TY - JOUR
T1 - Impact of sedation on the Performance Indicator of Colonic Intubation
AU - Nass, Karlijn J.
AU - van Doorn, Sascha C.
AU - van der Vlugt, Manon
AU - Fockens, Paul
AU - Dekker, Evelien
N1 - Funding Information: Evelien Dekker declares to have endoscopic equipment on loan of Fu-jiFilm, receive a research grant from FujiFilm. She received a honorarium for consultancy from FujiFilm, Olympus, Tillots, GI Supply and CPP-FAP and a speakers' fee from Olympus, Roche, GI Supply and Norgine. Paul Fockens declares to have received a honorarium for consultancy from Olympus, Cook Endoscopy and research support from Boston Scientific. The other authors declare that no conflicts of interest exist. Publisher Copyright: © 2021 Georg Thieme Verlag. All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background The Performance Indicator of Colonic Intubation (PICI) is a new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. This study assessed achievement of PICI within the Dutch colorectal cancer (CRC) screening program, and determined the association between PICI and adenoma detection rate (ADR). PICI achievement when using the Dutch median midazolam dose was also assessed. Methods This retrospective study was conducted within the Dutch fecal immunochemical test-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between January 2016 through January 2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) of 1 - 3, and use of ≤ 2.5 mg midazolam. Results 107 328 colonoscopies were performed during the study period. Adequate PICI was achieved in 49 500 colonoscopies (46.1 %). In colonoscopies with inadequate PICI, inadequacy was due to higher sedation doses in 87.8 %. Adequate PICI was associated with higher ADR (odds ratio 1.16, 95 % confidence interval 1.12 - 1.20). When using a cutoff of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95 410 colonoscopies (88.9 %). Conclusion PICI appeared to be heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as a quality indicator is limited.
AB - Background The Performance Indicator of Colonic Intubation (PICI) is a new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. This study assessed achievement of PICI within the Dutch colorectal cancer (CRC) screening program, and determined the association between PICI and adenoma detection rate (ADR). PICI achievement when using the Dutch median midazolam dose was also assessed. Methods This retrospective study was conducted within the Dutch fecal immunochemical test-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between January 2016 through January 2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) of 1 - 3, and use of ≤ 2.5 mg midazolam. Results 107 328 colonoscopies were performed during the study period. Adequate PICI was achieved in 49 500 colonoscopies (46.1 %). In colonoscopies with inadequate PICI, inadequacy was due to higher sedation doses in 87.8 %. Adequate PICI was associated with higher ADR (odds ratio 1.16, 95 % confidence interval 1.12 - 1.20). When using a cutoff of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95 410 colonoscopies (88.9 %). Conclusion PICI appeared to be heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as a quality indicator is limited.
UR - http://www.scopus.com/inward/record.url?scp=85094816723&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/a-1254-5182
DO - https://doi.org/10.1055/a-1254-5182
M3 - Article
C2 - 32882721
SN - 0013-726X
VL - 53
SP - 619
EP - 626
JO - Endoscopy
JF - Endoscopy
IS - 6
ER -