Cecal intubation rates: data from the New Hampshire Colonoscopy Registry

Area of Science:

• Gastroenterology
• Medical Statistics

Background:

• Colonoscopy is a key procedure for colorectal cancer screening and diagnosis.
• Cecal intubation, the complete insertion of the colonoscope to the cecum, is a measure of colonoscopy quality.
• Factors influencing cecal intubation rates are crucial for optimizing colonoscopy outcomes.

Purpose of the Study:

• To examine patient and endoscopist factors associated with colonoscopy cecal intubation rates.
• To analyze trends in colonoscopy completion rates over time.
• To identify predictors of incomplete colonoscopies in specific patient populations.

Main Methods:

• Analysis of data from the New Hampshire Colonoscopy Registry (NHCR) including 143,095 patients (≥40 years) with adequate bowel preparation.
• Stratification of colonoscopy completion rates by sex, body mass index (BMI), and age.
• Multivariable analysis to assess the impact of patient demographics, BMI, age, endoscopist specialty, and adenoma detection rates (ADRs) on cecal intubation.

Main Results:

• Lower cecal intubation rates were associated with BMI <25, obesity (BMI ≥30), and older age.
• Men had higher completion rates than women (OR, 1.46).
• Gastroenterology specialty (OR, 1.78) and ADR ≥25% (OR, 2.01) were linked to increased likelihood of cecal intubation.
• Endoscopist factors predicted cecal intubation in thin women.
• Incomplete exams were more common in right-sided colon examinations for men and obese patients.

Conclusions:

• Patient factors like age, sex, and BMI significantly impact colonoscopy completion rates, even after adjusting for endoscopist variables.
• Gastroenterologist performance and higher ADRs are associated with improved cecal intubation.
• Targeted strategies may be needed to improve colonoscopy completeness in older, female, and underweight or obese patients.