Aims Cecal intubation rate is a key quality indicator in colonoscopy, as it represents
the ability to reach the cecum and visualize the entire colon. This study aims to
comprehensively evaluate the cecal intubation rate and identify factors influencing
this important metric in a Tunisian endoscopy unit.
Methods A prospective study was conducted over a 3.5-year period, including 2,359 outpatient
colonoscopies performed at a tertiary care center in Tunisia. Cecal intubation rates,
cecal intubation time, and bowel preparation quality were assessed. Multivariate logistic
regression analysis was performed to identify patient, procedural, and endoscopist
factors independently associated with cecal intubation rates.
Results The overall cecal intubation rate (CIR) was 85.7% (2,022/2,359 patients), with a
mean cecal intubation time of 6.1±2.9 minutes. Bowel preparation quality was evaluated
using the Boston Bowel Preparation Scale (BBPS), with 44.1% of patients achieving
a score≥7 and 71.2% achieving a score≥6. Multivariate analysis revealed several factors
independently associated with lower cecal intubation rates, including patient age>65
years (OR 0.63, 95% CI 0.51-0.79, p<0.001), poor bowel preparation (BBPS<6) (OR 0.72,
95% CI 0.55-0.93, p=0.012), BMI<25 kg/m² (OR 0.76, 95% CI 0.60-0.97, p=0.023), and
history of constipation (OR 0.75, 95% CI 0.57-0.98, p=0.042). Interestingly, the cecal
intubation rate was also significantly influenced by endoscopist experience, with
procedures performed by non-experienced trainees (less than 3 years of endoscopy training)
having a lower CIR compared to experienced endoscopists (81.4% vs. 87.2%, p=0.039).
Further subgroup analysis showed that the impact of poor bowel preparation on CIR
was most pronounced in older patients (> 65 years), where the CIR was 77.2% for those
with BBPS<6, compared to 89.4% for those with BBPS≥6 (p<0.001), suggesting that optimizing
bowel preparation may be particularly important for improving cecal intubation in
the elderly population.
Conclusions While the overall cecal intubation rate in this Tunisian endoscopy unit approaches
international quality benchmarks, there is still room for improvement. Strategies
to enhance bowel preparation, especially in older and constipated patients, as well
as optimizing the colonoscopy team composition by leveraging more experienced endoscopists,
may help increase cecal intubation rates. Further research is needed to develop targeted
interventions addressing the identified patient and procedural factors that influence
this critical quality indicator.
