DEVELOPMENT AND VALIDATION OF A NOVEL SCORE FOR THE COMPLETENESS OF CAECAL INTUBATION – THE CCIS (COMPLETENESS OF CAECAL INTUBATION SCORE)

Aims 5-10% of colorectal cancers (CRC) are post-colonoscopy CRC. Potential causes include incomplete caecal visualisation. We created and validated the Completeness of Caecal Intubation Score (CCIS) as a potential new colonoscopy key performance indicator (KPI).

Methods The 8-point CCIS was developed by author consensus. CCIS includes determination of the appendiceal orifice (AO), three sides of the tri-radiate fold (TF1-3) and the four outer caecal quadrants (OQ1-4).

Endoscopists of varying experience were contacted using a survey to score the same 20 caecal image-sets using CCIS after an instructional video. Accuracy was determined compared to author opinion derived at a consensus meeting. Inter-rater reliability was calculated using the interclass correlation coefficient (ICC).

Results 79 endoscopists completed the survey. 69.6% were independently practising.

Fig. 1

CCIS was significantly higher in the images that were classified as completely visualised during first-impression evaluation (8/8 (IQR 0) vs 4/8 (IQR 4), p<0.001) and had a strongly positive correlation with the subjective stated percentage of the caecum visualised (correlation coefficient 0.83, p<0.001).

The overall accuracy of CCIS as compared to author-consensus was 82.3%, (95% confidence interval (95%CI) 81.7-83.0%). The overall inter-rater agreement for CCIS was moderate 0.53 (95%CI 0.39-0.71).

When considering exactly which caecal areas were visualised, accuracy was lower – 69.1% (95%CI 68.3-70.0%).

Conclusions Endoscopists of varying experience accurately determined CCIS with high accuracy and moderate inter-rater agreement. This score has the potential to be used as a retrospective key performance indicator and driver of best practice in colonoscopy.

Publication History

Article published online:
14 April 2022