PDF | https://doi.org/10.46613/congastro2023-180
This work is licensed under CC BY 4.0
Valero M1, Puga M2, Insausti A1, Salazar V1, Koll L1, Martinez M1, Gutierrez M1, Davila D1, Imhof H3, Burlando E3, Rodriguez P4, Herrera P4, Silva N4, Bernardi G4, Cordoba S4, Gobelet J5, Castillo G5, Daino D5, Paredes S6, Rodriguez S7, Epele J8, Yañez F9, Paiz J10, Merlin M10, Manzotti L11, Lopez R11, Isaguirre J12, Di Cicco M12, Ferrero S12, Promenzio E13, Bordon K14, Concha Y14, Castilla M14, Alcorta C15, Ledesma M15, Quinteros G15, Santillan G15, Mattar R15, Martinez G16, Zapata J17
1Instituto de Gastroenterología y Endoscopía de Avanzada (IGEA), Bahía Blanca, Argentina
2Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
3Grupo MIT, Santa Fe, Argentina
4Instituto Modelo de Cardiología Privado S.R.L., Córdoba, Argentina
5Sanatorio Allende, Córdoba, Argentina
6Instituto Modelo de Gastroenterología de Formosa, Formosa, Argentina
7Instituto Norpatagónico de Gastroenterología y Endoscopía Digestiva (INGED), Neuquén, Argentina
8Clínica San Miguel, Trelew, Argentina
9Clínica de Cuyo (CDC), Mendoza, Argentina
10Hospital Nacional Profesor Alejandro Posadas (HNPAP), El Palomar, Argentina
11Centro de Estudios Digestivos (CED), Mar del Plata, Argentina
12Hospital Italiano de Mendoza (HIM), Mendoza, Argentina
13Instituto Otorrinolaringológico Tandil, Tandil, Argentina
14Hospital Regional Río Grande (HRRG), Río Grande, Argentina
15Hospital Regional Ramón Carrillo (HRRC), Santiago del Estero, Argentina
16Instituto de Investigaciones Médicas Alfredo Lanari, Ciudad Autónoma de Buenos Aires, Argentina
17Universidad del Salvador (USAL), Ciudad Autónoma de Buenos Aires, Argentina
BACKGROUND: A high-quality colonoscopy is essential to avoid unadvertised adenomas. It includes caecal intubation (CI), which can be a challenge. Endoscopists require often progressive manoeuvres: abdominal compression (A), body rotation (B) or change of endoscopist (C). Failure carries to declined CI (D). A 10-min caecal intubation time (CIT) is a usual trial endpoint for colonoscopy difficulty, but it does not communicate manoeuvres.
AIM: To estimate the profitability of a novel colonoscopy difficulty score vs 10-min CIT.
METHODS: A national, multicentre, cross-section study (May’2022-Jun’2023). Expert endoscopists developed the “Argentina Brief Colonoscopy Difficulty” score (ABCD), based on manoeuvres A/B/C; or D as very high difficulty (figure 1). Data was prospectively recovered by 14 centres. ABCD and 10-min CIT were compared through an ordinal regression model and through a binary regression model. Both multivariate models were nested in the participating centres (NCT05422820).
RESULTS: 4511 colonoscopies: 58 yo (IQR 50-68), 53.4% women. ABCD score: 42.7% null, 30.3% low, 11.1% intermediate, 11.9% high and 3.9% very high difficulty. In 18.5% the endoscopist was in training (<400 colonoscopies). Only 8% of very high-difficulty colonoscopies were performed in training (P<.001). A second endoscopist was required in 4.6%. A higher ABCD was associated with older age (P<.001), female (P<.001), lower BMI (P<.05), prior declined CI (P<.001), screening (P<.05), afternoon schedule (P<.05), in training (P<.001), and poor BBPS (P<.001). A 10-min CIT was associated only with four of the eight previous characteristics and hernia (P<.001).
CONCLUSIONS: Compared to 10-min CIT, the ABCD demonstrated high profitability in terms of a significant association with characteristics related to colonoscopy difficulty. The ABCD constitutes a quality indicator advisable to communicate in every colonoscopy report.
