“Meticulous” caecal photo documentation correlates with improved polyp detection, and lower sedation rates
Karen Hartery, Orla Gildea, Carthage Moran, Catherine Rowan, Ateeq Jalil, Maire Buckley, Hugh Mulcahy, Juliette Sheridan, Garret Cullen, Glen Doherty, Gareth Horgan.
Dept of Gastroenterology and Centre for Colorectal Disease, St. Vincent’s University Hospital.
The European Society of Gastrointestinal Endoscopy recommends caecal photo documentation at endoscopy. Limited information exists regarding the correlation of caecal image quality and endoscopic outcomes.
Our primary objective was to assess whether endoscopists who are meticulous about caecal image documentation have higher polyp detection rates (PDR) and lower sedation rates.
Retrospective study analysing electronic endoscopy database records from an academic teaching hospital from January 1st, to July 31st, 2015. Caecal image documentation score (CIDS) was used to grade the quality of caecal images. CIDS is recorded as follows: no image taken, 0; unclear image, 1; clear image, 2; labeled clear image, 3. Endoscopists with a mean CIDS of ≥2.0 were considered meticulous and those with a mean CIDS <2.0 were not. Photos were analysed and scored by two independent observers.
684 procedures by 17 endoscopists were analysed, comprising five consultants and twelve trainees. The mean CIDS was 2.09. Ten endoscopists had a CIDS score ≥2 (457 procedures). Seven endoscopists had a CIDS <2 (227 procedures). The PDR was significantly higher in endoscopists with CIDS ≥2 (34.6% vs 24.2%, p=0.006). The adenoma detection rate (ADR) was significantly higher in patients aged >50 years in endoscopists with CIDS ≥2 (26.7% vs 18%, p=0.042). There was no difference in meticulousness between trainees and consultants (p=0.86). Endoscopists with CIDS <2 were more likely to use >5mg midazolam during a procedure (24.3% vs 8.7%, p<0.001, odds ratio 2.7, 95% confidence interval (CI) 1.9-4.0, p<0.001).
Endoscopists who are meticulous in caecal photo documentation have higher polyp and adenoma detection and use less sedation. The CIDS may have use as a marker of endoscopist performance.