OC-010 Implementation of a Novel Colonoscopy Performance Index, The Composite Caecal Intubation Rate (CIRC), in a UK Tertiary Centre
Authors: I Beintaris, H Spranger, P Bassett, S Thomas-Gibson
Journal: Gut (2016)

<h3>Introduction</h3> The Composite Caecal Intubation Rate (CIR<sup>c</sup>) has been proposed as a more pragmatic colonoscopy performance index, encompassing three key components; caecal intubation rate (CIR), patient comfort and sedation dose.<sup>1</sup> We calculated CIR<sup>c</sup>s within a Tertiary Unit (St Mark’s Hospital,UK), aiming to assess performance and look for possible correlation between CIR<sup>c</sup> and adenoma detection rate (ADR).<sup>2</sup> <h3>Methods</h3> We analysed all colonoscopies performed by 32 Endoscopists in 12 months. CIR<sup>c</sup> was the proportion of procedures fulfilling the following criteria; procedure completion, comfort score ≤3 (Gloucester scale)<sup>3</sup> and midazolam dose 0–2 mg. We examined the association between CIR<sup>c</sup> and annual colonoscopy volume, completion rate, midazolam dose and polyp detection rate (PDR). Finally, we sought for a correlation between CIR<sup>c</sup> and ADR for 7 Bowel Cancer Screening Programme (BCSP) Endoscopists. <h3>Results</h3> Analysis included 5416 colonoscopies. Overall CIR<sup>c</sup> was 85.6%. There was significant correlation between CIR<sup>c</sup> and annual colonoscopy volume; all colonoscopists with &gt;250 procedures had CIR<sup>c</sup>s &gt;85%. The majority of operators with &lt;200 procedures had the lower scores, but still more than 70%. There were Endoscopists with low annual volumes and high CIR<sup>c</sup> meaning that expert endoscopists with high lifetime (but low annual) volumes can nonetheless deliver high quality colonoscopy. There was also evidence of a negative correlation between midazolam and CIR<sup>c</sup>, but of no statistical significance. No significant association was observed with CIR or PDR. There was a reasonable positive correlation, albeit non significant, between ADR and CIR<sup>c</sup> in the BCSP Endoscopists’ subgroup. <h3>Conclusion</h3> CIR<sup>c</sup> is a more informative performance index, reflecting key aspects of colonoscopy. Reassuringly, overall CIR<sup>c</sup> achievement in the Unit was above National Audit data (54.1%).<sup>1</sup> Endoscopists with larger procedure volumes performed better. No significant correlation with ADR was seen, although a positive trend was noted. The small amount of patients included in the ADR analysis group is insufficient to draw definite conclusions. Applying CIR<sup>c</sup> at a local level may aid in identification of under-performers, although case-mix factors may affect results. <h3>References</h3> 1 Valori R, Damery S, Swarbrick E, <i>et al</i>. PWE-057 A composite measure of colonic intubation is better able to distinguish performance of colonoscopy and is associated with higher polyp detection rates. <i>Gut</i> 2014;<b>63</b>:A148. 2 Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. <i>N Engl J Med</i> 2014;<b>370</b>:1298–306. 3 Ekkelenkamp VE, Dowler K, Valori RM, Dunckley P. Patient comfort and quality in colonoscopy. <i>World J Gastroenterol</i> 2013;<b>19</b>:2355–61. <h3>Disclosure of Interest</h3> None Declared