Z Gastroenterol 2016; 54 - P33
DOI: 10.1055/s-0036-1584011

Cecal intubation rate correlates with adenoma detection rate but has no impact on advanced adenoma detection rate

D Sallinger 1, 2, E Waldmann 1, 3, B Majcher 1, 2, A Dokladanska 1, 2, I Gessl 1, M Gschwantler 2, M Trauner 1, M Ferlitsch 1, 2
  • 1Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III., Medical University, Vienna, Austria
  • 2Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
  • 3Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH),, Vienna, Austria

Introduction: Incomplete screening colonoscopy can result in missing precancerous lesions, such as adenomas. By a study of Kaminski et al., cecal intubation rate (CIR) as a major quality indicator, showed to be not associated with higher risk of interval cancer Adenoma detection rate (ADR) is considered a main quality measure in screening colonoscopy and should be at least 20%. Advanced adenomas (AA) carry greater risk for progression to cancer than non-advanced adenomas and should be detected early.

Because of lack association between CIR and the risk of interval cancer, our primary aim was to investigate whether there is a correlation between CIR and ADR. Further we wanted to assess if CIR correlates with AADR and if findings differ between high (≥95%) and low CIR-group (< 95%).

Methods: Within the Austrian quality assurance program, 148.284 colonoscopies performed by 197 endoscopists were analyzed. Spearman rank-order was used to assess correlation between CIR and ADR, as well as AADR.

Results: Median CIR was 97,38% [Interquartile range (IQR)= 94,24%-98,65%] and ranges from 72,95%-100%. Median ADR was 21,37% (IQR = 16,25%-27,78%) with a minimum of 4,45% and a maximum of 43,06%. Median AADR was 5,43% (IQR = 3,71%-8,40%) with a range from 0,00% to 20,93%.

Spearman rank order coefficient (rs) of 0,222 showed a significant correlation between CIR and ADR (p < 0,001). AADR was independent of CIR (Rs =-0,024, p = 0,735)) within both groups of endoscopists, those with CIR < 95% (rs = 0,152; p = 0,251; n = 59) as well as within high (≥95%) CIR-group (rs =-0,036; p = 0,679; n = 138).

Conclusion: CIR correlates with ADR but has no impact on participants' detection of advanced adenomas, which could explain the lack of impact of CIR and the risk of interval cancer in the study of Kaminski et al.