Monitoring photographic proof of cecal intubation: A closed-loop audit of best practice colonoscopy
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SHORT REPORT
Monitoring photographic proof of cecal intubation: A closed-loop audit of best practice colonoscopy Thomas Whitehead-Clarke 1
&
Roshan Sothinathan 2 & Ms. Anu Sandhya 2 & Divya Sharma 2 & Mohammad Ashraf Raja 2
Received: 29 April 2020 / Accepted: 3 August 2020 # Indian Society of Gastroenterology 2020
Abstract Gold standard colonoscopy in the UK demands a 90% cecal intubation (CI) rate. Endoscopists must provide photographic evidence of CI, which can include images of the terminal ileum, appendix orifice, anastomosis or ileocecal valve. Whilst photographic proof of intubation should be obtained for all complete colonoscopies, this is not routinely audited. Three hundred and ninety-six complete colonoscopies were analyzed, 200 in an initial audit, and 196 in a second audit. Photos taken during colonoscopy were reviewed for evidence of successful CI, as well as whether these photographs had been marked as “proof of intubation” (POI). Results were shared at departmental governance meetings in order to assess any improvement in practice. Initial audit revealed 70% of colonoscopies had provided sufficient proof of CI but only 50% provided photographs that were described as such. Twenty percent of colonoscopies provided sufficient images, but these were not identified as POI. Thirty percent of all colonoscopies provided insufficient proof of CI. Upon repeat audit, 71% of colonoscopies met best practice standards, with the remaining 29% showing insufficient evidence of CI. In the modern era of digital technology, lack of photographic evidence should be seen as unacceptable and may raise important clinical and medicolegal concerns. We recommend that audits such as this become standard practice to ensure best practice. Keywords Best practice guidelines . Colon cancer . Colon polyps . Colonic neoplasms . Colonoscopy . Colorectal surgery . Gastroenterology . Nurse endoscopist . Surveillance
Introduction Colonoscopy is the gold standard investigation for suspected colorectal cancer and is of paramount importance for the diagnosis of inflammatory bowel disease and colonic polyps. Unlike the practice of flexible sigmoidoscopy, colonoscopy in the UK is highly standardized with hospitals’ cecal intubation (CI) rates regularly audited to maintain standards.
This work was performed at the Department of General Surgery, Epsom and St Helier NHS Trust, Wrythe Ln, Sutton, Carshalton, SM5 1AA * Thomas Whitehead-Clarke [email protected] 1
Division of Surgery and Interventional Science, University College London, London W1W 7TY, UK
2
General Surgery Department, Epsom and St Helier NHS trust, Wrythe Ln, Sutton, Carshalton SM5 1AA, UK
In order to describe a colonoscopy as complete, and that CI has been achieved, photographs should be used to identify specific anatomical landmarks in the cecum [1–3]. Some articles have suggested that particular structures provide more reliable evidence of CI, including the ileocecal valve and appendix orifice [2, 3]. Some authors have also discussed the identification of the t
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