The performance indicator of colonic intubation (PICI) in a FIT-based colorectal cancer screening program

Abstract

Objective: Cecal intubation rate (CIR) is known to be inversely associated with interval colorectal cancer (CRC) risk. Cecal intubation may be achieved by the use of force and sedation jeopardizing patient safety. The Performance Indicator of Colonic Intubation (PICI) is defined as the proportion of colonoscopies achieving cecal intubation with use of ≤2 mg midazolam and no-mild patient-experienced discomfort. We aimed (i) to measure the variation of PICI between colonoscopists and colonoscopy units; (ii) to assess the correlation between the individual components of PICI; and (iii) to evaluate the association between PICI and commonly used performance indicators.

Materials and methods: For the period 1 July 2015 through 30 June 2017 of the prevalent round of the Danish FIT-based CRC screening program, we included colonoscopies performed at four units in the Central Denmark Region within 60 days after a positive FIT-test. The PICI variation was evaluated using rates and ranges. Correlations between individual PICI components were assessed using Pearson correlation coefficients. Polyp detection rate (PDR), Adenoma detection rate (ADR), Polyp retrieval rate (PRR) and Withdrawal time (WT) were assessed within PICI quartiles.

Results: The overall PICI was 78.7% with substantial variation between colonoscopists (40.0–91.9%) and units (72.6–82.0%). CIR was significantly correlated with patient-experienced comfort (r = 0.49, n = 73, p < .0001) and we observed that colonoscopists with a PICI between 79.9% and 84.3%) had the highest ADR.

Conclusion: We found a substantial variation in PICI between colonoscopists and between colonoscopy units, which may reflect potential for quality improvements.

Keywords:

• Colorectal cancer
• screening
• performance indicators
• quality indicators
• performance indicator of colonic intubation
• adenoma detection rate
• polyp detection rate
• cecal intubation rate
• polyp recovery
• polyp retrieval rate
• withdrawal time

Acknowledgments

Members of the Central Denmark Region's ‘Quality of Colonoscopies’ group:

Ken Ljungmann, Department of Surgery, Aarhus University Hospital, Denmark

Anne-Sofie Kannerup, Department of Surgery, Randers Regional Hospital, Denmark

Gunnar Madsen, Department of Surgery, Horsens Regional Hospital, Denmark

Thomas Møller Jensen, Department of Medicine, Horsens Regional Hospital, Denmark

Knud Thygesen Nielsen, Department of Surgery, Randers Regional Hospital, Denmark

Søren Lyhne, Department of Medicine, Randers Regional Hospital, Denmark

Mogens Harrits Jepsen, Department of Surgery, Herning Regional Hospital, Denmark

Einar Pahle, Department of Surgery, Aarhus University Hospital, Denmark

Dorrit Thode, Department of Public Health programmes, Randers Regional Hospital, Denmark

Disclosure statement

BA received test-kits from Roche and self-sampling kits from Axlab for another study and SHN has received a speaking fee from Norgine. Remaining authors declare no conflicting interests.

Author contributions

All authors created the idea of this study and made the final design. ML and SHN categorized and analyzed the data. ML created the tables and figures and drafted the manuscript. All authors critically reviewed and approved the final manuscript.