Photographic documentation of caecal intubation: Are we doing it right?
B Hall1, J Rasool1, F O’ Hara1, YC Khiev1, E Carton1, J Keohane1, S Patchett2, S Sengupta1
1. Department of Gastroenterology and Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth 2. Department of Gastroenterology, Beaumont Hospital, Beaumont Road, Dublin 9
Caecal intubation rate (CIR) is an important key performance indicator in assessing the quality of colonoscopy. Importantly, high caecal intubation rates are associated with less interval cancers. Caecal intubation can be defined as passage of the tip of the colonoscope past the ileo-caecal valve. However, the metric may be affected by the definition of caecal intubation. This underlines the importance of photographic evidence of caecal landmarks at time of colonoscopy.
To assess inter-observer agreement of appropriate photographic documentation of caecal intubation.
Data was extracted from EndoRAAD (Manitex, Ireland). Caecal images were isolated and anonymised in an encrypted database. Images were then distributed independently to four experienced endoscopists blinded to baseline data. Each reader was asked to comment on each image (Yes or No) with regard to whether caecal intubation was achieved as per the presence of caecal landmarks. An exact definition of caecal intubation was not supplied to the readers prior to the study. All results expressed as a mean and analysed using SPSS 19 software. Inter-observer agreement was assessed using Cohen’s kappa index (0.40.8 considered moderately significant, K>0.8 considered highly significant).
In total, 200 caecal photos were obtained and analysed. Individually, CIR for reader one, two, three and four was 59% (n=119), 65% (n=130), 68% (n=136) and 72% (n=145), respectively. The mean caecal intubation rate was 66% (n =132). There did appear to be good inter-observer agreement in terms of photographic evidence of caecal intubation. Mean inter-observer agreement was 93% (n=185). The kappa index assessing interobserver agreement between each reader is included in table 1.
Photographic documentation of caecal landmarks is an important key performance indicator. This study showed good inter-observer agreement (93%) between a group of experienced endoscopists in defining caecal landmarks which is reassuring. However, a caecal intubation rate of 66% as defined by photographic evidence of caecal landmarks suggests the importance of increasing awareness of adequate photographic documentation of caecal intubation amongst endoscopists.