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Quality indicators in pediatric colonoscopy
Jorge Saba Zeidan1, Paulina Canales Ramirez2, Elizabeth Navarro Diaz2
1Departamento de Pediatría y Cirugía Infantil Occidente, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Insights
Pediatric colonoscopy ileal intubation rates were 60.6% overall. Optimizing bowel preparation and using general anesthesia significantly improved ileal intubation success, enhancing quality standards for pediatric inflammatory bowel disease screening.
Area of Science:
- Pediatric Gastroenterology
- Endoscopy Quality Improvement
- Inflammatory Bowel Disease Diagnostics
Background:
- Ileal intubation is a key quality metric in pediatric colonoscopy, crucial for diagnosing inflammatory bowel disease.
- Achieving high ileal intubation rates (>85%) is essential for comprehensive colonoscopy evaluations.
Purpose of the Study:
- To determine the ileal intubation rate in pediatric colonoscopies.
- To assess factors influencing ileal intubation, including bowel preparation and anesthesia type.
Main Methods:
- An observational, descriptive, cross-sectional study of 99 pediatric colonoscopies in Santiago, Chile (2020-2022).
- Exclusion of procedures not intended for ileal intubation.
- Evaluation of bowel preparation (Boston Bowel Preparation Scale), sedation/anesthesia, and intubation success rates.
Main Results:
- Overall ileal intubation rate was 60.6%, significantly lower than the quality benchmark.
- Ileal intubation rates were 45.8% with sedation versus 82.5% with general anesthesia.
- Boston scale score ≥ 6 (OR: 5.6) and general anesthesia (OR: 11.7) were associated with higher ileal intubation likelihood.
Conclusions:
- Optimizing bowel preparation and utilizing general anesthesia can substantially increase pediatric ileal intubation rates.
- Improving ileal intubation aligns with quality standards and enhances diagnostic efficiency for pediatric gastrointestinal conditions.
Objectives:
An ileal intubation rate > 85% is one of the most important quality indicators in pediatric colonoscopy, particularly due to screening for inflammatory bowel disease. The primary objective of this study was to determine the ileal intubation rate. Secondary objectives included assessing other quality indicators, such as bowel preparation, type of sedation, and use of general anesthesia.
Patients And Methods:
Observational, descriptive, cross-sectional study. All colonoscopies performed at two pediatric hospitals in Santiago, Chile, between September 2020 and November 2022 were included. Colonoscopies without the intention of ileal intubation were excluded. The following were evaluated: sociodemographic characteristics, procedure indication, type of sedation, bowel preparation regimen, Boston Bowel Preparation Scale score, endoscopist's experience, whether a pediatric gastroenterology trainee was present during the procedure, ileal and cecal intubation rates, reasons for incomplete procedures, and complications.
Results:
A total of 99 colonoscopies performed at two pediatric hospitals in Santiago, Chile, were included. Of the patients, 47.5% were male, with a median age of 12 years. Sedation was used in 51% of procedures, while 49% were performed under general anesthesia. Sodium picosulfate was the most frequently used bowel preparation agent (82.8%). The main indications for colonoscopy were rectal bleeding and suspected or follow-up of inflammatory bowel disease. The overall ileal intubation rate was 60.6%; stratified by intervention type, it was 45.8% with sedation and 82.5% with general anesthesia. In multivariate analysis, a Boston scale score ≥ 6 (OR: 5.6) and the use of general anesthesia (OR: 11.7) were significantly associated with a higher likelihood of ileal intubation.
Conclusions:
Our findings suggest that optimizing bowel preparation and the use of general anesthesia can significantly improve ileal intubation rates, contributing to compliance with international quality standards and more efficient use of hospital resources.
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