Predictive factors affecting cecal intubation failure in colonoscopy trainees

Abstract

Background: Successful cecal intubation (SCI) is not only a quality indicator but also an important marker in a colonoscopy trainee's progress. We conducted this study to determine factors predicting SCI in colonoscopy trainees, and to compare these factors before and after trainees achieve technical competence.

Methods: Design of this study was a cross-sectional studies of two time series design for one year at a single center. From March 2011 to February 2012, a total 2,050 subjects who underwent colonoscopy by four first-year gastrointestinal fellows were enrolled at Christian hospital, Wonju, Republic of Korea. Four gastrointestinal fellows have filled out the colonoscopic documentation. Main outcome measurement was predictive factors affecting cecal intubation failure and learning curves.

Results: Colonoscopy was successfully completed to the cecum in 1,720 patients (83.9%). Success rates gradually increased as trainees performed more colonoscopies: the rate of SCI was 62% in the first 50 cases, and grew to 93% by the 250th case. Logistic regression analysis of factors affecting cecal intubation failure showed that female gender, low BMI (BMI < 18.5 kg/m²), poor bowel preparation, and past history of stomach surgery were more often associated with cecal intubation failure, particularly before the trainees achieved technical competence.

Conclusion: Several patient characteristics were identified that may predict difficulty of cecal intubation in colonoscopy trainees. Particularly, low BMI, inadequate bowel cleansing, and previous stomach operation were predictors of cecal intubation failure before the trainees have reached technical competency. The results could be informative so that trainees enhance the success rate regarding better colonoscopy training programs.

Figure 1

Cecal intubation rate learning curves. The learning curve for average successful cecal intubation rates within 15 minutes based on the number of colonoscopies is shown. (P < 0.05 with the Turkey test, error bars represent the 95% confidence interval). Cecal intubation rates reach the 92.5% at 250-300th procedures.

Figure 2

Cecal intubation time learning curves. The learning curve for average cecal intubation times is shown. (Error bars represent the 95% confidence interval). A significant inverse correlation between cecal intubation times and level of experience is shown.

Figure 3

Withdrawal time learning curves. The learning curve for average withdrawal times is shown. (Error bars represent the 95% confidence interval). Withdrawal times decrease with the level of experience, but steady around 10 minutes after 150 procedures.