Aims The visualization of the whole colonic mucosa due to complete colonoscopy with caecal
intubation has been accepted as a quality parameter for screening colonoscopy. However,
there is little evidence of the caecal intubation rate and its association with long-term
patient outcome.
Methods We did a linkage of individuals that participated in the Austrian Quality Assurance
Program to the Austrian death registry to obtain information on deaths of post-colonoscopy
colorectal cancer. We performed logistic regression to estimate the association of
baseline characteristics with caecal intubation as well as the caecal intubation rate
with the probability to detect adenomas or proximal serrated polyps.
Results 381460 screening participants between 01/2010 and 12/2022 were included in this analysis.
We found that for with every one percentage point increase in the CIR, the probability
to detect an adenoma increased by five percentage points (OR 1.05, 95% CI 1.052 –
1.0576, p<0.001) and every one percentage point increase of the CIR lead to an eight
percentage point increase in the probability to detect a proximal serrated polyp (OR
1.08, 95% CI 1.0694 – 1.0873, p<0.001, table 3). There was a significantly lower risk
for PCCRC death when endoscopists had a CIR of 95%-100% (HR 0.54, 95% CI 0.39 – 0.73,
p<0.001), however, we found no significant difference in PCCRC mortality when endoscopists
had a CIR<90% or 90% – 95%.
Conclusions the endoscopist’s cecal intubation rate is associated with their ability to detect
adenomas and proximal serrated polyps. There is no difference in the hazards for PCCRC
death between a CIR of 90%-95% and<90%, a CIR above 95% might be the most appropriate
cutoff.
