A Single Center Review of Pediatric Colonoscopy Quality Indicators

Objectives: Colonoscopy with terminal ileal (TI) intubation is an important diagnostic and therapeutic tool in the care of children with digestive diseases, especially in those with inflammatory bowel disease (IBD). Ileal intubation rate is a recognized quality indicator for pediatric colonoscopy. Our primary aim was to identify our single-center ileal intubation rate and to secondarily identify specific factors, including bowel preparation quality, procedure duration, and cecal intubation rates which impact successful ileal intubation and by extension, complete colonoscopy. Methods: A retrospective chart review of all colonoscopies in 2015 was completed, identifying 458 procedures. Sixty-seven patients were excluded, resulting in 391 colonoscopies reviewed. Results: We analyzed 391 colonoscopy procedures with a mean patient age of 14.4 +/- 5.3 years. The most frequent primary indications for colonoscopy included abdominal pain with "red flag" symptoms (35.5%), known IBD (25.1%), and isolated abdominal pain (11.5%). Ileal intubation was achieved in 91% of all colonoscopies, with a 94.4% cecal intubation rate. Failure of ileal and cecal intubations was classified into four categories: disease related conditions, bowel preparation related, technical aspects, and miscellaneous issues. Potentially modifiable factors accounted for the majority of cases of failed TI intubation. The mean colonoscopy time with and without successful TI intubation were 39 minutes and 48.1 minutes, respectively. Conclusions: Completion of colonoscopy to the TI is an essential part of a complete colonoscopy. TI intubation was possible in 91% of patients. This rate could potentially improve to 95% with optimization of modifiable factors such as improving bowel preparation or further refinement of endoscopic skills. Address correspondence and reprint requests to Christine Seif Pasquarella, MD, Cleveland Clinic Main Campus Mail Code A111 9500 Euclid Avenue Cleveland, OH 44195 (e-mail: christine.pasquarella@gmail.com). Received 6 October, 2017 Accepted 16 November, 2018 Guarantor of the article: Marsha Kay, M.D. Specific author contributions: Christine Seif Pasquarella, M.D. drafted the manuscript and designed the tables and figure presented. She approved the final draft submitted. Katherine Lamparyk, Psy.D. reviewed and contributed to the drafted manuscript. She approved the final draft submission. Barbara Kaplan, M.D., reviewed and contributed to the drafted manuscript and approved the final draft submitted. Lori Mahajan, M.D., reviewed and contributed to the drafted manuscript and approved the final draft submitted. Marsha Kay, M.D. reviewed and critically revised the drafted manuscript. She approved the final draft submitted. Financial support: No funding sources to declare. Potential competing interests: None declared. This paper has not been published previously and this paper is not currently under consideration elsewhere for publication. Conflicts of interest: None to disclose. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from Gastroenterology via xlomafota13 on Inoreader https://ift.tt/2GrYxRF
via IFTTT