Quality indicators in pediatric colonoscopy: An Australian tertiary center experience

Abstract

Introduction: Quality indicators for colonoscopy in adults are mainly driven by colorectal cancer screening, and include cecal intubation and adenoma detection rates. Cecal intubation rates of >90% is recommended in adults. In contrast, colorectal cancer is rare in children so colonoscopy is predominantly diagnostic. Common indicators for pediatric colonoscopy include investigating for inflammatory bowel disease (IBD), diarrhoea or abdominal pain. In these conditions, ileal intubation is recommended as it optimizes diagnostic yield. There is a paucity of data on quality indicators for pediatric colonoscopy, and it remains unclear whether high rates of cecal and ileal intubation is achievable in pediatrics. Aims: This study was undertaken to audit all colonoscopies performed in a tertiary pediatric center to examine for the clinical indications for procedure, completion rates to cecum and ileum, and rate of significant findings. Methods: Retrospective review of all colonoscopies from November 2011 to October 2015 was performed. The ORMIS theatre management database was used to identify patients having colonoscopy using ICD-10 codes 32090 (colonoscopy) and 32087 (colonoscopy® polypectomy). Patients having intentional flexible sigmoidoscopy were excluded from analysis although incorrectly coded patients who proceeded to total colonoscopy were included. Patient demographics, indication for procedure, presence of trainee, quality of bowel preparation, extent of colonoscopy and confirmation of location, reasons for incomplete procedure, diagnostic findings, and complications were noted. Results: 652 patients were identified as having had total colonoscopy after exclusion of incorrectly coded patients. Median age of patients was 13.0 (range 0.4-18.2) years, with 53% male. The most common indications for colonoscopy were IBD review (57.9%, 378/652), rectal bleeding (10%, 68/652), abdominal pain (10%, 68/652), and diarrhea (8.6%, 56/652). All patients had procedures under general anesthesia. Trainees performed 69.8% (452/652) of procedures. Quality of bowel preparation was mentioned in 62.9% (410/ 652), of which 21.9% (90/410) were considered inadequate. Cecal intubation rate was 96.3% (628/652) and ileal intubation 92.4% (603/652). Photographs and/or biopsies were used to confirm extent of procedure in 99.2% of patients. Factors predicting success of ileal intubation include quality of bowel preparation and patient age. Normal histology was noted in 61.8% (403/652) of colonoscopies. 37 (5.6%) patients had polypectomy; most were juvenile polyps (54%, 20/37). No perforations occurred but three patients had hematoma, which were managed expectantly. Conclusion: High rates, ≥90%, of caecal and ileal intubation are achievable in pediatric colonoscopy. Ileal intubation should be considered a quality indicator in diagnostic colonoscopy in pediatrics.L6191084842017-11-10 <br />