Predictive factors affecting cecal intubation failure in colonoscopy trainees.

Area of Science:

• Gastroenterology
• Medical Education
• Endoscopy Quality Improvement

Background:

• Successful cecal intubation (SCI) is a key quality indicator and benchmark for colonoscopy trainee progression.
• Identifying predictive factors for SCI is crucial for optimizing training and patient outcomes.

Purpose of the Study:

• To determine factors predicting successful cecal intubation (SCI) in colonoscopy trainees.
• To compare these predictive factors before and after trainees achieve technical competence.

Main Methods:

• A one-year, single-center, cross-sectional study with two time series.
• 2,050 colonoscopies performed by four first-year gastrointestinal fellows were analyzed.
• Logistic regression identified factors associated with cecal intubation failure.

Main Results:

• Overall SCI rate was 83.9%, increasing from 62% in the first 50 cases to 93% by the 250th case.
• Factors predicting failure before technical competence included female gender, low BMI (<18.5 kg/m²), poor bowel preparation, and prior stomach surgery.
• These factors were particularly significant in predicting failure in early-stage trainees.

Conclusions:

• Patient characteristics such as low BMI, inadequate bowel preparation, and previous stomach surgery predict cecal intubation difficulty in trainees.
• These predictive factors are most relevant before trainees attain technical competency.
• Understanding these predictors can inform the development of targeted colonoscopy training programs to improve SCI rates.