Effect of cecal intubation rate on adenoma and serrated polyp detection and the impact on post colonoscopy colorectal cancer deaths

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.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024