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

• Published in: Scandinavian journal of gastroenterology 2019-09, Vol.54 (9), p.1176-1181
• Main Authors: Lund, Martin, Erichsen, Rune, Njor, Sisse Helle, Laurberg, Søren, Valori, Roland, Andersen, Berit
• Format: Article
• Language: English
• Subjects: adenoma detection rate; cecal intubation rate; Colorectal cancer; performance indicator of colonic intubation; performance indicators; polyp detection rate; polyp recovery; polyp retrieval rate; quality indicators; screening; withdrawal time
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/00365521.2019.1648548

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