Effect of cecal intubation rate on post colonoscopy colorectal cancer deaths and detection of colorectal cancer precursors.

Abstract

Background & aims: The visualization of the whole colonic mucosa with complete colonoscopy including cecal intubation has been accepted as a quality parameter for screening colonoscopy. However, there is little evidence regarding the cecal intubation rate (CIR) and its association with long-term patient outcome.

Methods: We did a linkage of individuals that participated in an Austrian Colonoscopy Quality Assurance Program to the Austrian death registry to obtain information on deaths of post-colonoscopy colorectal cancer (PCCRC). We performed logistic regression and time-to-event analyses to estimate the association the CIR with the probability to detect adenomas or proximal serrated polyps and the hazards for PCCRC death.

Results: 349782 screening participants between 01/2012 and 12/2022 were included. With every one percentage point increase in the CIR, the probability to detect an adenoma increased by one percentage point (OR 1.01, 95% CI 1.0 - 1.01, p <0.001) and increased by three percentage points to detect a proximal serrated polyp (OR 1.03, 95% CI 1.01 - 1.04, p<0.001). There was a significantly lower risk for PCCRC death when endoscopists had a CIR of 95%-100% (HR 0.44, 95% CI 0.33 - 0.59, p <0.001), compared to endoscopists with a CIR < 90% or 90% - 95%.

Conclusions: the endoscopist's cecal intubation rate is strongly associated with their ability to detect adenomas and proximal serrated polyps. A CIR of 95-100% was associated with the lowest hazards for PCCRC death. Based on this data, a CIR above 95% is the desirable target.