Effect of Cecal Intubation Rate on Post Colonoscopy Colorectal Cancer Deaths and Detection of Colorectal Cancer...

The visualization of the whole colonic mucosa with complete colonoscopy including cecal intubation has been accepted as a quality parameter for screening colonoscopy. However, there is little evidence regarding the cecal intubation rate (CIR) and its association with long-term patient outcome.

We did a linkage of individuals that participated in an Austrian Colonoscopy Quality Assurance Program to the Austrian death registry to obtain information on deaths of post-colonoscopy colorectal cancer (PCCRC). We performed logistic regression and time-to-event analyses to estimate the association the CIR with the probability to detect adenomas or proximal serrated polyps and the hazards for PCCRC death.

A total of 349,782 screening participants between January 2012 and December 2022 were included. With every 1 percentage point increase in the CIR, the probability to detect an adenoma increased by 1 percentage point (odds ratio, 1.01; 95% confidence interval [CI], 1.0-1.01; P < .001) and increased by 3 percentage points to detect a proximal serrated polyp (odds ratio, 1.03; 95% CI, 1.01-1.04; P < .001). There was a significantly lower risk for PCCRC death when endoscopists had a CIR of 95% to 100% (hazard ratio, 0.44; 95% CI, 0.33-0.59; P < .001), compared with endoscopists with a CIR <90% or 90% to 95%.

The endoscopist's CIR is strongly associated with their ability to detect adenomas and proximal serrated polyps. A CIR of 95% to 100% was associated with the lowest hazards for PCCRC death. Based on this data, a CIR above 95% is the desirable target.