Successful colonoscopy; completion rates and reasons for incompletion

Area of Science:

• Gastroenterology
• Endoscopy
• Quality Improvement

Background:

• Colonoscopy completion rates are key performance indicators.
• Factors like poor bowel preparation and colonic obstruction can unfairly lower reported rates.
• Accurate assessment of endoscopist skill requires accounting for external confounding factors.

Purpose of the Study:

• To evaluate the impact of adjusting colonoscopy completion rates for non-endoscopist-controlled factors.
• To compare crude versus adjusted completion rates.
• To identify patient and procedural factors influencing colonoscopy success.

Main Methods:

• Retrospective analysis of 2,216 colonoscopies from a prospective database (1993-2000).
• Calculation of crude and adjusted completion rates.
• Adjustment excluded cases with poor bowel preparation or obstructing colonic disease.
• Analysis stratified by sex, age, and prior bowel resection.

Main Results:

• Overall crude completion rate was 77.9%, while the adjusted rate was 85.0%.
• Males had significantly higher adjusted completion rates (88.9%) than females (81.6%, p<0.05).
• Adjusted completion rates were significantly higher after bowel resection (93.5%) compared to no resection (82.8%, p<0.05).
• No significant difference was found between inpatient and outpatient referrals (P=0.36).

Conclusions:

• Adjusting colonoscopy completion rates for factors like poor bowel preparation and disease enables more accurate comparisons between endoscopists and units.
• This method highlights the significant impact of inadequate bowel preparation on procedural success.
• Adjusted rates offer a fairer assessment of endoscopist competence, independent of external variables.