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Quality indicators in pediatric colonoscopy: an Australian tertiary center experience
H K Singh1, G D Withers1, L C Ee1
1a Department of Gastroenterology, Hepatology & Liver Transplant , Lady Cilento Children's Hospital , Brisbane , Australia.
Insights
High cecal and ileal intubation rates are achievable in pediatric colonoscopy, even in young children. Ileal intubation is a key quality indicator for pediatric procedures, particularly for inflammatory bowel disease (IBD) assessment.
Area of Science:
- Pediatric Gastroenterology
- Endoscopy Quality Improvement
- Colorectal Cancer Screening
Background:
- Pediatric colonoscopy quality indicators are not well-established, unlike in adults where colorectal cancer screening drives metrics like cecal intubation rates (>90% recommended).
- Colorectal cancer is rare in children, necessitating different quality benchmarks for pediatric colonoscopy.
- Achievability of high cecal intubation rates in young children remains unclear.
Purpose of the Study:
- To audit colonoscopies in a pediatric tertiary center.
- To examine indications, completeness of examination (cecal and ileal intubation), findings, and complications.
- To assess the feasibility of high intubation rates in pediatric colonoscopy.
Main Methods:
- Retrospective review of colonoscopies performed between November 2011 and October 2015.
- Analysis of clinical indications, procedure completeness, and outcomes.
- Evaluation of factors affecting intubation success.
Main Results:
- 652 pediatric colonoscopies were reviewed; common indications included inflammatory bowel disease (IBD) (57.9%), rectal bleeding (10%), and abdominal pain (10%).
- Cecal intubation rate was 96.3% and ileal intubation rate was 92.4%.
- Poor bowel preparation and age <5 years were inversely related to successful ileal intubation.
Conclusions:
- High rates of cecal and ileal intubation are attainable in pediatric colonoscopy.
- Ileal intubation should be considered a crucial quality indicator for pediatric colonoscopy.
- This is especially relevant given that inflammatory bowel disease is a primary indication for the procedure in children.
Objectives:
Quality indicators for colonoscopy in adults are largely driven by colorectal cancer screening, and include cecal intubation rates, with rates of >90% recommended. In contrast, colorectal cancer is rare in childhood, with paucity of data on relevant quality indicators for pediatric colonoscopy. It is also unclear whether high rates of cecal intubation are achievable in small children. Our aim was to audit all colonoscopies performed in a tertiary pediatric center to examine clinical indications for procedure, completeness of examination with cecal and ileal intubation, significant findings, and complications.
Methods:
Retrospective review of colonoscopies performed between November 2011 and October 2015 was undertaken.
Results:
Total colonoscopy was performed in 652 patients, 53% male, with median age 13.0 (range 0.4-18.2) years. The most common indications for colonoscopy were assessment of inflammatory bowel disease (IBD) 57.9% (378/652), rectal bleeding 10% (68/652) and abdominal pain 10% (68/652). Trainees performed 69.8% (452/652) of procedures. Quality of bowel preparation was mentioned in 63% (410/652), of which 22% (90/410) were considered inadequate. Cecal intubation rate was 96.3% (628/652) and ileal intubation rate was 92.4% (603/652). Extent of procedure was confirmed in 99.2% of patients with photographs and/or ileal biopsy. Poor quality of bowel preparation (p = .001) and age <5years (p = .007) were inversely related to successful ileal intubation.
Conclusions:
High rates of cecal and ileal intubation are achievable in pediatric colonoscopy. Ileal intubation should be considered a quality indicator since the main indicator for pediatric colonoscopy is to investigate IBD.
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