PWE-057 A Composite Measure Of Colonic Intubation (circ) Is Better Able To Distinguish Performance Of Colonoscopy And Is Associated With Higher Polyp Detection Rates

Abstract

INTRODUCTION: Caecal intubation rate (CIR) is a key performance indicator of colonic intubation. CIR with acceptable tolerance is only achieved in some patients with more sedation. As most colonoscopists achieve >90% intubation, CIR alone cannot determine excellent performance. This study proposes a new composite measure of colonoscopy intubation (CIRC) that combines caecal intubation, patient comfort and sedation. Characteristics of patient, unit, equipment and colonoscopist associated with CIRC and the relation of CIRC to pathology detection are reported. AIMS & METHODS: Data from 20085 colonoscopies reported in a UK national audit (Gut 2013;62:242-249) were used for this analysis. The CIRC was defined as percentage of procedures achieving caecal intubation (adjusted for obstruction), 5= median dose of midazolam (2mg) and nurse assessed comfort score 1-3 (max 5). Multivariate analysis using binary logistic regression assessed patient, unit and colonoscopist factors in order to derive Odds Ratios (ORs) and 95% confidence intervals (CIs) for factors independently associated with CIRc after controlling for effects of all model variables. ORs have significance of 50.001 unless stated. RESULTS: Overall achievement of CIRC was 54.1% (n=10865 procedures). The CIRC was better able to distinguish differences in performance than single measures (CIR and polyp detection). Older age, male sex (OR 1.40; CI:1.32-1.49), adequate/excellent bowel prep and FOBT screen positivity were all associated with a higher chance of achieving CIRC. Unit (JAG) accreditation (OR 1.26; CI 1.16-1.35) and the presence of 4=1 magnetic imagers in the unit (OR 1.29; 1.19- 1.40) were associated with higher CIRC. Greater annual volume, fewer years' experience and course participation were associated with higher CIRC. Course faculty had higher CIRC (OR 1.74;1.57-1.92). Achieving CIRC was associated with significantly higher polyp detection rates (OR 1.12; 1.04-1.20) and higher cancer detection rates (OR 1.14; 0.98-1.32, p=0.10). CONCLUSION: The CIRC provides a richer picture of colonoscopic intubation than CIR alone and is better able to distinguish factors associated with intubation competence in relation to patients, units and colonoscopists. Unit (JAG) accreditation was associated with higher CIRC. Colonoscopists who perform more procedures, have more experience of training or being trained and have practised fewer years had significantly higher rates of CIRC. The CIRCwas associated with a significantly higher polyp detection rate. It is proposed that CIRC replaces CIR as the key performance indicator for intubation of the colon.