Effective colonoscopy relies on meeting rigorous quality control thresholds. Some prior studies evaluating colonoscopy key performance indicators (KPIs) have excluded patients with previous colonic resections (non-intact colons), who also deserve high quality colonoscopy. This study aimed to compare colonoscopy KPIs between patients with non-intact and intact colons.
Consecutive colonoscopies performed at Whanganui Hospital (New Zealand) between September 2016-March 2020 were included. The primary outcome was the caecal or ileal intubation rate (CIIR). Secondary outcomes were the adenoma detection rate (ADR), polyp DR (PDR), colonoscope withdrawal time (CWT), and caecal or ileal intubation time (CIIT).
In total, 3,017 colonoscopies (322 non-intact; 2,695 intact colons) were performed. CIIR was significantly higher in non-intact than intact colons (98.4% vs. 95.0%; p=0.01). When all colonoscopies were included the CIIR was 95.4% compared to 95.0% when non-intact colonoscopies were excluded. However, the ADR (39.9% vs. 38.8%; p=0.77) and PDR (58.4% vs. 59.1%; p=0.86) were similar. CWT (p<0.0001) and the CIIT (p<0.0001) were significantly shorter in participants with non-intact colons.
The CIIR exceeded recommended targets and was 3.4% higher in patients with non-intact than intact colons. Patients with non-intact colons comprise a small proportion of the overall colonoscopy cohort and it is unlikely this small difference is relevant for most endoscopists or endoscopy units. The ADR and PDR were similar among patients with non-intact and intact colons, despite non-intact colonoscopies being significantly quicker. Patients with non-intact colons deserve high quality colonoscopy and therefore their KPIs should be included in colonoscopy performance reports. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: Some prior studies evaluating colonoscopy quality have excluded patients with previous colonic resections (non-intact colons), assuming it is easier to achieve quality targets in non-intact colons. This study found comparable colonoscopy quality among patients with non-intact and intact colons and therefore all patients should be included in colonoscopy performance reports.

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