Like the last two days, this post addresses “high quality” colonoscopy…
A recent report (M Thomson et al. JPGN 2019: 69: 6-12) describes quicker pediatric colonoscopy times than previously reported and with 100% rate of ileal intubation.
In this report, there were 181 colonoscopies.
Time of colonoscopy:
- The authors emphasize the fact that their mean time to the terminal ileum was 9.8 minutes. Their good technical skill is probably related in part to experience: all 6 endoscopists had more than 10 years of experience (mean 19 years) and more than a thousand prior colonoscopies each.
Ileal Intubation Rate:
- The 100% ileal intubation rate similarly indicates good technical skill. It may indicate that their patient population was healthier as ileal structuring (which can prevent ileal intubation) can be noted in patients with Crohn’s disease.
Low Diagnostic Yield:
- In my view, the study reports a low diagnostic yield. They report 33% had abnormal histology (when excluding patients with IBD followup examinations)
- 38% of their patients had colonoscopy due to abdominal pain. They reported a yield in this group of only 11.6% though this includes 4 patients with “TI lymphoid hyperplasia.” Is this an abnormal finding?
My take: This study shows that with good technical skill colonoscopy can be done quickly with ileal intubation times averaging 10 minutes and with ileal intubation rates close to 100%. In my view, another quality metric is diagnostic yield and their yield is lower than has been reported in most pediatric studies.
- K Siau et al. JPGN 2019; 69: 18-23. This study describes “Direct Observation of Procedural Skills” (DOPS). Among 29 trainees, 81% of DOPS were rate competent after 125-140 procedures.
- MT Barakat et al. JPGN 2019; 69: 24-31. This study noted that the vast majority of pediatric GI centers (>90%) were performing less than 25 ERCPs annually and that >70% “believe their institution’s current arrangement for performing pediatric therapeutic endoscopy is inadequate.”