Effect of Cecal Intubation Rate on Post Colonoscopy Colorectal Cancer Deaths and Detection of Colorectal Cancer Precursors.

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: A total of 349,782 screening participants between January 2012 and December 2022 were included. With every 1 percentage point increase in the CIR, the probability to detect an adenoma increased by 1 percentage point (odds ratio, 1.01; 95% confidence interval [CI], 1.0-1.01; P < .001) and increased by 3 percentage points to detect a proximal serrated polyp (odds ratio, 1.03; 95% CI, 1.01-1.04; P < .001). There was a significantly lower risk for PCCRC death when endoscopists had a CIR of 95% to 100% (hazard ratio, 0.44; 95% CI, 0.33-0.59; P < .001), compared with endoscopists with a CIR <90% or 90% to 95%.

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