Endoscopy 2021; 53(06): 619-626
DOI: 10.1055/a-1254-5182
Original article

Impact of sedation on the Performance Indicator of Colonic Intubation

Karlijn J. Nass
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
,
Sascha C. van Doorn
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
,
Manon van der Vlugt
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
,
Paul Fockens
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
,
Evelien Dekker
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
› Author Affiliations

Abstract

Background The Performance Indicator of Colonic Intubation (PICI) is a new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. This study assessed achievement of PICI within the Dutch colorectal cancer (CRC) screening program, and determined the association between PICI and adenoma detection rate (ADR). PICI achievement when using the Dutch median midazolam dose was also assessed.

Methods This retrospective study was conducted within the Dutch fecal immunochemical test-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between January 2016 through January 2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) of 1 – 3, and use of ≤ 2.5 mg midazolam.

Results 107 328 colonoscopies were performed during the study period. Adequate PICI was achieved in 49 500 colonoscopies (46.1 %). In colonoscopies with inadequate PICI, inadequacy was due to higher sedation doses in 87.8 %. Adequate PICI was associated with higher ADR (odds ratio 1.16, 95 % confidence interval 1.12 – 1.20). When using a cutoff of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95 410 colonoscopies (88.9  %).

Conclusion PICI appeared to be heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as a quality indicator is limited.

Supplementary material



Publication History

Received: 10 April 2020

Accepted: 03 September 2020

Publication Date:
03 September 2020 (online)

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