Is a Photograph of the Caecum Or Terminal Ileum Reliable Enough for Documenting Completion of Colonoscopy -A Prospective Study?

摘要

Introduction and Aim: Documenting colonoscopy completion is an important aspect of quality assurance and a suitable tool is not yet available. The aim of this study was to independently assess the reliability of caecal or terminal ileal photographs as a proof of colonoscopy completion. Materials and Methods: Colonoscopists were requested to take a convincing photograph of the caecum or terminal ileum to document completion of their examination during a prospective colonoscopy audit in a District General Hospital. 177 photographs were collected over 8 months. A further 23 controls (taken of other regions of the large bowel) photographs were added randomly. Based on the landmark captured they were further divided into group "D" when only appendicial orifice was captured, "E" when appendiceal and ileocaecal valve were captured, "F" when only ileocaeca! valve was captured, "G" when terminal ileum was captured without water flush and "H" when the terminal ileum was photographed after a water flush. Water flush was used to enhance the villi. Eight independent clinicians (4 colorectal surgeons and 4 gastroenterologists) were requested to categorise the photos as 'caecum, terminal ileum or not sure". Those identified as caecum and terminal ileum were further graded as 1, 2 or 3 depending on the level of certainty. Results: A total of 200 photographs were used. The true locations were caecal in 91 (45.5%) cases, terminal ileal in 86 (43%) cases and 23 (11.5%) were controls. Appendiceal orifice is the most commonly captured landmark (group D, 69 cases -34.5%). Other landmarks captured were group E -13 (6.5%), F - 9 (4.5%), G - 47 (23.5%), and H-39 (19.5%).