 

  6. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 343(3):162–168, 2000

    CAS  Google Scholar 

  7. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF: Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343(3):169–174, 2000

    CAS  PubMed  Google Scholar 

  8. Harewood GC, Lieberman DA: Colonoscopy practice patterns since introduction of Medicare coverage for average-risk screening. Clin Gastroenterol Hepatol 2(1):72–77, 2004

    PubMed  Google Scholar 

  9. Prajapati DN, Saeian K, Binion DG, Staff DM, Kim JP, Massey BT, Hogan WJ: Volume and yield of screening colonoscopy at a tertiary medical center after change in medicare reimbursement. Am J Gastroenterol 98(1):194–199, 2003

    PubMed  Google Scholar 

  10. Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, Kirk LM, Litin S, Lieberman DA, Waye JD, Church J, Marshall JB, Riddell RH: Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 97(6):1296–1308, 2002

    Google Scholar 

  11. Chak A, Cooper GS, Blades EW, Canto M, Sivak MV Jr: Prospective assessment of colonoscopic intubation skills in trainees. Gastrointest Endosc 44(1):54–57, 1996

    CAS  PubMed  Google Scholar 

  12. Marshall JB, Barthel JS: The frequency of total colonoscopy and terminal ileal intubation in the 1990s. Gastrointest Endosc 39(4):518–520, 1993

    PubMed  CAS  Google Scholar 

  13. Waye JD, Bashkoff E: Total colonoscopy: Is it always possible?. Gastrointest Endosc 37(2):152–154, 1991

    Article  CAS  PubMed  Google Scholar 

  14. Melton LJ 3rd: History of the Rochester Epidemiology Project. Mayo Clin Proc 71(3):266–274, 1996

    PubMed  Google Scholar 

  15. Saunders BP, Fukumoto M, Halligan S, Jobling C, Moussa ME, Bartram CI, Williams CB: Why is colonoscopy more difficult in women?. Gastrointest Endosc 43(2, Pt 1):124–126,1996

    PubMed  CAS  Google Scholar 

  16. Webb WA: Colonoscoping the “difficult” colon. Am Surg 57(3):178–182, 1991

    PubMed  CAS  Google Scholar 

  17. Church J: Complete colonoscopy: How often, and if not, why not?. Am J Gastroenterol 87:1320, 1992 (abstr)

    Google Scholar 

  18. Blades EW, Chak A: Effect of previous surgery on performance of colonoscopy. Am J Gastroenterol 88:1567, 1993 (abstr)

    Google Scholar 

  19. Demartino P, Conn, M., Allen M: Factors influencing time to cecum during colonoscopy. Am J Gastroenterol 88:1572, 1993 (abstr)

    Google Scholar 

  20. Marshall JB, Barthel JS: The frequency of total colonoscopy and terminal ileal intubation in the 1990s. Gastrointest Endosc 39(4):518–520, 1993

    Article  PubMed  CAS  Google Scholar 

  21. ASGE: Principles of Training in GI Endoscopy. Manchester, MA, Standards of Training Committee, American Society for Gastrointestinal Endoscopy, 1991

  22. Cotton PB, Connor P, McGee D, Jowell P, Nickl N, Schutz S, Leung J, Lee J, Libby E: Colonoscopy: practice variation among 69 hospital-based endoscopists. Gastrointest Endosc 57(3):352–357, 2003

    PubMed  Google Scholar 

  23. Singhvi S, Small, P, Bell, GD, Pearson J, Boobis L, Crighton I: Audit of colonoscopy in a large DGH: implications for trainers and trainees of the JAG recommendations. Gut 46:A15, 2000 (abstr)

    Google Scholar 

  24. Robinson J, Small P, Bell GD, Crighton I,Corson J, Hancock J: A prospective audit of colonoscopy in a large DGH—Factors effecting caecal intubation rates. Gut 48:A10, 2001 (abstr)

    Google Scholar 

  25. Bowles CJA, Leicester R, Swarbrick E, Williams CB, Romaya C, Epstein O: Intercollegiate—BSG National Colonoscopy Audit: methods used to identify the caecum and caecal intubation rate. Gut 48:A10–A11, 2001

    Google Scholar 

  26. Bowles CJ, Leicester R, Romaya C, Swarbrick E, Williams CB, Epstein O: A prospective study of colonoscopy practice in the UK today: Are we adequately prepared for national colorectal cancer screening tomorrow?. Gut 53(2):277–283, 2004

    PubMed  CAS  Google Scholar 

  27. Rex DK: Colonoscopy practice variation. Gastrointest Endosc 58(4):639–640, 2003

    PubMed  Google Scholar 

  28. Cirocco WC, Rusin LC: Confirmation of cecal intubation during colonoscopy. Dis Colon Rectum 38(4):402–406, 1995

    PubMed  CAS  Google Scholar 

  29. Marshall JB, Brown DN: Photodocumentation of total colonoscopy: How successful are endoscopists? Do reviewers agree? Gastrointest Endosc 44(3):243–248, 1996

    PubMed  CAS  Google Scholar 

  30. Rex DK: Effect of variable stiffness colonoscopes on cecal intubation times for routine colonoscopy by an experienced examiner in sedated patients. Endoscopy 33(1):60–64, 2001

    PubMed  CAS  Google Scholar 

  31. Howell DA, Ku PM, Desilets DJ, Campana JM: A comparative trial of variable stiffness colonoscopes. Gastointest Endosc 51:AB179, 2000 (abstr)

    Google Scholar 

  32. Gostout CJ, Sorbi D, Knipshield MA: Variable rigidity colonoscopes: A prospective, randomized controlled study. Gastointest Endosc 53:AB179, 2001 (abstr)

    Google Scholar 

Download references

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

    Gavin C. Harewood MD, MSc

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  1. Gavin C. Harewood MD, MSc
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Correspondence to Gavin C. Harewood MD, MSc.

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Harewood, G.C. Relationship of Colonoscopy Completion Rates and Endoscopist Features. Dig Dis Sci 50, 47–51 (2005). https://doi.org/10.1007/s10620-005-1276-y

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  • DOI: https://doi.org/10.1007/s10620-005-1276-y

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