Pediatric Gastroenterology

Pediatric Colonoscopy (N = 1,116)

2016 - 2018

The Department of Pediatric Gastroenterology annually reviews all pediatric colonoscopic procedures to confirm the documentation of the specific indications for colonoscopy and to determine the cecal intubation rate and the rate of completion of the examination to the terminal ileum (TI).

Procedures performed in patients with a history of prior colonic or ileal resections and colonoscopies that were planned as limited procedures were excluded. Cecal and ileal intubation rates were compared with reported outcomes in pediatric patients at other institutions. The department evaluated patient or procedural-related factors that limited rate of completion of the examination to the terminal ileum. Time to complete the procedure (“scope in/scope out”) as a potential surrogate quality indictor was also determined.

2016 2017 2018
Colonoscopies, N 359 368 389
Colonoscopy complete to the terminal ileum, N (%) 334 (93) 346 (94) 346 (90)
Colonoscopy with cecal intubation, N (%) 348 (97) 361 (98) 361 (95)
Unsuccessful TI intubation in patients with IBD, N (%) 12 (3.3) 9 (2.4) 19 (4.8)
Incomplete colonoscopy due to inadequate bowel prep, N (%) 2 (0.6) 5 (1.4) 4 (1.0)
Average colonoscopy procedure "scope in/scope out" time, min 38 39 39
Average procedure time for complete colonoscopy to the TI, min 37 39 38
Average procedure time for colonoscopy without TI intubation, min 52 44 54

IBD = inflammatory bowel disease, TI = terminal ileum

In 2018, the cecal intubation rate and the rate of completion of the examination to the TI were 95% and 90%, respectively. In 19 patients diagnosed with inflammatory bowel disease, colonoscopy was limited because of the presence of marked intestinal inflammation or a finding of colonic or ileal strictures. This contributed to the overall decrease in the colonoscopy completion rate to the cecum and TI. The cecal and TI intubation rates exceed those rates reported in other large multicenter series of children undergoing colonoscopy¹ (85% for cecal intubation and 69.4% for TI intubation). The time to perform the procedure was increased in colonoscopies where the TI could not be reached, likely reflecting increased time attempting to intubate the ileocecal valve.